In a recent study published in The Lancet Diabetes and Endocrinology, researchers examined the post-acute risk and burden of incident diabetes beyond the initial 30 days of coronavirus disease 2019 (COVID-19).
Existing literature has reported on post-acute COVID-19 sequelae, such as extrapulmonary dysfunctions and diabetes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients. However, the burden and risk of incident diabetes beyond the acute infection period have not been characterized comprehensively, especially among non-hospitalized patients. A large-scale longitudinal assessment of the glycometabolic sequelae of COVID-19 after 30 days of infection is lacking.
About the study
In the present study, the researchers determined the risks and associated one-year burdens of diabetes incidence in SARS-CoV-2-positive patients beyond the initial 30 days of infection.
Data was provided by the national United States’ (US) Veteran Health Administration (VHA) department and the Veterans Affairs (VA) Corporate Data Warehouse (CDW). Based on this data, 181,280 US Veterans, SARS-CoV-2-positive between March 1, 2020, and September 30, 2021, were recruited for the study.
The data comprised demographical, clinical, and laboratorical information along with the history of hypoglycemic medications. To enable comparison, a SARS-CoV-2-negative contemporary control group with 4,118,441 individuals and a pre-pandemic control group with 4,286,911 individuals both groups were selected as controls. While the contemporary controls were recruited in the same period as COVID-19 patients, the pre-pandemic reference group was enrolled between March 1, 2018, and September 30, 2019. In addition, the PubMed database was searched for published studies between December 1, 2019, and September 6, 2021. The keywords used for the data search were “COVID-19”, “diabetes “, “long COVID-19” and “SARS CoV-2” without language restrictions.
All the participants were non-diabetic with glycated hemoglobin (HBA1c) values below 6.4 before the commencement of the study and did not use hypoglycemic medications a year before the date of testing positive (T0) for COVID-19. The participants were longitudinally followed up until December 20, 2021 (mean 352 days). The SARS-CoV-2 positive cohort was further divided into three groups based on their care settings during the acute phase of COVID-19-non-hospitalized (n=162,096), hospitalized (n=15,078), and hospitalized with intensive care unit (ICU) admission (n=4106).
The primary outcomes assessed were the diabetes incidence risks, as adjusted hazard ratios (HR) and associated burdens per 1000 patients in a year and a composite endpoint of the two outcomes. In addition, COVID-19-associated death was evaluated to determine the reproducibility of the study findings. Moreover, the associations between COVID-19 and hearing-aid use, acne, and laboratory parameters were evaluated. Patient factors such as age, sex, ethnicity, body mass index (BMI), smoking habits, comorbidities, and long-term care use (nursing homes or assisted-living centers) were also assessed to determine which of these factors increased the likelihood of diabetes beyond the acute period of COVID-19.
Cox logistic regression survival models were used for analyzing data which was adjusted for baseline differences among the three groups with inverse probability weighting for algorithmically selected and predefined covariates.
In the post-acute COVID-19 phase, SARS-CoV-2-positive patients demonstrated excessive burden (13.5) and heightened risks (HR 1.4) of diabetes incidence as well as an excessive burden (12.4), and increased risks (1.9) of hypoglycemics use. The incident diabetes risk and excessive burden of the composite endpoint were estimated as HR 1.5 and 18, respectively. The burdens and risks of incident diabetes post-acute COVID-19 phase were significantly high in non-hospitalized COVID-19 patients and increased gradually corresponding to the COVID-19 severity and the care settings during the acute COVID-19 period. In addition, SARS-CoV-2 infection was associated with a greater risk of death (HR 1.5).
The incidence of diabetes risks and burdens were higher among Blacks aged above 65 years with comorbidities such as hypertension, cardiovascular disorders, prediabetes, and hyperlipidemia. The risk was also higher in obese individuals with a BMI >25 kg/m². However, no significant associations were found between COVID-19 and risks of hearing aid use, acne, and laboratorian alterations in serum albumin, total protein, calcium, potassium, and high-density lipoprotein.
To conclude, the one-year burdens and risks of hypoglycemics usage and incident diabetes beyond the acute COVID-19 period were increased in the COVID-19 cohort in comparison to both the control groups. Thus, diabetes should be considered as an important component of the post-acute COVID-19 sequelae, and SARS-CoV-2 post-infection care should involve early detection and prompt treatment of diabetes.