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Long COVID can trigger type 2 diabetes in some – VA cohort study

People who had COVID-19 were at greater risk of developing Type 2 diabetes within a year than those who weren’t infected, according to a large review of patient records released in the US.

The finding is true even for people who had less severe or asymptomatic forms of coronavirus infection, though the chances of developing new-onset diabetes were greater as the severity of COVID symptoms increased, according to researchers who reviewed the records of more than 181,000 Department of Veterans Affairs (VA) patients diagnosed with coronavirus infections between 1 March 2020, and 30 September 2021

Their data were compared with the medical records of more than 4.1m VA patients who were not infected during the same period and another 4.28m who received medical care from VA in 2018 and 2019. This kind of study cannot prove cause and effect, but it showed a strong association between the two diseases.

Overall, reports The Washington Post, the researchers calculated that people diagnosed with COVID-19 were 46% more likely to develop Type 2 diabetes for the first time or be prescribed medication to control their blood sugar.

Put another way, 2 out of 100 COVID patients were more likely to develop Type 2 diabetes, a condition in which the pancreas makes insufficient amounts of the hormone insulin, leaving blood sugar levels poorly controlled. Type 2 diabetes can cause damage to kidneys, nerves, blood vessels and the heart, among its other effects.

The results have implications for the more than 471m people known to have been infected during the pandemic, nearly 80m of them in the United States, and especially for people suffering from long-haul COVID.

“For the broader public, if you’ve had COVID-19, you need to pay attention to your blood sugar,” said Ziyad Al-Aly, chief of research and development at VA St Louis Health Care System, who led the review.

Previous smaller studies and physicians who have treated COVID patients have noted an apparent increase in new diabetes diagnoses associated with coronavirus infection. But Al-Aly said his review was the largest consideration of the issue and looked at the greatest length of time after the acute phase of an infection — from 31 days after infection to a median of nearly one year per patient.

VA patients tend to be older than the general population, with more white people and males. But Al-Aly said the large numbers of people involved made him confident that his findings were applicable to the public.

“The risk was evident in all subgroups”, including women, racial minorities, younger people and people with different body mass indexes, he said.

More than 99% of the infected VA patients developed Type 2 diabetes, as opposed to Type 1, a condition in which insulin-producing cells in the pancreas stop producing the hormone entirely. Al-Aly speculated that the cells’ reduced efficiency may be caused by inflammation, produced either by the virus itself or the body’s response to it.

“Taken together,” the researchers wrote, “current evidence suggests that diabetes is a facet of the multifaceted long COVID syndrome and that post-acute care strategies of people with COVID-19 should include identification and management of diabetes.”

The research was published in The Lancet Diabetes & Endocrinology.

Study details
Risks and burdens of incident diabetes in long COVID: a cohort study

Yan Xie, Ziyad Al-Aly.

Published in The Lancet on 21 March 2022

Summary

Background
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 characterised. 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.

Methods
In this cohort study, we used the national databases of the US Department of Veterans Affairs to build a cohort of 181 280 participants who had a positive COVID-19 test between March 1, 2020, and Sept 30, 2021, and survived the first 30 days of COVID-19; a contemporary control (n=4 118 441) that enrolled participants between March 1, 2020, and Sept 30, 2021; and a historical control (n=4 286 911) that enrolled participants between March 1, 2018, and Sept 30, 2019. Both control groups had no evidence of SARS-CoV-2 infection. Participants in all three comparison groups were free of diabetes before cohort entry and were followed up for a median of 352 days (IQR 245–406). We used inverse probability weighted survival analyses, including predefined and algorithmically selected high dimensional variables, to estimate post-acute COVID-19 risks of incident diabetes, antihyperglycaemic use, and a composite of the two outcomes. We reported two measures of risk: hazard ratio (HR) and burden per 1000 people at 12 months.

Findings
In the post-acute phase of the disease, compared with the contemporary control group, people with COVID-19 exhibited an increased risk (HR 1·40, 95% CI 1·36–1·44) and excess burden (13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes; and an increased risk (1·85, 1·78–1·92) and excess burden (12·35, 11·36–13·38) of incident antihyperglycaemic use. Additionally, analyses to estimate the risk of a composite endpoint of incident diabetes or antihyperglycaemic use yielded a HR of 1·46 (95% CI 1·43–1·50) and an excess burden of 18·03 (95% CI 16·59–19·51) per 1000 people at 12 months. Risks and burdens of post-acute outcomes increased in a graded fashion according to the severity of the acute phase of COVID-19 (whether patients were non-hospitalised, hospitalised, or admitted to intensive care). All the results were consistent in analyses using the historical control as the reference category.

 

The Lancet article – Risks and burdens of incident diabetes in long COVID: a cohort study (Open access)

 

The Washington Post article – Covid infection associated with a greater likelihood of Type 2 diabetes, according to review of patient records (Open access)

 

See more from MedicalBrief archives:

 

Global database for research to examine link between COVID-19 and diabetes

 

COVID-19 may trigger new diabetes — NEJM expert letter

 

More evidence that diabetes/overweight tied to severe COVID-19 — Hospital meta-analysis

 

One in 10 diabetes patients with COVID-19 dies within 7 days — French CORONADO study

 

 

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