Highlights This retrospective cohort study of 181,280 participants examined the post-acute risk and burden of incident diabetes in people who survived the first 30 days of SARS-CoV-2 infection. The cohort was compared to two controls: 1) contemporary control group consisting of people who did not become infected with COVID during the same period; and 2) pre-pandemic era control group. There was an increased risk (HR, 1.40) and excess burden (13.46, per 1000 people at 12 months) of incident diabetes compared with control groups. The findings of this study suggest that people with COVID-19 are at increased risk for diabetes and antihyperglycemic use, and that diabetes identification and management should be included in post-acute care strategies for COVID-19 infection. 19. |
Background
There is increasing evidence to suggest 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.
Methods
In this cohort study, we used the US Department of Veterans Affairs national databases to create a cohort of 181,280 participants who tested positive for COVID-19 between March 1, 2020 and September 30, 2021, and survived the first 30 days of COVID-19; a contemporaneous control (n=4,118,441) that enrolled participants between March 1, 2020 and September 30, 2021; and a historical control (n=4,286,911) that enrolled participants between March 1, 2018 and September 30, 2019.
Both control groups had no evidence of SARS-CoV-2 infection. Participants in all three comparison groups were free of diabetes before entering the cohort and were followed 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, antihyperglycemic use, and a combination of the two outcomes. Two risk measures were reported: hazard ratio (HR) and burden per 1000 people at 12 months.
Results
In the post-acute phase of the disease, compared with the contemporary control group, people with COVID-19 exhibited 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 antihyperglycemic use.
Additionally, analyzes estimating the risk of a composite endpoint of incident diabetes or antihyperglycemic use yielded an HR of 1.46 (95% CI, 1.43-1.50) and an excess burden of 18.03. (95% CI, 16.0). 59-19·51) per 1000 people at 12 months.
The risks and burdens of post-acute outcomes increased in a graded manner depending on the severity of the acute phase of COVID-19 (whether patients were not hospitalized, were hospitalized, or were admitted to intensive care).
In conclusion , we suggest that in the post-acute phase of the disease, people with COVID-19 have a higher risk and burden of diabetes and antihyperglycemic use. Risks and burdens were evident among those who were not hospitalized during the acute phase of infection and increased according to the severity of acute infection represented by the care setting (non-hospitalized, hospitalized, and admitted to intensive care).
Taken together, current evidence suggests that diabetes is one facet of the multifaceted long COVID syndrome and that post-acute care strategies for people with COVID-19 should include diabetes identification and management.
Interpretation
In the post-acute phase, we report increased 12-month risks and burdens of incident diabetes and antihyperglycemic use in people with COVID-19 compared to a contemporaneous control group of people who enrolled during the same period and had not contracted SARS-CoV -2, and a historical control group from a pre-pandemic era. Post-acute care for COVID-19 should include identification and management of diabetes.
Added value of this study
In this study involving 181,280 people with COVID-19, 4,118,441 contemporary controls, and 4,286,911 historical controls, we provided risk and burden estimates for 12 months of incident diabetes outcomes. Our results suggest that beyond the first 30 days of infection, COVID-19 survivors exhibited increased risks and burdens of incident diabetes and antihyperglycemic use.
Risks and burdens were significant among those who were not hospitalized and increased gradually depending on the care setting of the acute phase of the illness (i.e., whether people were not hospitalized, hospitalized, or admitted to intensive care during the acute phase of the illness). acute COVID-19). Associated risks and burdens were evident in comparisons with the contemporary control group and the historical control group.
Implications of all available evidence
Taken together, there is evidence to suggest that beyond the acute phase of COVID-19, survivors may be at increased risk of developing incident diabetes and at increased risk of incident antihyperglycemic use in the post-acute phase of the disease.
Diabetes should be considered as one facet of the multifaceted long COVID syndrome. Post-acute care strategies for people with COVID-19 should integrate diabetes screening and management.
Money
US Department of Veterans Affairs and the American Society of Nephrology.
