People who contract COVID-19 are significantly more likely to later be diagnosed with diabetes, according to a new study published in The Lancet Diabetes and Endocrinology.
The authors, Yan Xie, MPH, and Ziyad Al-Aly, MD, who are affiliated with the VA Saint Louis Care System in St. Louis, wrote, “There is growing evidence suggesting that beyond the acute phase of SARS-CoV-2 infection, people with COVID-19 could experience a wide range of post-acute sequelae, including diabetes. However, the risks and burdens of diabetes in the post-acute phase of the disease have not yet been comprehensively characterized. To address this knowledge gap, we aimed to examine the post-acute risk and burden of incident diabetes in people who survived the first 30 days of SARS-CoV-2 infection.”
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They retrieved their data from U.S. Department of Veterans Affairs (VA) national health care databases. They identified a group of 181,280 U.S. veterans who had survived the first 30 days of a COVID-19 infection between March 1, 2020, and September 30, 2021. They also identified two control groups — a contemporary cohort consisting of 4,118,441 participants without COVID-19 who used the VHA services during 2019 and a historical cohort made up of 4,286,911 participants without COVID-19 who used the VHA services during 2017. They then followed up these three groups to estimate the risks and burdens of diabetes, the use of medicines that affect the level of sugar in the blood (antihyperglycemics), and hospitalization status. Among the COVID-19 patients, 15,078 were hospitalized, 162,096 were not hospitalized, and 4,106 were admitted to an intensive-care unit (ICU). The researchers did not include any patients who died within a month of contracting COVID.
Increased risk of diabetes after COVID-19 infection
The researchers reported that the patients who tested positive for COVID-19 had a 40% higher risk for diabetes compared to the contemporary control group. In addition, they found what they called “a significantly higher excess burden of new diabetes” among those who had tested positive for COVID-19. The researchers also reported that people who survived what’s called the “post-acute” phase of COVID-19 (the first 30 days) had an 85% higher risk of requiring a blood-sugar-lowering medication than the control groups.
And patients still faced a higher risk of diabetes whether they were hospitalized, not hospitalized, or placed in an ICU. In the control groups, for example, the later incidence of diabetes was about 34 people per 1,000. Among the patients who had entered an ICU for COVID-19, the incidence was about 123 per 1,000. The researchers also considered other possible risk factors and reported that the post-COVID diabetes risk was even higher in people who were over 65, Black, had a high body-mass index (a measure of weight that takes height into account), and had symptoms of prediabetes, cardiovascular disease, high blood pressure, or high blood sugar.
In all, the researchers concluded that COVID-19 patients have a 46% increased risk for both incident diabetes and blood sugar medication use. As they wrote, “Beyond the acute phase of COVID-19, survivors are at an increased risk of developing incident diabetes and antihyperglycemic use. Therefore diabetes should be considered as a component of the multifaceted long COVID.” The researchers pointed out that their study was not the first to find a link between COVID-19 infection and later diabetes. Last January, the U.S. Centers for Disease Control (CDC) reported that the risks of being diagnosed with diabetes (both type 1 and type 2) were significantly higher for children who had been infected with COVID-19.
In an accompanying essay, K.M. Venkat Narayan, MD, and Lisa Staimez, PhD, wrote that these new findings suggest that blood sugar management will need to become “an integral part of clinical guidelines” for recovered COVID-19 patients. As they put it, “ . ..any COVID-19-related increases in diabetes incidence could lead to unprecedented cases of diabetes worldwide — wreaking havoc on already overstretched and under-resourced clinical and public health systems globally.”
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