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. 2023 Apr:90:104487.
doi: 10.1016/j.ebiom.2023.104487. Epub 2023 Feb 28.

Incidence of new-onset in-hospital and persistent diabetes in COVID-19 patients: comparison with influenza

Affiliations

Incidence of new-onset in-hospital and persistent diabetes in COVID-19 patients: comparison with influenza

Justin Y Lu et al. EBioMedicine. 2023 Apr.

Abstract

Background: This study investigated the incidences and risk factors associated with new-onset persistent type-2 diabetes during COVID-19 hospitalization and at 3-months follow-up compared to influenza.

Methods: This retrospective study consisted of 8216 hospitalized, 2998 non-hospitalized COVID-19 patients, and 2988 hospitalized influenza patients without history of pre-diabetes or diabetes in the Montefiore Health System in Bronx, New York. The primary outcomes were incidences of new-onset in-hospital type-2 diabetes mellitus (I-DM) and persistent diabetes mellitus (P-DM) at 3 months (average) follow-up. Predictive models used 80%/20% of data for training/testing with five-fold cross-validation.

Findings: I-DM was diagnosed in 22.6% of patients with COVID-19 compared to only 3.3% of patients with influenza (95% CI of difference [0.18, 0.20]). COVID-19 patients with I-DM compared to those without I-DM were older, more likely male, more likely to be treated with steroids and had more comorbidities. P-DM was diagnosed in 16.7% of hospitalized COVID-19 patients versus 12% of hospitalized influenza patients (95% CI of difference [0.03,0.065]) but only 7.3% of non-hospitalized COVID-19 patients (95% CI of difference [0.078,0.11]). The rates of P-DM significantly decreased from 23.9% to 4.0% over the studied period. Logistic regression identified similar risk factors predictive of P-DM for COVID-19 and influenza. The adjusted odds ratio (0.90 [95% CI 0.64,1.28]) for developing P-DM was not significantly different between the two viruses.

Interpretation: The incidence of new-onset type-2 diabetes was higher in patients with COVID-19 than influenza. Increased risk of diabetes associated with COVID-19 is mediated through disease severity, which plays a dominant role in the development of this post-acute infection sequela.

Funding: None.

Keywords: COVID-19; Cytokine storm; Hyperglycemia; Inflammation; Predictive model.

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Conflict of interest statement

Declaration of interests Authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Patient selection flowchart. PMH: past medical history, DM: diabetes. Hospitalized influenza patient demographics pre (2018 and 2019) and post (2020 to Feb 2021) pandemic were similar and were thus combined. Note that there were more hospitalized (n = 8216) than non-hospitalized COVID-19 patients (n = 2998) in our cohort because the exclusion/inclusion criteria used to confirm no history of preDM and DM and many non-hospitalized patients did not have these detailed data and thus excluded.
Fig. 2
Fig. 2
Incidences across the pandemic. (A) Number of hospitalized COVID-19 patients, interrupted time series analysis for (B) I-DM and (C) P-DM incidence. Blue lines indicate the date of the first vaccine rollout (Dec 14, 2021). P values indicate statistical significance value between incidence rate of diabetes before and after COVID-19 vaccine rollout.

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