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. 2023 Apr 3;6(4):e238866.
doi: 10.1001/jamanetworkopen.2023.8866.

Association of COVID-19 Infection With Incident Diabetes

Zaeema Naveed  1   2 , Héctor A Velásquez García  1   2 , Stanley Wong  1 , James Wilton  1 , Geoffrey McKee  1 , Bushra Mahmood  3 , Mawuena Binka  1 , Drona Rasali  1 , Naveed Z Janjua  1   2   4
Affiliations

Association of COVID-19 Infection With Incident Diabetes

Zaeema Naveed et al. JAMA Netw Open. .

Erratum in

  • Errors in Table 1.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 May 1;6(5):e2316822. doi: 10.1001/jamanetworkopen.2023.16822. JAMA Netw Open. 2023. PMID: 37195669 Free PMC article. No abstract available.

Abstract

Importance: SARS-CoV-2 infection may lead to acute and chronic sequelae. Emerging evidence suggests a higher risk of diabetes after infection, but population-based evidence is still sparse.

Objective: To evaluate the association between COVID-19 infection, including severity of infection, and risk of diabetes.

Design, setting, and participants: This population-based cohort study was conducted in British Columbia, Canada, from January 1, 2020, to December 31, 2021, using the British Columbia COVID-19 Cohort, a surveillance platform that integrates COVID-19 data with population-based registries and administrative data sets. Individuals tested for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction (RT-PCR) were included. Those who tested positive for SARS-CoV-2 (ie, those who were exposed) were matched on sex, age, and collection date of RT-PCR test at a 1:4 ratio to those who tested negative (ie, those who were unexposed). Analysis was conducted January 14, 2022, to January 19, 2023.

Exposure: SARS-CoV-2 infection.

Main outcomes and measures: The primary outcome was incident diabetes (insulin dependent or not insulin dependent) identified more than 30 days after the specimen collection date for the SARS-CoV-2 test with a validated algorithm based on medical visits, hospitalization records, chronic disease registry, and prescription drugs for diabetes management. Multivariable Cox proportional hazard modeling was performed to evaluate the association between SARS-CoV-2 infection and diabetes risk. Stratified analyses were performed to assess the interaction of SARS-CoV-2 infection with diabetes risk by sex, age, and vaccination status.

Results: Among 629 935 individuals (median [IQR] age, 32 [25.0-42.0] years; 322 565 females [51.2%]) tested for SARS-CoV-2 in the analytic sample, 125 987 individuals were exposed and 503 948 individuals were unexposed. During the median (IQR) follow-up of 257 (102-356) days, events of incident diabetes were observed among 608 individuals who were exposed (0.5%) and 1864 individuals who were not exposed (0.4%). The incident diabetes rate per 100 000 person-years was significantly higher in the exposed vs nonexposed group (672.2 incidents; 95% CI, 618.7-725.6 incidents vs 508.7 incidents; 95% CI, 485.6-531.8 incidents; P < .001). The risk of incident diabetes was also higher in the exposed group (hazard ratio [HR], 1.17; 95% CI, 1.06-1.28) and among males (adjusted HR, 1.22; 95% CI, 1.06-1.40). The risk of diabetes was higher among people with severe disease vs those without COVID-19, including individuals admitted to the intensive care unit (HR, 3.29; 95% CI, 1.98-5.48) or hospital (HR, 2.42; 95% CI, 1.87-3.15). The fraction of incident diabetes cases attributable to SARS-CoV-2 infection was 3.41% (95% CI, 1.20%-5.61%) overall and 4.75% (95% CI, 1.30%-8.20%) among males.

Conclusions and relevance: In this cohort study, SARS-CoV-2 infection was associated with a higher risk of diabetes and may have contributed to a 3% to 5% excess burden of diabetes at a population level.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr McKee reported receiving grants from the Canadian Institutes for Health Research outside the submitted work. Dr Janjua reported receiving personal fees from Gilead and AbbVie outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Cumulative Incidence of Incident Diabetes
See this image and copyright information in PMC

Comment in

References

    1. World Health Organization . WHO coronavirus (COVID-19) dashboard. Accessed February 06, 2022. https://covid19.who.int/
    1. Leung TYM, Chan AYL, Chan EW, et al. . Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020;9(1):2190-2199. doi:10.1080/22221751.2020.1825914 - DOI - PMC - PubMed
    1. Müller JA, Groß R, Conzelmann C, et al. . SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nat Metab. 2021;3(2):149-165. doi:10.1038/s42255-021-00347-1 - DOI - PubMed
    1. Sathish T, Tapp RJ, Cooper ME, Zimmet P. Potential metabolic and inflammatory pathways between COVID-19 and new-onset diabetes. Diabetes Metab. 2021;47(2):101204. doi:10.1016/j.diabet.2020.10.002 - DOI - PMC - PubMed
    1. Long H, Li J, Li R, et al. . Plasma glucose levels and diabetes are independent predictors for mortality in patients with COVID-19. Epidemiol Infect. 2022;150:e106. doi:10.1017/S095026882200022X - DOI - PMC - PubMed

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