COVID-19 Infection Can Increase a Patient’s Risk of New-Onset Diabetes

Rates of diagnoses for new-onset cardiometabolic diseases were higher in the 3 months after COVID-19 infection compared to pre-COVID-19 infection, according to a new study published in JAMA Network Open. The risk of developing diabetes was also higher among unvaccinated patients.

“In adjusted multivariable models, risk of new-onset diabetes (vs benchmark) diagnosis occurring after vs before COVID-19 infection was significantly elevated,” the study authors wrote. “Mechanisms contributing to post-infection diabetes risk remain unclear, although persistent inflammation contributing to insulin resistance is a proposed pathway.”

At the beginning of the COVID-19 pandemic, previous studies found that post-infection, some patients had an increased risk of new-onset cardiometabolic diseases—diabetes, hypertension, and hyperlipidemia.

Although the latest Omicron subtype appeared to be less virulent, there was not sufficient data on a person’s risk of developing cardiometabolic disease following COVID-19 infection, nor the impact of a person’s vaccination status on their risk of developing a cardiometabolic disease.

Investigators conducted the current study to address these questions, identifying 23,709 patients who had been infected with COVID-19 at least 1 or more times. Patients were treated between March 2020 and June 2022 at Cedars-Sinai Health System in Los Angeles.

Using codes from the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, investigators then studied newly reported cardiometabolic diagnoses before, or after, the patient’s first COVID-19 infection.

Comparing the results of the cardiometabolic diagnoses with a benchmark diagnosis unrelated to COVID-19, investigators observed that rates of diagnoses for new-onset cardiometabolic diseases and benchmark diseases were higher in the 90 days following their infection compared to before.

The likelihood of developing new-onset diabetes was significantly higher post-COVID-19 infection than it was pre-infection. Among the cardiometabolic diseases, the odds of developing incident diabetes were highest, followed by hypertension, benchmark diagnosis, then hyperlipidemia.

Investigators also linked vaccination status to risk of developing new-onset diabetes. The data showed that the odds ratio of diabetes post-infection was 1.78 for unvaccinated individuals and 1.07 for vaccinated individuals. However, “the interaction term between vaccination status and diabetes diagnosis was not statistically significant,” the study authors wrote in the paper.

Analyzing age, sex, or preexisting cardiovascular risk factors, the investigators did not find evidence that proves these factors increase a person’s risk of cardiometabolic disease after COVID-19 infection. Investigators could not link age, sex, or the timing of a person’s first COVID-19 infection with the risk of new-onset cardiometabolic diagnosis before or after infection either.

The study was limited because it used diagnostic coding, did not account for confounders, and there was not a sufficient sample size or statistical power that could test for multiple interactions.

“Additional studies are needed to understand cardiometabolic sequelae of COVID-19 and whether COVID-19 vaccination attenuates risk of cardiometabolic disease,” the study authors wrote in the paper.

Reference

Kwan A, Ebinger J, Botting P, et al. Association of COVID-19 Vaccination With Risk for Incident Diabetes After COVID-19 Infection. JAMA Netw Open. 2023 doi:10.1001/jamanetworkopen.2022.55965. Accessed February 16, 2023.