New-onset type 2 diabetes risk higher with mild COVID-19 vs. other respiratory infections
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Adults who have a mild case of COVID-19 are more likely to develop type 2 diabetes than those who had an acute upper respiratory infection, according to findings from Germany published in Diabetologia.
“Recent studies raised the possibility that SARS-CoV-2 can cause diabetes,” Wolfgang Rathmann, MSPH, professor of epidemiology and deputy director of the Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich Heine University in Düsseldorf, Germany, told Healio. “However, there is a lack of studies investigating the incidence of diabetes after COVID-19 in mild cases. To provide more evidence, we analyzed electronic health records from general and internal medicine practices across Germany. We found that new cases of type 2 diabetes were more common in patients who tested positive for COVID-19 than those with an acute upper respiratory infection. This means that the relative risk of developing type 2 diabetes in mild COVID-19 cases was 28% higher than in patients with upper respiratory infections, which are also mainly caused by viruses.”
Rathmann and colleagues conducted a retrospective study analyzing data from adults with newly diagnosed COVID-19 in the Disease Analyzer electronic health care database in Germany. Adults with an initial COVID-19 diagnosis between March 2020 and January 2021 and without a previous diabetes diagnosis were included. Those with COVID-19 were matched by sex, age, health insurance coverage, diagnosis month and comorbidities with a control group of adults with acute upper respiratory infection.
There were 35,865 adults diagnosed with COVID-19 included in the analysis (mean age, 42.6 years; 45.6% women). The COVID-19 group had a higher rate of new-onset type 2 diabetes compared with the control group (incidence rate ratio [IRR] = 1.28; 95% CI, 1.05-1.57). There were no increased rates of other forms of diabetes between the two groups.
In a sensitivity analysis, 9,823 people with a COVID-19 diagnosis were matched with controls who had at least one COVID-19 test, but never tested positive. In this group, rates of new-onset type 2 diabetes were significantly higher in those with COVID-19 compared with the control group (IRR = 1.51; 95% CI, 1.05-2.18).
“COVID-19 infection may lead to diabetes by upregulation of the immune system after remission, which may induce pancreatic beta-cell dysfunction and insulin resistance,” Rathmann said. “Insulin resistance is when cells in muscles, fat and liver do not respond well to insulin and cannot easily take up glucose from the blood. In addition, some COVID-19 patients may have been at risk for developing diabetes due to having obesity or prediabetes, and the stress related to COVID-19 accelerated this process.”
Rathmann said most people with a mild form of COVID-19 will not develop diabetes, but those who are recovered should be aware of their increased risk.
“We recommend that anyone who has recovered from COVID-19 be aware of the warning signs and symptoms of diabetes, such as fatigue, frequent urination and increased thirst, and seek treatment right away,” Rathmann said. “If confirmed, the present study indicates that diabetes screening in people who recovered even from mild COVID-19 should be recommended.”
For more information:
Wolfgang Rathmann, MSPH, can be reached at rathmann@ddz.de.
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