. 2024 Aug;12(8):558-568.

doi: 10.1016/S2213-8587(24)00159-1.

Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people

Kurt Taylor¹, Sophie Eastwood², Venexia Walker³, Genevieve Cezard⁴, Rochelle Knight⁵, Marwa Al Arab¹, Yinghui Wei⁶, Elsie M F Horne⁷, Lucy Teece⁸, Harriet Forbes⁹, Alex Walker¹⁰, Louis Fisher¹⁰, Jon Massey¹⁰, Lisa E M Hopcroft¹⁰, Tom Palmer¹¹, Jose Cuitun Coronado¹, Samantha Ip¹², Simon Davy¹⁰, Iain Dillingham¹⁰, Caroline Morton¹⁰, Felix Greaves¹³, John Macleod¹⁴, Ben Goldacre¹⁰, Angela Wood¹⁵, Nishi Chaturvedi², Jonathan A C Sterne¹⁶, Rachel Denholm¹⁷; Longitudinal Health and Wellbeing and Data and Connectivity UK COVID-19 National Core Studies; CONVALESCENCE study; OpenSAFELY collaborative

Collaborators, Affiliations

Collaborators

Marwa Al Arab, Fatima Almaghrabi, Colm Andrews, Ellena Badrick, Sarah Baz, Chelsea Beckford, Samantha Berman, Tom Bolton, Charlotte Booth, Ruth Bowyer, Andy Boyd, Charis Bridger-Staatz, Sinead Brophy, Archie Campbell, Kirsteen C Campbell, Alisia Carnemolla, Jd Carpentieri, Genevieve Cezard, Nishi Chaturvedi, Nathan Cheetham, Ruth Costello, Thomas Cowling, Matthew Crane, Jose Ignacio Cuitun Coronado, Helen Curtis, Spiros Denaxas, Rachel Denholm, Giorgio Di Gessa, Richard Dobson, Ian Douglas, Katharine M Evans, Chao Fang, Vanessa Ferreira, Lucy Finnigan, Louis Fisher, Robin Flaig, Amos Folarin, Harriet Forbes, Diane Foster, Laura Fox, Maxim Freydin, Paz Garcia, Andy Gibson, Fiona Glen, Ben Goldacre, Ana Goncalves Soares, Felix Greaves, Amelia Green, Mark Green, Michael Green, Gareth Griffith, Lee Hamill Howes, Olivia Hamilton, Annie Herbet, Emily Herrett, Lisa Hopcroft, Elsie Horne, Bo Hou, Alun Hughes, William Hulme, Lizzie Huntley, Samantha Ip, Wels Jacques, Peter Jezzard, Louise Jones, Arun Kanagaratnam, Arun Karthikeyan Suseeladevi, Vittal Katikireddi, John Kellas, Jonathan I Kennedy, Milla Kibble, Rochelle Knight, Anika Knueppel, Daniel Kopasker, Theocharis Kromydas, Alex Kwong, Sinead Langan, Agnieszka Lemanska, Elena Lukaschuk, Brain Mackenna, John Macleod, Jane Maddock, Viyaasan Mahalingasivam, Kathryn Mansfield, Fintan McArdle, Daniel McCartney, Rosie McEachan, Eoin McElroy, Stela McLachlan, Ruth Mitchell, Bettina Moltrecht, Jess Morley, Linda Nab, Stefan Neubauer, Lidia Nigrelli, Teri North, Kate Northstone, Jacqui Oakley, Tom Palmer, Chloe Park, Michael Parker, Sam Parsons, Praveetha Patalay, Kishan Patel, Francisco Perez-Reche, Stefan Piechnik, Dominik Piehlmaier, George Ploubidis, Elena Rafeti, Betty Raman, Yatharth Ranjan, Alicja Rapala, Rebecca Rhead, Amy Roberts, Alexia Sampri, Zeena-Britt Sanders, Gillian Santorelli, Laura C Saunders, Anoop Shah, Syed Ahmar Shah, Steve Sharp, Richard Shaw, Laura Sheard, Aziz Sheikh, Richard Silverwood, Liam Smeeth, Stephen Smith, Jean Stafford, Andrew Steptoe, Jonathan Sterne, Claire Steves, Callum Stewart, Kurt Taylor, John Tazare, Lucy Teece, Richard Thomas, Ellen Thompson, Kate Tilling, Nicholas Timpson, Laurie Tomlinson, Renin Toms, Elizabeth Tunnicliffe, Emma L Turner, Alex Walker, Venexia Walker, Scott Walter, Kevin Wang, Yinghui Wei, Rebecca Whitehorn, Bozena Wielgoszewska, James M Wild, Kathryn Willan, Robert Willans, Dylan Williams, Andrew Wong, Angela Wood, Hannah Woodward, John Wright, Tiffany Yang, Paola Zaninotto, Bang Zheng, Jingmin Zhu

Affiliations

¹ Population Health Sciences, University of Bristol, Bristol, UK.
² MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
³ Population Health Sciences, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁴ British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
⁵ Population Health Sciences, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK.
⁶ Centre for Mathematical Sciences, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK.
⁷ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK.
⁸ Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁹ Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
¹⁰ The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
¹¹ Population Health Sciences, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
¹² British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
¹³ National Institute for Health and Care Excellence, Manchester, UK; Department of Primary Care and Public Health, Imperial College London, London, UK.
¹⁴ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK.
¹⁵ British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK; National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK; Cambridge Centre of Artificial Intelligence in Medicine, University of Cambridge, Cambridge, UK; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
¹⁶ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK. Electronic address: jonathan.sterne@bristol.ac.uk.
¹⁷ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK.

PMID: 39054034
PMCID: PMC7617111
DOI: 10.1016/S2213-8587(24)00159-1

Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people

Kurt Taylor et al. Lancet Diabetes Endocrinol. 2024 Aug.

. 2024 Aug;12(8):558-568.

doi: 10.1016/S2213-8587(24)00159-1.

Authors

Collaborators

Marwa Al Arab, Fatima Almaghrabi, Colm Andrews, Ellena Badrick, Sarah Baz, Chelsea Beckford, Samantha Berman, Tom Bolton, Charlotte Booth, Ruth Bowyer, Andy Boyd, Charis Bridger-Staatz, Sinead Brophy, Archie Campbell, Kirsteen C Campbell, Alisia Carnemolla, Jd Carpentieri, Genevieve Cezard, Nishi Chaturvedi, Nathan Cheetham, Ruth Costello, Thomas Cowling, Matthew Crane, Jose Ignacio Cuitun Coronado, Helen Curtis, Spiros Denaxas, Rachel Denholm, Giorgio Di Gessa, Richard Dobson, Ian Douglas, Katharine M Evans, Chao Fang, Vanessa Ferreira, Lucy Finnigan, Louis Fisher, Robin Flaig, Amos Folarin, Harriet Forbes, Diane Foster, Laura Fox, Maxim Freydin, Paz Garcia, Andy Gibson, Fiona Glen, Ben Goldacre, Ana Goncalves Soares, Felix Greaves, Amelia Green, Mark Green, Michael Green, Gareth Griffith, Lee Hamill Howes, Olivia Hamilton, Annie Herbet, Emily Herrett, Lisa Hopcroft, Elsie Horne, Bo Hou, Alun Hughes, William Hulme, Lizzie Huntley, Samantha Ip, Wels Jacques, Peter Jezzard, Louise Jones, Arun Kanagaratnam, Arun Karthikeyan Suseeladevi, Vittal Katikireddi, John Kellas, Jonathan I Kennedy, Milla Kibble, Rochelle Knight, Anika Knueppel, Daniel Kopasker, Theocharis Kromydas, Alex Kwong, Sinead Langan, Agnieszka Lemanska, Elena Lukaschuk, Brain Mackenna, John Macleod, Jane Maddock, Viyaasan Mahalingasivam, Kathryn Mansfield, Fintan McArdle, Daniel McCartney, Rosie McEachan, Eoin McElroy, Stela McLachlan, Ruth Mitchell, Bettina Moltrecht, Jess Morley, Linda Nab, Stefan Neubauer, Lidia Nigrelli, Teri North, Kate Northstone, Jacqui Oakley, Tom Palmer, Chloe Park, Michael Parker, Sam Parsons, Praveetha Patalay, Kishan Patel, Francisco Perez-Reche, Stefan Piechnik, Dominik Piehlmaier, George Ploubidis, Elena Rafeti, Betty Raman, Yatharth Ranjan, Alicja Rapala, Rebecca Rhead, Amy Roberts, Alexia Sampri, Zeena-Britt Sanders, Gillian Santorelli, Laura C Saunders, Anoop Shah, Syed Ahmar Shah, Steve Sharp, Richard Shaw, Laura Sheard, Aziz Sheikh, Richard Silverwood, Liam Smeeth, Stephen Smith, Jean Stafford, Andrew Steptoe, Jonathan Sterne, Claire Steves, Callum Stewart, Kurt Taylor, John Tazare, Lucy Teece, Richard Thomas, Ellen Thompson, Kate Tilling, Nicholas Timpson, Laurie Tomlinson, Renin Toms, Elizabeth Tunnicliffe, Emma L Turner, Alex Walker, Venexia Walker, Scott Walter, Kevin Wang, Yinghui Wei, Rebecca Whitehorn, Bozena Wielgoszewska, James M Wild, Kathryn Willan, Robert Willans, Dylan Williams, Andrew Wong, Angela Wood, Hannah Woodward, John Wright, Tiffany Yang, Paola Zaninotto, Bang Zheng, Jingmin Zhu

Affiliations

¹ Population Health Sciences, University of Bristol, Bristol, UK.
² MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
³ Population Health Sciences, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁴ British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
⁵ Population Health Sciences, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK.
⁶ Centre for Mathematical Sciences, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK.
⁷ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK.
⁸ Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁹ Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
¹⁰ The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
¹¹ Population Health Sciences, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
¹² British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
¹³ National Institute for Health and Care Excellence, Manchester, UK; Department of Primary Care and Public Health, Imperial College London, London, UK.
¹⁴ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK.
¹⁵ British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK; National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK; Cambridge Centre of Artificial Intelligence in Medicine, University of Cambridge, Cambridge, UK; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
¹⁶ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK. Electronic address: jonathan.sterne@bristol.ac.uk.
¹⁷ Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK.

PMID: 39054034
PMCID: PMC7617111
DOI: 10.1016/S2213-8587(24)00159-1

Abstract

Background: Some studies have shown that the incidence of type 2 diabetes increases after a diagnosis of COVID-19, although the evidence is not conclusive. However, the effects of the COVID-19 vaccine on this association, or the effect on other diabetes subtypes, are not clear. We aimed to investigate the association between COVID-19 and incidence of type 2, type 1, gestational and non-specific diabetes, and the effect of COVID- 19 vaccination, up to 52 weeks after diagnosis.

Methods: In this retrospective cohort study, we investigated the diagnoses of incident diabetes following COVID-19 diagnosis in England in a pre-vaccination, vaccinated, and unvaccinated cohort using linked electronic health records. People alive and aged between 18 years and 110 years, registered with a general practitioner for at least 6 months before baseline, and with available data for sex, region, and area deprivation were included. Those with a previous COVID-19 diagnosis were excluded. We estimated adjusted hazard ratios (aHRs) comparing diabetes incidence after COVID-19 diagnosis with diabetes incidence before or in the absence of COVID-19 up to 102 weeks after diagnosis. Results were stratified by COVID-19 severity (categorised as hospitalised or non-hospitalised) and diabetes type.

Findings: 16 669 943 people were included in the pre-vaccination cohort (Jan 1, 2020-Dec 14, 2021), 12 279 669 in the vaccinated cohort, and 3 076 953 in the unvaccinated cohort (both June 1-Dec 14, 2021). In the pre-vaccination cohort, aHRs for the incidence of type 2 diabetes after COVID-19 (compared with before or in the absence of diagnosis) declined from 4·30 (95% CI 4·06-4·55) in weeks 1-4 to 1·24 (1·14-1.35) in weeks 53-102. aHRs were higher in unvaccinated people (8·76 [7·49-10·25]) than in vaccinated people (1·66 [1·50-1·84]) in weeks 1-4 and in patients hospitalised with COVID-19 (pre-vaccination cohort 28·3 [26·2-30·5]) in weeks 1-4 declining to 2·04 [1·72-2·42] in weeks 53-102) than in those who were not hospitalised (1·95 [1·78-2·13] in weeks 1-4 declining to 1·11 [1·01-1·22] in weeks 53-102). Type 2 diabetes persisted for 4 months after COVID-19 in around 60% of those diagnosed. Patterns were similar for type 1 diabetes, although excess incidence did not persist beyond 1 year after a COVID-19 diagnosis.

Interpretation: Elevated incidence of type 2 diabetes after COVID-19 is greater, and persists for longer, in people who were hospitalised with COVID-19 than in those who were not, and is markedly less apparent in people who have been vaccinated against COVID-19. Testing for type 2 diabetes after severe COVID-19 and the promotion of vaccination are important tools in addressing this public health problem.

Funding: UK National Institute for Health and Care Research, UK Research and Innovation (UKRI) Medical Research Council, UKRI Engineering and Physical Sciences Research Council, Health Data Research UK, Diabetes UK, British Heart Foundation, and the Stroke Association.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests NC is compensated by AstraZeneca for membership of data monitoring and safety committees for clinical trials. All other authors declare no competing interests.

Figures

**Figure 1. Maximally adjusted HRs comparing the incidence of type 2 diabetes events after COVID-19 with the incidence before or in the absence of COVID-19 in all cohorts**
Points are plotted at the median time of the outcome event within each follow-up period in each cohort. Error bars are 95% CI. HR=hazard ratio.

**Figure 2. Maximally adjusted HRs comparing the incidence of type 1, gestational, and other diabetes events after COVID-19 with the incidence before or in the absence of COVID-19 in all cohorts**
Points are plotted at the median time of the outcome event within each follow-up period in each cohort. Error bars are 95% CI. HR=hazard ratio.

See this image and copyright information in PMC

Comment in

The enduring effect of the COVID-19 pandemic on diabetes.
Al-Aly Z, Cao B. Al-Aly Z, et al. Lancet Diabetes Endocrinol. 2024 Aug;12(8):508-510. doi: 10.1016/S2213-8587(24)00180-3. Lancet Diabetes Endocrinol. 2024. PMID: 39054029 No abstract available.

References

1. Thompson EJ, Williams DM, Walker AJ, et al. Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records. Nat Commun. 2022;13:3528. - PMC - PubMed
1. WHO. WHO COVID-19 dashboard. [accessed June 18, 2024]. https://covid19.who.int .
1. Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol. 2022;10:311–21. - PMC - PubMed
1. Bull-Otterson L, Baca S, Saydah S, et al. Post-COVID conditions among adult COVID-19 survivors aged 18–64 and ≥65 years—United States, March 2020–November 2021. MMWR Morb Mortal Wkly Rep. 2022;71:713–17. - PMC - PubMed
1. Rezel-Potts E, Douiri A, Sun X, Chowienczyk PJ, Shah AM, Gulliford MC. Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK. PLoS Med. 2022;19:e1004052. - PMC - PubMed

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Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people

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Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people

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Conflict of interest statement

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