The Incidence of Diabetes Among 2,808,106 Veterans With and Without Recent SARS-CoV-2 Infection

Abstract

OBJECTIVE To examine associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection/coronavirus disease 2019 with incident diabetes. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using Veterans Health Administration data. We defined all patients without preexisting diabetes with one or more nasal swabs positive for SARS-CoV-2 (1 March 2020–10 March 2021; n = 126,710) as exposed and those with no positive swab and one or more laboratory tests (1 March 2020–31 March 2021; n = 2,651,058) as unexposed. The index date for patients exposed was the date of first positive swab and for patients unexposed a random date during the month of the qualifying laboratory test. We fit sex-stratified logistic regression models examining associations of SARS-CoV-2 with incident diabetes within 120 days and all follow-up time through 1 June 2021. A subgroup analysis was performed among hospitalized subjects only to help equalize laboratory surveillance. RESULTS SARS-CoV-2 was associated with higher risk of incident diabetes, compared with no positive tests, among men (120 days, odds ratio [OR] 2.56 [95%CI 2.32–2.83]; all time, 1.95 [1.80–2.12]) but not women (120 days, 1.21 [0.88–1.68]; all time, 1.04 [0.82–1.31]). Among hospitalized participants, SARS-CoV-2 was associated with higher risk of diabetes at 120 days and at the end of follow-up in men (OR 1.42 [95% CI 1.22–1.65] and 1.32 [1.16–1.50], respectively) but not women (0.72 [0.34–1.52] and 0.80 [0.44–1.45]). Sex ∗ SARS-CoV-2 interaction P values were all <0.1. CONCLUSIONS SARS-CoV-2 is associated with higher risk of incident diabetes in men but not in women even after greater surveillance related to hospitalization is accounted for.

Risk of incident diabetes post-COVID-19: A systematic review and meta-analysis

“…Incidence RR can be roughly interpreted as HR, especially when a single HR averaged over the duration of the study’s follow-up has been reported and the follow-up period is comparable among studies [14] . Since we planned to pool reported HR/RR from studies, the study by Wander et al was excluded that reported significantly higher odds ratio (OR) for incident DM in men following COVID-19 adjusting for greater surveillance post-hospitalization [15] . Characteristics of all studies and quality assessment have been demonstrated ( Supplementary Table 1–2 ).…”

“…We do acknowledge several limitations of this study. None of the studies accounted for greater surveillance following hospitalization like the one that was excluded from analysis [15] . However, increased risk of diabetes in patients following hospitalized COVID-19 versus influenza adds value to interpretation of our findings.…”

Going viral in the islet: mediators of SARS-CoV-2 entry beyond ACE2

“…Prevalent diabetes is an independent risk factor for hospitalisation and death among individuals with COVID-19 (Wander et al 2021). Conversely, a positive test for SARS-CoV-2 is associated with a 40% higher risk of new-onset diabetes and increased use of glucose-lowering medications, including insulin (Al-Aly et al 2021, Wander et al 2022, Xie & Al-Aly 2022.…”

Association of COVID-19 with Diabetes: A Systematic Review and Meta-Analysis

“…A total of 853 studies were screened. The exclusion process yielded 5 studies 3,5,9,19,20 conducted in 2 countries. Barret et al (2022) was reported in this meta-analysis as two independent studies.…”

“…The severe acute respiratory syndrome coronavirus 2 (SARSCoV2), the causative strain of coronavirus disease 2019 (COVID- 19) was rst detected in early December 2019 in Wuhan, China. As of June 6, 2022, more than 520 million COVID-19 cases and 6•3 million deaths were reported globally.…”