COVID-19 linked to increased risk for new-onset diabetes in men, but not women
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Contracting COVID-19 is associated with a higher risk for developing new-onset diabetes for men, but not women, according to Department of Veterans Affairs data published in Diabetes Care.
“SARS-CoV-2 infection is associated with a higher risk of new diabetes in men, but not in women, even after we accounted for the possibility that people with recent SARS-CoV-2 infection are probably more likely than people without SARS-CoV-2 to have diagnostic tests that would find diabetes,” Pandora L. Wander, MD, MS, FACP, staff physician at VA Puget Sound Health Care System, assistant professor of medicine and adjunct assistant professor of epidemiology at the University of Washington, told Healio. “It is too early to say what the big picture clinical implications will be in the long term. In the short term, clinicians should keep in mind that a recent COVID-19 is linked to a higher risk of new diabetes. Also, this relationship may be bidirectional, as diabetes likely contributes to adverse outcomes from COVID-19, too.”
Wander and colleagues conducted a retrospective cohort study of 2,777,768 adults with electronic medical records available for the VA and at least one laboratory value that did not support a diabetes diagnosis at baseline (mean age, 59 years; 86% men). Participants were defined as having a SARS-CoV-2 infection if they tested positive at least once between March 2020 and March 10, 2021. The index date was defined as the date of the first positive SARS-CoV-2 test for those with COVID-19 or a random date during the month any laboratory test was performed in those who did not have a positive SARS-CoV-2 test. Incident diabetes was defined as a diabetes diagnosis up to 120 days after the index date or between the index date and the end of follow-up on June 1, 2021. Researchers also analyzed a subgroup of 55,741 participants who were hospitalized within 30 days after their index date, of whom 12,418 tested positive for COVID-19.
COVID-19 linked to higher diabetes risk for men
The cohort was divided into a group of adults testing positive for SARS-CoV-2 (n = 126,710) and those with no positive SARS-CoV-2 test (n = 2,651,058). After adjusting for age, race and ethnicity, BMI, tobacco use and facility location, testing positive for SARS-CoV-2 was associated with a higher risk for incident diabetes in men at 120 days (adjusted OR = 2.56; 95% CI, 2.32-2.83) and through the end of the follow-up period (aOR = 1.95; 95% CI, 1.8-2.12), but no increased risk was found in women. In the subgroup of hospitalized participants, men who tested positive for COVID-19 were more likely to develop diabetes at 120 days (aOR = 1.42; 95% CI, 1.22-1.65) and through the end of follow-up (aOR = 1.32; 95% CI, 1.16-1.5) compared with those who did not test positive for COVID-19, but there were no differences observed in women.
“Our study was not designed to look at underlying causes; however, we can speculate about possible reasons for the different results we saw in men and in women,” Wander said. “One possibility is that immune responses after COVID-19 may contribute to the pathogenesis of new diabetes. If that is the case, differences in immune response between men and women might explain our results.”
Risk factors for new-onset diabetes
For men, other factors associated with higher risk of new-onset diabetes included age older than 60 years, Black or Latino ethnicity, a BMI of 30 kg/m2 or higher and former or current tobacco users. For men who were hospitalized other factors associated with a higher risk of new-onset diabetes included older age and a higher BMI. Among women, a BMI of 25 kg/m2 or higher and current tobacco users were associated with a risk for incident diabetes. No risk factors were observed among hospitalized women.
Wander said future research must answer several questions regarding the mechanisms of new-onset diabetes after a COVID-19 infection.
“First, what is the link between SARS-CoV-2 and new-onset diabetes?” Wander said. “For example, SARS-CoV-2 might directly injure the cells in the pancreas that make insulin or surrounding cells. Alternatively, persistence of the virus in tissue might contribute to insulin resistance. Second, are changes in blood sugar after SARS-CoV-2 infection permanent, or might they reverse over time? Finally, what are the long-term impacts of SARS-CoV-2 infection on blood sugar control and diabetes complications?”
For more information:
Pandora L. Wander, MD, MS, FACP, can be reached at pandora.wander@va.gov.
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