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. 2022 Apr 19;17(4):e0266809.
doi: 10.1371/journal.pone.0266809. eCollection 2022.

The associations between COVID-19 diagnosis, type 1 diabetes, and the risk of diabetic ketoacidosis: A nationwide cohort from the US using the Cerner Real-World Data

Fares Qeadan  1 , Benjamin Tingey  1 , Jamie Egbert  1 , Marcus G Pezzolesi  2 , Mark R Burge  3 , Kathryn A Peterson  4 , Trenton Honda  5
Affiliations

The associations between COVID-19 diagnosis, type 1 diabetes, and the risk of diabetic ketoacidosis: A nationwide cohort from the US using the Cerner Real-World Data

Fares Qeadan et al. PLoS One. .

Abstract

Objective: To assess the risk of new-onset type 1 diabetes mellitus (T1D) diagnosis following COVID-19 diagnosis and the impact of COVID-19 diagnosis on the risk of diabetic ketoacidosis (DKA) in patients with prior T1D diagnosis.

Research design and methods: Retrospective data consisting of 27,292,879 patients from the Cerner Real-World Data were used. Odds ratios, overall and stratified by demographic predictors, were calculated to assess associations between COVID-19 and T1D. Odds ratios from multivariable logistic regression models, adjusted for demographic and clinical predictors, were calculated to assess adjusted associations between COVID-19 and DKA. Multiple imputation with multivariate imputation by chained equations (MICE) was used to account for missing data.

Results: The odds of developing new-onset T1D significantly increased in patients with COVID-19 diagnosis (OR: 1.42, 95% CI: 1.38, 1.46) compared to those without COVID-19. Risk varied by demographic groups, with the largest risk among pediatric patients ages 0-1 years (OR: 6.84, 95% CI: 2.75, 17.02) American Indian/Alaskan Natives (OR: 2.30, 95% CI: 1.86, 2.82), Asian or Pacific Islanders (OR: 2.01, 95% CI: 1.61, 2.53), older adult patients ages 51-65 years (OR: 1.77, 95% CI: 1.66, 1.88), those living in the Northeast (OR: 1.71, 95% CI: 1.61, 1.81), those living in the West (OR: 1.65, 95% CI: 1.56, 1.74), and Black patients (OR: 1.59, 95% CI: 1.47, 1.71). Among patients with diagnosed T1D at baseline (n = 55,359), 26.7% (n = 14,759) were diagnosed with COVID-19 over the study period. The odds of developing DKA for those with COVID-19 were significantly higher (OR 2.26, 95% CI: 2.04, 2.50) than those without COVID-19, and the largest risk was among patients with higher Elixhauser Comorbidity Index.

Conclusions: COVID-19 diagnosis is associated with significantly increased risk of new-onset T1D, and American Indian/Alaskan Native, Asian/Pacific Islander, and Black populations are disproportionately at risk. In patients with pre-existing T1D, the risk of developing DKA is significantly increased following COVID-19 diagnosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Inclusion and exclusion criteria used to generate the final analytic cohort consisting of patients without pre-existing T1D diagnosis.
Data from were used to examine the associations between COVID-19 diagnosis and incident T1D in the US.
Fig 2
Fig 2. Inclusion and exclusion criteria used to generate the final analytic cohort consisting of patients with pre-existing T1D, no recent DKA diagnosis, non-recent DKA indications removed, and appropriate diagnosis dates known.
Data were used to assess the extent to which COVID-19 diagnosis increases the risk of DKA among those with pre-existing T1D.
Fig 3
Fig 3. Incidence rate per 100,000 of DKA diagnosis from January 2019 to September 2021 (by COVID-19 status) among patients with previous T1D diagnosis.
Fig 4
Fig 4. Predicted probability of DKA vs. ECI (by COVID-19 status) among patients with previous diagnosis of T1D.
See this image and copyright information in PMC

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