Spotlight on diabetes incidence in the pandemic

Two studies tried to determine whether COVID-19 infection leads to a subsequent increase in the risk of developing diabetes, while another highlighted how type 2 diabetes has risen among youth since the start of the pandemic.

Multiple recent studies looked at the incidence of diabetes during the COVID-19 pandemic.

One study, published by Diabetes Care on Jan. 16, followed patients admitted to hospitals in England for COVID-19 and/or pneumonia in April to August 2020. Their incidence of diabetes after discharge was compared to that of patients admitted with pneumonia over the same dates in 2017, 2018, and 2019. In the 2020 groups, diabetes incidence rates were 16.4 (95% CI, 12.8 to 20.7) per 1,000 person-years in those with COVID-19 without pneumonia, 19.0 (95% CI, 13.8 to 25.6) per 1,000 in those with COVID-19 with pneumonia, and 16.6 (95% CI, 13.3 to 20.4) per 1,000 in those with pneumonia without COVID-19. The study authors observed that although these rates were objectively higher than in the comparison groups, after adjustment for ethnicity and social deprivation, they were not significantly different from those admitted for pneumonia in 2019, 2018, and 2017, at 13.7 (95% CI, 10.8 to 17.3), 13.8 (95% CI, 10.9 to 17.4), and 14.2 (95% CI, 10.9 to 18.3) per 1,000 person-years, respectively. “Accordingly, our data do not support a clear impact of COVID-19 on the incidence of diabetes when carefully compared with risks in several comparator groups, including contemporaneously assessed risks in those hospitalized with pneumonia, at least in the short-term,” they concluded.

In contrast, an Israeli study, published by BMJ Open Diabetes Research and Care on Jan. 20, matched 936 patients who had COVID-19 in March 2020 to August 2021 with controls who didn't have COVID-19. During a mean follow-up of 10.9 months, there were 1,145 (0.72%) new diabetes diagnoses in the COVID-19 patients versus 1,013 (0.64%) in the controls (P=0.004). When patients were categorized by illness severity, outpatients with COVID-19 were not at higher risk of diabetes during their illness or afterward. However, patients hospitalized with COVID-19 did have a higher risk of diabetes, particularly if they were severely ill. The increase in risk was highest during their acute illness (hazard ratio [HR] compared to patients without COVID-19, 2.47; 95% CI, 1.86 to 3.29) but remained significant at four months (HR, 1.60; 95% CI, 1.12 to 2.29). “Acute and post-acute COVID-19 were associated with new DM [diabetes mellitus] only among hospitalized patients, with the highest risk among those hospitalized with severe disease. Those patients should be followed and monitored post-discharge for new DM,” the study authors concluded. They noted that several theories have been proposed for an association between SARS-CoV-2 and hyperglycemia but that the study was limited by its observational design.

Finally, a U.S. study, published by Diabetes Care on Jan. 13, compared rates of new-onset type 2 diabetes in youth before the pandemic (January 2017 to February 2020) and during the pandemic (March to December 2020 and January to December 2021) at one children's hospital. It found that diagnoses of type 2 diabetes among patients ages 21 years and younger increased nearly threefold during the pandemic versus prior and by 61% in 2021 compared to the first year of the pandemic. Patients' body mass index (BMI) also increased during the pandemic compared to before. In the first year of the pandemic, patients presenting with diabetes were younger and had a higher incidence of diabetic ketoacidosis and/or hyperglycemic hyperosmolar syndrome. “The rising BMI percentile reported in youth with new-onset type 2 diabetes is not surprising and likely reflects pandemic-related obesogenic factors, including decreased physical activity, poor sleep hygiene, increased screen time, and energy-dense food consumption,” the study authors said. They noted that COVID-19 infection status was available for a third of the patients and did not seem to relate to diabetes incidence. “Only one patient showed COVID-19 positivity and none with severe presentation [of diabetes] had COVID-19 infection at diagnosis,” the authors said. “Providers should be aware of the escalating incidence of youth-onset type 2 diabetes to avoid delays in diagnosis and inform educational programs to combat the continued impact of the pandemic on health outcomes.”