Prior COVID-19 infection increases risk for incident diabetes by 17%
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Key takeaways:
- Adults who tested positive for COVID-19 have a 17% higher risk for incident diabetes than those who tested negative.
- About 3.41% of incident diabetes cases were attributable to previous COVID-19 infection.
Adults who previously tested positive for COVID-19 have a higher risk for developing diabetes than those who did not test positive, according to findings published in JAMA Network Open.
“The study highlights the importance of medical professionals being mindful of the possible long-term consequences of COVID-19,” Naveed Zafar Janjua, MBBS, MSc, DrPH, executive director of data and analytic services at British Columbia Center for Disease Control, Provincial Health Services Authority; and clinical professor in the school of population and public health at University of British Columbia, told Healio. “It is important to monitor individuals who have recovered from COVID-19 for diabetes, especially those who had more severe disease during acute phase of infection, as early detection and treatment can be critical in managing diabetes and preventing complications.”
Janjua and colleagues obtained data from the British Columbia COVID-19 cohort, a public health surveillance platform integrating COVID-19 data sets with registry and administrative data in British Columbia. Adults who were tested for COVID-19 in 2020 and 2021 were included in the study. A group of adults who tested positive for COVID-19 were matched, 1:4, by sex, age and test collection date to a cohort of adults who tested negative for COVID-19. Incident diabetes cases more than 30 days after the COVID-19 test date were obtained from medical visits, hospitalization records, chronic disease registry data and prescription drug use for diabetes management.
There were 629,935 adults included in the study (median age, 32 years; 51.2% women), of whom 125,987 tested positive for COVID-19 and 503,948 tested negative. The cohort was followed for a median of 257 days.
Incident diabetes was observed among 0.4% of the study population. There were 608 adults who tested positive for COVID-19 and 1,864 who tested negative who developed incident diabetes. The COVID-19 group had a higher diabetes incidence rate (672.2 per 100,000 person-years) than adults without COVID-19 (508.7 per 100,000 person-years; P < .001). Adults who tested positive for COVID-19 had a greater risk for developing incident diabetes than those who tested negative (adjusted HR = 1.17; 95% CI, 1.06-1.28). The risk for incident diabetes was higher among men who tested positive for COVID-19 than those who tested negative (adjusted HR = 1.22; 95% CI, 1.06-1.4) but there was no difference in risk among women. The risk for developing incident diabetes was higher for adults with COVID-19 admitted to the ICU (HR = 3.29; 95% CI, 1.98-5.48) or hospital (HR = 2.42; 95% CI, 1.87-3.15) than those who did not have COVID-19.
Among the study population, 3.41% of incident diabetes cases were attributed to COVID-19. Among men, that percentage increased to 4.75%.
“Given the large number of people infected with COVID-19, these excess diabetes cases could translate into very large population level burden of diabetes, which could strain an already stretched health care system,” Janjua said.
In sensitivity analysis, adults who tested positive for COVID-19 had an increased risk for noninsulin-dependent diabetes (HR = 1.17; 95% CI, 1.04-1.31) compared with those who tested negative. However, no increased risk was observed for insulin-dependent diabetes.
“Overall, the study findings are not surprising as others have previously reported higher risk [for] diabetes following COVID-19,” Janjua said. “We see a higher risk of diabetes and other chronic conditions following other infections such as hepatitis C and hepatitis B. COVID-19 has affected a very large number of people worldwide and hence the overall population level impact of COVID-19 on excess diabetes risk could be very large.”
Janjua said more studies are needed to determine at what point the risk for diabetes increases after COVID-19 infection, whether the increased risk for incident diabetes is permanent, whether COVID-19 vaccination and treatment could reduce the risk for diabetes, and if diet or physical activity have any effect on the risk for diabetes. He said studies analyzing the underlying mechanism for new-onset diabetes related to COVID-19 and whether the association changes with new COVID-19 variants are also needed.
For more information:
Naveed Zafar Janjua, MBBS, MSc, DrPH, can be reached at naveed.janjua@bccdc.ca.
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