Recovered COVID-19 Patients Have Much Greater Risk of Incident Diabetes

More evidence is coming out on what Long COVID, persistent symptoms and lasting side effects from initial infection, might mean. One of the most concerning is emerging evidence that patients who recovered from SARS-CoV-2 infection are at higher risk of developing new cases of diabetes. Even though the outcome is more likely after more-severe cases, it can occur even after milder infections, researchers warn. Here are more details.

LOUIS, MO – Patients who have recovered from COVID-19 should be routinely evaluated for diabetes and related metabolic issues.

That’s according to authors of a new study published in The Lancet Diabetes & Endocrinology who reached their conclusion using a database of millions of U.S. veterans.

“There is growing evidence suggesting that beyond the acute phase of SARS-CoV-2 infection, people with COVID-19 could experience a wide range of post-acute sequelae, including diabetes,” wrote researchers from the Clinical Epidemiology Center at the department of Veterans’ Affairs (VA) Saint Louis, MO, Health Care System. “However, the risks and burdens of diabetes in the post-acute phase of the disease have not yet been comprehensively characterized.”

For their cohort study, the study team used the VA database to build a cohort of 181,280 participants who had a positive COVID-19 test between March 1, 2020, and Sept. 30, 2021, and survived the first 30 days of COVID-19. The study also included two control groups with no evidence of SARS-CoV-2 infection – a contemporary control of 4.1 million that enrolled participants during the same time period and a historical control of 4.3 million participants between March 1, 2018, and Sept 30, 2019. None of the participants had diabetes when entering the study, the authors noted.

Over a follow-up of a median of 352 days (IQR 245–406), researchers analyzed post-acute COVID-19 risks of incident diabetes, antihyperglycemic use and a composite of the two outcomes. Two measures of risk -- hazard ratio (HR) and burden per 1000 people at 12 months – were reported.

“In the post-acute phase of the disease, compared with the contemporary control group, people with COVID-19 exhibited an increased risk (HR 1·40, 95% CI 1·36–1·44) and excess burden (13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes; and an increased risk (1·85, 1·78–1·92) and excess burden (12·35, 11·36–13·38) of incident antihyperglycemic use,” study results indicated.

Researchers’ analyses to estimate the risk of a composite endpoint of incident diabetes or antihyperglycemic use resulted in an HR of 1·46 (95% CI 1·43–1·50) and an excess burden of 18·03 (95% CI 16·59–19·51) per 1000 people at 12 months.

“Risks and burdens of post-acute outcomes increased in a graded fashion according to the severity of the acute phase of COVID-19 (whether patients were non-hospitalized, hospitalized, or admitted to intensive care),” the authors explained. “All the results were consistent in analyses using the historical control as the reference category.’

In addition, subgroup analyses suggested that COVID-19 was associated with an increased risk of diabetes outcomes across age (≤65 years and >65 years), race (White and Black), sex (male and female), BMI categories (>18·5 to ≤25 kg/m2, >25 to ≤30 kg/m2, and >30 kg/m2), and area deprivation index quartiles. More in-depth analysis suggested diabetes risk was increased in patients:

  • Older than 65 years;
  • Of Black race compared to white;
  • Who had pre-existing cardiovascular disease, hypertension, hyperlipidemia, or prediabetes; and/or
  • Were overweight and obese with BMIs of >25 kg/m2 and ≤30 kg/m2 or >30 compared to those with a BMI of >18·5 kg/m2 to ≤25 kg/m2  in a graded fashion.

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