Diabetes is ‘facet’ of long COVID syndrome
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Individuals with COVID-19 had increased risk and burden for diabetes and use of diabetes drugs at least 30 days after infection compared with people without COVID-19, according to data published in The Lancet Diabetes & Endocrinology.
In addition, risk and burden increased with increasing severity of acute COVID-19, according to Yan Xie, MPH, a biostatistician from the Clinical Epidemiology Center at the Research and Development Service at the VA Saint Louis Health Care System in Missouri, and Ziyad Al-Aly, MD, assistant professor at the School of Medicine at Washington University in St. Louis, director of the Clinical Epidemiology Center, and the chief of research and education service at VA St. Louis Health Care System.
“Taken together, current evidence suggests that diabetes is a facet of the multifaceted long COVID syndrome and that post-acute care strategies of people with COVID-19 should include identification and management of diabetes,” Xie and Al-Aly wrote.
Xie and Al-Aly evaluated data from the national databases of the U.S. Department of Veterans Affairs on 181,280 participants with a positive COVID-19 test between March 2020 and September 2021 who survived the first 30 days of infection. They compared those data with data from the same database on individuals with no evidence of COVID-19: 4,118,441 participants as contemporary controls enrolled between March 2020 and September 2021, and 4,286,911 participants as historical controls enrolled between March 2018 and September 2019.
All participants were without diabetes prior to study enrollment and were followed for a median of 352 days. Researchers estimated post-acute COVID-19 risks for incident diabetes, use of diabetes medications and a composite of both outcomes.
Compared with the contemporary control group, participants with COVID-19 had an increased risk for incident diabetes (HR = 1.4; 95% CI, 1.36-1.44) as well as excess burden of incident diabetes (13.46 per 1,000 people; 95% CI, 12.11-14.84) at 12 months. In addition, participants with COVID-19 had an increased risk for incident use of diabetes drugs (HR = 1.85; 95% CI, 1.78-1.92) and excess burden of use (12.35 per 1,000 people; 95% CI, 11.36-13.38).
Researchers also observed an increased risk for a composite endpoint of incident diabetes or diabetes drug use (HR = 1.46; 95% CI, 1.43-1.5) as well as an excess burden of the composite of both outcomes (18.03 per 1,000 people; 95% CI, 16.59-19.51) at 12 months. When participants were categorized according to severity of the acute phase of COVID-19 infection — not hospitalized, hospitalized or admitted to the ICU — risks and burdens increased with severity.
Results remained consistent in analyses of the historical control group.
“Although the risks and burdens increased according to the severity of the acute infection (as proxied by the care setting), they were evident and not trivial among people who were not hospitalized for COVID-19 — this group represents most people with COVID-19. For example, the excess burden of diabetes among nonhospitalized individuals was 8.28 per 1,000 people at 12 months,” the researchers wrote. “Given the large and growing number of people infected with COVID-19 (> 450 million people globally as of March 15, 2022), these absolute numbers might translate into substantial overall population level burdens,” the researchers wrote.
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