Summary Emerging evidence suggests that coronavirus disease-2019 (COVID-19) may lead to a wide range of post-acute sequelae outcomes, including new onset diabetes. The objective of this meta-analysis was to estimate the incidence of newly diagnosed diabetes in COVID-19 survivors. We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials, and the World Health Organization Coronavirus Disease Global Literature and clinical trials registries for studies reporting on the association of COVID-19. 19 and diabetes. Search dates were December 2019 to October 16, 2022. Two investigators independently assessed studies for inclusion. Risk of bias was assessed using the Newcastle-Ottawa scale. We estimated the effect of COVID-19 on incident diabetes by random effects meta-analysis using the generic inverse variance method. We identified 8 eligible studies consisting of 4,270,747 COVID-19 patients and 43,203,759 controls. The median age was 43 years (interquartile range, IQR 35-49) and 50% were women. COVID-19 was associated with a 66% increased risk of incident diabetes (hazard ratio, 1.66; 95% CI, 1.38, 2.00). The risk was not modified by age, sex, or study quality. The median risk of bias assessment was 7. In this systematic review and meta-analysis, COVID-19 was associated with an increased risk of developing new-onset diabetes among survivors. Active management of glucose dysregulation after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is warranted. |
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COVID-19 survivors have a 66% higher risk of developing type 1 or type 2 diabetes after their diagnosis compared to those who have not been diagnosed with COVID-19, according to a study by researchers at the College of Medicine of Penn State. Their findings are among the latest evidence suggesting that people diagnosed with COVID-19 may experience a variety of health problems in the period following the illness.
While previous research has indicated that COVID-19 may lead to a higher incidence of diabetes in survivors, compared to the general population, the causes are not well understood. According to researchers, SARS-CoV-2, the virus that causes COVID-19, binds to an enzyme receptor found on the surface of many organs and tissues, including cells found in the pancreas, intestine thin and kidneys. Other research teams have discovered that the virus affects insulin levels and induces the death of pancreatic beta cells, which produce insulin.
“We cannot definitively conclude that COVID-19 causes diabetes , and more research is needed on whether there is a biological cause to explain this association,” said Paddy Ssentongo, internal medicine resident physician at Penn State Health. “But we know that other viruses such as mumps virus, rotavirus and cytomegalovirus are associated with the development of diabetes, so it is not implausible that SARS-CoV-2, which has been shown to affect multiple systems in the human body, can also do the same."
Ssentongo and Djibril Ba, assistant professor of public health sciences, completed one of the largest meta-analyses, or comprehensive review of existing studies, of the association between COVID-19 and diabetes. They extracted data from eight eligible studies out of more than 850 that took place from December 2019 to mid-October 2022. Their final analysis included data from more than 4 million COVID-19 patients and 43 million control patients who were not diagnosed with the disease. .
While each of the eight studies reported a different risk level, the team used statistical models to find an average or pooled risk ratio, which is a measure of how much higher risk a COVID-19 survivor would have of developing diabetes than someone who was not diagnosed with the virus. They found a pooled hazard ratio of 1.66, implying that COVID-19 survivors have a 66% increased risk of developing new-onset diabetes . The risk did not vary according to age, sex or the quality of the study used. Through additional statistical analysis, the team studied whether any studies were disproportionately influencing their results and found that none of the included studies were influencing the results more than the others. The results were published in Scientific Reports .
“To date, more than 660 million people have tested positive for COVID-19,” Ba said. “It is important for survivors and their healthcare providers to be aware of this trend so they can be vigilant for the development of diabetes.”
Ba said their results are similar to previous studies that examined the relationship between COVID-19 and diabetes, but that their analysis is one of the largest to date. However, he noted that some people in the control group may have had mild, undetected asymptomatic COVID-19 because they had not been tested. As a result, misclassification could have led to an underestimation of the strength of the association between the two diseases. The researchers were also unable to study whether vaccination status affected the results, since that data was not available to them.
The research team said future studies should examine the social determinants of health associated with new-onset diabetes so that effective public health prevention and management strategies can be developed. They also said more research is needed into whether there are biological causes to explain this increased risk of diabetes, and that genomic data could be used to identify COVID-19 survivors at higher risk of developing the disease.
Yue Zhang, Lisa Witmer, and Vernon Chinchilli of Penn State College of Medicine also contributed to this research. The authors declare that they have no conflicts of interest or specific funding for this research.
Final message In this systematic review and meta-analysis, COVID-19 was a risk factor for developing new-onset diabetes among survivors. Active monitoring of glucose dysregulation after recovery from severe acute respiratory syndrome coronavirus 2 infection is warranted. |
