COVID-19 Infection Linked to Increased Risk of Developing Type 2 Diabetes

Professor Wolfgang Rathmann

Results of a recent analysis of data from more than 1100 physician practices in Europe detail a possible link between mild SARS-CoV-2 infection and increased risk of a subsequent diabetes diagnosis.

A propensity score-matched analysis with data from more than 35,865 individuals with a documented COVID-19 infection, results of the study indicate these patients had an increased rate of subsequent type 2 diabetes diagnoses compared to their counterparts with other forms of acute upper respiratory infection.

"COVID-19 infection may lead to diabetes by upregulation of the immune system after remission, which may induce pancreatic beta-cell dysfunction and insulin resistance, or patients may have been at risk for developing diabetes due to having obesity or prediabetes, and the stress COVID-19 put on their bodies speeded it up", says lead investigator Professor Wolfgang Rathmann, of the German Diabetes Center at Heinrich Heine University, in a statement.

Citing previous studies demonstrating the SARS-CoV-2 could damage insulin-producing beta cells and the increase in sedentary lifestyles during the pandemic, Rathmann and a pair of colleagues from the Heinrich Heine University sought to determine whether COVID-19 infection was associated with an increased risk of subsequent diabetes. Investigators designed their study as a retrospective cohort analysis of the Disease Analyzer, which is a healthcare database composed of a representative panel physicians’ practices in Germany.

Using ICD-10 codes, investigators created a pair of cohorts of individuals with newly diagnosed COVID-19 or acute upper respiratory infection with a first diagnosis between March 1, 2020-January 31, 2021. From their search, investigators identified a cohort of 35,865 individuals with COVID-19 infection for inclusion in their analyses who were prosperity score-matched to 35,865 controls with acute upper respiratory infection. Propensity score matching was based on sex, age, health insurance, index month, and comorbidities, including obesity, hypertension, hyperlipidemia, myocardial infarction, and stroke.

The mean age of these cohorts was 42.6 years and 45.6% were women. The COVID-19 group had median follow-up of 119 (IQR, 0-210) days and the acute upper respiratory infection cohort had median follow-up of 161 (IQR, 4-225) days.

Results of the investigators’ analyses revealed patients with COVID-19 had an increased incidence rate of type 2 diabetes compared to their counterparts with acute upper respiratory infections, with incidence rates of 15.8 and 12.3 per 1000 person-years, respectively. In models assessing incidence rate ratio, those with COVID-19 with 28% more likely to develop type 2 diabetes than their counterparts (IRR, 1.28 [95% CI, 1.05-1.57]). In additional analyses, investigators observed no increase in IRR for other forms of diabetes.

Investigators pointed out limitations within their study could have impacted findings, including the relatively short follow-up period.

“Since the COVID-19 patients were only followed for about three months, further follow-up is needed to understand whether type 2 diabetes after mild COVID-19 is just temporary and can be reversed after they have fully recovered, or whether it leads to a chronic condition,” Rathmann added.

This study, “Incidence of newly diagnosed diabetes after Covid-19,” was published in Diabetologia.