Veterans who had tested positive for COVID-19 had significantly increased risk of developing diabetes compared to contemporary and historical controls, a recent study found. The cohort study had a median follow-up of 352 days and found that the risk of diabetes increased in a graded fashion with the severity of COVID-19 infection (outpatient, inpatient, ICU).
The study was published by The Lancet Diabetes & Endocrinology on March 21 and summarized in the April ACP Diabetes Monthly. The following commentary by Victor M. Montori, MD, MSc, FACP, was published in the ACP Journal Club section of Annals of Internal Medicine on Aug. 2.
Diabetes is one of the diverse, persistent, postacute syndromes affecting patients who have survived COVID-19. Xie and colleagues reported an increased incidence of diabetes after COVID-19, adjusting for predictors of developing dysglycemia (e.g., age, body mass index, and material poverty) and of detecting it (e.g., markers of health care services access and use). Diabetes was associated with COVID-19 severity, advanced age, Black race, cardiovascular risk, obesity, and prediabetes. Diabetes incidence may have been underestimated because of the relatively brief follow-up (median, 1 y) and the underrepresentation of women and people of color (that racism would have placed at high risk for acute, severe COVID-19 and for diabetes).
Mechanisms that may explain the association between COVID-19 and diabetes include viral action on beta cells and adipose tissue, severe stress and glucocorticoid use during acute COVID-19, effects of lockdowns, gym and restaurant closures, and social and political discord associated with pandemic control measures.
Although the effect of COVID-19 on diabetes incidence seems small (1 more patient in every 100 will develop diabetes at 1 y overall; 2 more if they had prediabetes at baseline), it may represent a large population as many at-risk people have had acute COVID-19.
Even before the pandemic, we responded clinically to the large prevalence of prediabetes instead of deploying at-scale public health measures. Unfortunately, it seems unlikely that a COVID-19–related surge in cases will change this response. In addition to existing case detection and lifestyle advice programs, we must respond to each survivor with vigilance and care for long-term consequences.