▎ WuXi AppTec content team editor
There is growing evidence that after the acute phase of COVID-19 infection, infected people may also develop long-term symptoms beyond the respiratory system, including diabetes.
Recently, two independent large-scale research data were published in two authoritative medical journals in the field of diabetes, The Lancet - Diabetes and Endocrinology, and Diabetologia, a subsidiary of the European Association for The Study of Diabetes (EASD). Two studies further support the higher risk of diabetes faced by people living with COVID-19, and patients with mild diseases cannot be ignored either. These findings suggest that care strategies after acute infection should include active screening and management of diabetes.
Screenshot source: The Lancet Diabetes & Endocrinology
The study, published in The Lancet – Diabetes and Endocrinology, came from the VA Saint Louis Health Care System in Virginia, USA. The cohort study included more than 180,000 survivors who tested positive for COVID-19 between March 2020 and September 2021 and survived the first 30 days of acute infection. At the same time, two groups of patients who were not infected with COVID-19 were recruited as controls: (1) nearly 4.12 million people were recruited as current controls during the same period from March 2020 to September 2021, and (2) 4.287 million people with medical records from the same healthcare database were included as historical controls. All three groups of patients were free of diabetes at the time of inclusion in the study cohort, with a median follow-up time of 352 days.
After the statistics, it was found that compared with the current control group, the risk of diabetes in the later stage of the new crown infection was significantly increased by 40%, and the risk of needing to use hypoglycemic drugs was significantly increased by 85%, which was equivalent to an additional 13.46 cases/1000 cases and 12.35 cases/1000 people who had diabetes and the burden of using hypoglycemic drugs in the 12 months after infection. The combined risk of developing diabetes or needing hypoglycemic drugs increased by 46% in COVID-19 infected persons (18.03 cases per 1000 people after 12 months).
As the severity of COVID-19 increases during the acute phase (no hospitalization, hospitalization, or intensive care), so does the risk of new-onset diabetes or the need for re-use of hypoglycemic drugs. Notably, even for mild, unpatient COVID-19 infections, the additional burden of new diabetes or taking hypoglycemic drugs increased by 8.28 per 1000 people after 1 year.
▲Compared with the current control group, with the increase in the severity of the acute stage of new crown infection, the risk of new diabetes, the risk of needing to use hypoglycemic drugs and the risk of the combined outcome of the two also increased significantly. (Image source: References[1])
Consistent trends were observed in different ages (≤65 and >65 years), ethnicity (white and black), sex (male and female), and BM categories (> 18.5 to ≤25, >25 to ≤30, >30) and socioeconomic status. But relatively speaking, people aged 65, black people, people with cardiovascular disease, hypertension, hyperlipidemia or prediabetes, and people with a BMI of >25 are at higher risk of new diabetes or the need for hypoglycemic drugs after infection with the new crown.
In comparison with the historical control group, the conclusion is also consistent.
Continuing these data, the paper notes that after the acute phase of COVID-19 infection, survivors may be at increased risk of new-onset diabetes or hypoglycemic drugs, and that diabetes should be seen as an aspect of prolonged COVID-19 syndrome.
A retrospective cohort study published in Diabetia came from Heinrich Heine University Düsseldorf in Germany. The study data were provided by a group of 1171 physician representatives from across Germany and covered 8.8 million patients.
Between March 2020 and January 2021, a total of 35,865 cases of COVID-19 were recorded, and other patients with acute upper respiratory tract infections (usually caused by viruses) were listed as a control group, and the two groups were matched according to sex, age, health insurance status, infection months and comorbidities (obesity, hypertension, hyperlipidemia, myocardial infarction, stroke), and the demographic characteristics (average age 43 years; 46% were female) and clinical characteristics of the latter two groups were similar.
By July 2021, the median follow-up period in the COVID-19 group was 119 days; the upper-class follow-up in the control group was 161 days. An analysis of the risk of newly diagnosed diabetes mellitus (ICD-10) found that the risk of developing type 2 diabetes in PATIENTS was significantly higher by 28% compared with other acute upper respiratory tract infections (15.8 cases/1000 people-year vs 12.3/1000 person-years), and the risk of other forms of diabetes was not increased.
"COVID-19 infection may lead to diabetes by upregulating the immune system, which can lead to pancreatic β cell dysfunction and insulin resistance, or patients may be at risk of developing diabetes due to obesity or prediabetes, and the stress brought by COVID-19 accelerates the development of the disease." Study corresponding author Dr Wolfgang Rathmann noted. However, since the study was followed up for only about 4 months, "further follow-up is needed to understand whether mild post-COVID-19 type 2 diabetes is only temporary, can be reversed after full recovery, or will eventually lead to chronic disease." ”
Image credit: 123RF
A co-editor review article in The Lancet- Diabetes and Endocrinology notes that these findings warrant prospective studies in a wider population to confirm long-term health effects. The article suggests that in the future, more standardized diagnostic assessments of diabetes, more detailed analysis of potential factors influencing sequelae (e.g., infection severity, viral load, and the presence of antibodies to autoimmune attack) will be needed, and potential mechanisms for the association of COVID-19 infection with diabetes need to be explored. Given the far-reaching implications of increasing the burden of diabetes, identifying the association between COVID-19 infection and diabetes risk is important for clinical strategies and public health.