Study Confirms Increased Risk of New-Onset Type 2 Diabetes After COVID-19 Infection

Susan Cheng, MD, MPH

Investigators from Cedars-Sinai purport the results of their new study confirm people who have had COVID-19 were at an increased risk for new-onset diabetes.

An analysis of electronic medical record data from more than 20,000 adults with a documented COVID-19 infection within the Cedars-Sinai Health System, results of the study providence evidence detailing an increased risk of new-onset type 2 diabetes after COVID-19 exposure, with this risk apparent regardless of a person’s vaccination, although unvaccinated patients appeared to incur a greater risk as a result of infection.¹

“Although we don’t yet know for certain, the trends and patterns that we see in the data suggest that COVID-19 infection could be acting in certain settings like a disease accelerator, amplifying risk for a diagnosis that individuals might have otherwise received later in life,” senior investigator Susan Cheng, MD, MPH, professor of Cardiology and director for Cardiovascular Population Sciences in the Smidt Heart Institute.² “So, it could be that instead of being diagnosed with diabetes by age 65, a person with preexisting risk for diabetes might—after a COVID-19 infection—be more likely to develop diabetes by age 45 or 55.”

From the early days of the pandemic, diabetes has been at the forefront of discussions—first, as a comorbidity associated with increased risk of disease severity³ and, next, when studies began to emerge suggesting an increased risk of diabetes following infection.⁴ Citing a lack of data emerging on this topic since the emergence of Omicron variants, Cheng and colleagues at the Smidt Heart Institute designed their research endeavor as a cohort study of adults with at least 1 documented COVID-19 infection who received treatment within the Cedars-Sinai Health System in Los Angeles, California from March 2020-June 2022.

For the purpose of analysis, investigators used a self-controlled exposure-crossover design to estimate the odds of a new cardiometabolic diagnosis occurring 90 days after compared to 90 days before COVID-19 infection. Investigators noted they performed a comparison of the odds of a new cardiometabolic diagnosis with those of a new benchmark diagnosis, such as urinary tract infection and gastroesophageal reflux, to account for temporal confounders arising from disruptions in health care use during the COVID-19 pandemic.

Additionally, investigators pointed out multivariable logistic regression models were used to estimate odds ratio (OR) for a new cardiometabolic compared to new benchmark diagnosis occurring 90 days after compared to 90 days before infection with adjustment for age, sex, timing of infection, and COVID-19 vaccination status. Of note, timing of infection was stratified as before and after the emergence of the Omicron variant.

From their search of Cedars-Sinai health records, investigators identified a cohort of 23,709 patients for inclusion in their study. This cohort had a mean age of 47.4 (SD, 19.3) years and 54% were female. Results of the investigators’ initial analyses indicated the highest odds postinfection were observed for new-onset diabetes (OR, 2.35 [95% CI, 1.94-2.89]; P <.001), followed by hypertension (OR, 1.54 [95% CI, 1.35-1.76]; P <.001), benchmark diagnoses (OR, 1.42 [95% CI, 1.42 [95% CI, 1.25-1.61]; P <.001), and hyperlipidemia (OR, 1.22 [95% CI, 1.03-1.47]; P=.03).¹

In multivariable-adjusted models, when compared to the risk observed for new benchmark diagnoses after and before COVID-19 infection, the risk of new-onset type 2 diabetes was significantly elevated after COVID-19 infection compared against before COVID-19 infection (OR, 1.58 [95% CI, 1.24-2.02]; P <.001), but this increase in risk was not observed for risk of new-onset hypertension and hyperlipidemia relative to benchmark diagnoses.¹

When assessing risk according to vaccination status, results indicated the risk after infection was higher among unvaccinated patients (OR, 1.78 [95% CI, 1.35-2.37]; P <.001) than vaccinated (OR, 1.07 [95% CI, 0.64-1.77]; P=.80), but the interaction between vaccination status and diabetes diagnosis did not reach statistical significance (OR, 0.59 [95% CI, 0.34-1.06]; P=.08). Additional analyses found no evidence of interaction by age, sex, or preexisting cardiovascular risk factors and investigators pointed out age, sex, and timing of infection were not associated with increased risk of a new cardiometabolic diagnosis before or after COVID-19 infection in any models.¹

“Our results verify that the risk of developing Type 2 diabetes after a COVID-19 infection was not just an early observation but, in fact, a real risk that has, unfortunately, persisted through the Omicron era,” added lead investigator Alan Kwan, MD, a cardiovascular physician in the Smidt Heart Institute at Cedars-Sinai.²

References

1. Kwan AC, Ebinger JE, Botting P, Navarrette J, Claggett B, Cheng S. Association of COVID-19 Vaccination With Risk for Incident Diabetes After COVID-19 Infection. JAMA Netw Open. 2023;6(2):e2255965. doi:10.1001/jamanetworkopen.2022.55965
2. Verified: COVID-19 Infection Increases Diabetes Risk. Cedars-Sinai Newsroom. February 2023. https://www.cedars-sinai.org/newsroom/verified-covid-19-infection-increases-diabetes-risk/. Accessed February 15, 2023.
3. Iapoce C. Obesity rates linked to severe outcomes in COVID-19 patients. HCP Live. https://www.hcplive.com/view/obesity-rates-linked-to-severe-outcomes-in-covid-19-patients. Published January 12, 2023. Accessed February 15, 2023.
4. Campbell P. Covid-19 infection linked to increased risk of developing type 2 diabetes. Endocrinology Network. https://www.endocrinologynetwork.com/view/covid-19-infection-linked-to-increased-risk-of-developing-type-2-diabetes. Published March 24, 2022. Accessed February 15, 2023.