RISK OF INCIDENT DIABETES FOLLOWING COVID-19 INFECTION: A POPULATION-BASED COHORT STUDY

INTRO: SARS-CoV-2 infection primarily affects the respiratory system. However, other organ systems may also be involved, leading to acute and chronic sequelae. Among other post-acute sequelae, incident diabetes is also being assessed but population-based evidence is still sparse. We evaluated the association between COVID-19 infection including severity of infection and diabetes incidence using population-based registries and datasets. METHODS: We conducted a population-based matched retrospective cohort study using data from the BC COVID-19 Cohort. The exposure was SARS-CoV-2 infection, and the primary outcome was incident diabetes identified >30 days after the specimen collection-date for COVID-19 test. We performed multivariable Cox proportional hazard modeling to assess the effect of COVID-19 infection and disease severity on diabetes. Stratified analyses were performed to evaluate the effect modification of SARS-CoV-2 infection on diabetes risk. Finally, we computed, the confounder-adjusted population attributable fraction from the Cox models FINDINGS: During the median follow-up of 257 days, 608 (0.5%) events were observed among exposed and 1,864 (0.4%) among unexposed. Incident-diabetes rate/100,000 person-years was significantly higher among the exposed group vs. unexposed group (672.2 vs 508.7 respectively). The risk of incident diabetes was higher among those with COVID-19 infection (HR=1.16, 95% CI:1.06–1.28), and among males (aHR=1.22, 95%CI:1.06-1.40). The risk of diabetes was much higher among people with more severe disease (HRICU=3.32, 95%CI:1.99 – 5.54; HRhospitalized=1.97, 95%CI:1.33 – 2.93). CONCLUSION: SARS-CoV-2 infection is associated with higher risk of diabetes overall and among males. Severe SARS-CoV-2 infection is associated with higher risk of diabetes among both males and females. Furthermore, infection with SARS-CoV-2 could contribute to 3-5% increase in burden of diabetes, which will result in substantial number of diabetes cases with impact on healthcare needs for management of diabetes and its complications in addition to health of affected population.