COVID-19 infection is associated with increased risk for diabetes, according to study results published in JAMA Network Open.
Researchers conducted a population-based cohort study in British Columbia, Canada, to determine the association between COVID-19 infection and the risk for diabetes. Data were sourced between January 2020 and December 2021. Eligible patients were tested for SARS-CoV-2 infection via real-time reverse transcription polymerase chain reaction (RT-PCR). Patients who tested positive vs negative for infection were matched 1:4 by sex, age, and specimen collection date. The primary outcome was incident diabetes, identified more than 30 days after the specimen collection date. Multivariable Cox proportional hazard modeling was used to assess the relationship between COVID-19 infection and diabetes risk.
The study included 629,935 patients, of whom 125,987 were positive and 503,948 were negative for COVID-19 infection. Overall, the median patient age was 32 (IQR, 25.0-42.0) years, 51.2% of the population were women, and the median follow-up duration was 257 (IQR, 102-356) days. In addition, 25.7% of patients had major depressive disorder, 14.1% had asthma, and 63.2% and 75.4% of infected and uninfected patients were unvaccinated, respectively.
Of patients who tested positive and negative for COVID-19 infection, 0.5% and 0.4% were diagnosed with diabetes, respectively.
The researchers found that the incidence of diabetes per 100,000 person-years was significantly higher among patients who were positive (incidence rate [IR], 672.2; 95% CI, 618.7-725.6) vs negative (IR, 508.7; 95% CI, 485.6-531.8) for COVID-19 infection (P <.001). The risk for incident diabetes was also higher among patients who tested positive for COVID-19 infection (adjusted hazard ratio [aHR], 1.17; 95% CI, 1.06-1.28).
Similar findings were noted after the analysis was restricted to unvaccinated patients.
In subgroup analyses, male patients who tested positive for COVID-19 were at significantly increased risk for incident diabetes (aHR, 1.22; 95% CI, 1.06-1.40). For COVID-19-positive women, the risk for incident diabetes was also higher but not statistically significant (aHR, 1.12; 95% CI, 0.99-1.27. The highest risk for incident diabetes was observed among patients with severe COVID-19 infection, including those who required intensive care unit (aHR, 3.29; 95% CI, 1.98-5.48) or hospital (aHR, 2.42; 95% CI, 1.87-3.15) admission.
Among the overall study population, the rate of incident diabetes diagnoses attributable to COVID-19 infection was 3.41% (95% CI, 1.20-5.61)..
Limitations of this study include the inability to rule out residual confounding, potential surveillance bias, and the possibility of false-negative RT-PCR testing results.
“The underlying pathophysiological mechanism explaining the association between COVID-19 infection and diabetes is not clearly understood,” the researchers noted.
Disclosures: One study author declared affiliations with biotech, pharmaceutical, pharmaceutical and/or device companies.
Naveed Z, Velásquez García HA, Wong S, et al. Association of COVID-19 infection with incident diabetes. JAMA Netw Open. 2023;6(4):e238866 doi:10.1001/jamanetworkopen.2023.8866