Incident diabetes risk higher for adults after COVID-19 infection
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Adults who contract COVID-19 have a higher risk for developing incident diabetes in the 90 days after the infection compared with before the infection, according to data published in JAMA Network Open.
“Diabetes is an extremely important disease and cardiovascular risk factor [that] may be asymptomatic in patients,” Alan C. Kwan, MD, MSc, cardiologist at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, told Healio. “In general, screening for diabetes should start in all adults aged 35 and older, or those with increased risk, and continue at least every 3 years. Our study adds to previous research showing increased risk of diabetes and CV events after COVID infection. While the level of evidence by our study and others may not reach the degree needed to affect formal guidelines at this time, we believe it is reasonable to have increased clinical suspicion for diabetes after COVID infection, and a lower threshold for testing. We believe that our study and others suggest the potential role of COVID to affect CV risk, and so both prevention of COVID infection and an increased attention to CV health after COVID infection is warranted.”
Kwan and colleagues conducted a cohort study of adults who contracted COVID-19 and were treated in the Cedars-Sinai Health System from March 2020 to June 2022. Diagnoses of incident hypertension, hyperlipidemia and diabetes taking place before or after COVID-19 infection were obtained from medical records. Researchers used a self-controlled exposure crossover design to estimate the odds of a new diagnosis in the 90 days after a COVID-19 infection compared with the 90 days before an infection. Odds of a new cardiometabolic diagnosis were also compared with odds of a new diagnosis for urinary tract infection or gastroesophageal reflux as an incident benchmark diagnosis unrelated to COVID-19.
There were 23,709 adults who contracted COVID-19 during the study period (mean age, 47.4 years; 54% women). Adults had a higher risk for developing diabetes instead of a benchmark disease in the 90 days after a COVID-19 infection compared with before the infection (adjusted OR = 1.58; 95% CI, 1.24-2.02; P < .001). There was no difference in risk for hypertension or hyperlipidemia compared with a benchmark diagnosis after infection.
Adults who did not receive a COVID-19 vaccine were more likely to be diagnosed with diabetes after a COVID-19 infection compared with before an infection (OR = 1.78; 95% CI, 1.35-2.37; P < .001). However, there was no interaction between vaccination status and diabetes diagnosis. Age, sex and timing of infection were not associated with an increased risk for any cardiometabolic diagnosis before or after a COVID-19 infection.
“Currently, the observations we have provided regarding diabetes and COVID infection are relatively simple and do not yet provide either mechanistic understanding or encapsulate the complexities of the COVID pandemic,” Kwan said. “Further research in mechanisms for why increased cardiometabolic risk occurs is critical to managing and preventing significant harm to population health. Additionally, more complex understanding of the interactions between multiple infections and vaccinations are needed to ensure that these data remain relevant as we move along in the pandemic.”
For more information:
Alan C. Kwan, MD, MSc, can be reached at alan.kwan@cshs.org.
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