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COVID-19 infection appears to significantly increase the risk of diabetes by about 40% in a year, showing new data from a very large Veterans Affairs population.
“If a patient has a history of COVID-19, it is a risk factor for diabetes and must be reliably screened for diabetes,” said a nephrologist and head of research and development at VA St. Louis. Co-author Ziyad Al-Aly, MD Luis Healthcare, Missouri, said Medscape Medical News..
“It’s still too early to develop guidelines. I think we need to handle the data landscape to understand what this really means, but all these roads are one-way. Obviously, COVID-19 increases the risk of diabetes. The risk is small but not negligible. “
The database contains more than 8 million and 180,000 people previously diagnosed with COVID-19. Subgroup analysis based on diabetes risk score, classification of obesity index, age, race, prediabetes, and deprivation levels compared to 31% to more than double uninfected, even after adjusting for confounding. Factors that have found a significantly increased risk of diabetes.
There was a gradient in diabetes risk depending on the severity of COVID-19 (that is, whether the patient was not hospitalized, hospitalized, or stayed in the intensive care unit), but in patients with “mild” COVID-19. Even during that time, there was a considerable excess burden of diabetes. .. The risk of diabetes has also increased compared to modern and historical controls.
The research is Release March 21 The Lancet Diabetes and Endocrinology Also by Yan Xie, MPH, and Al-Aly of VA St. Louis Healthcare.
Data are consistent with data from another study Release From the national German primary care database. The study was smaller and shorter than the new VA study, but consistent, said Al-Aly, a clinical epidemiologist at Washington University School of Medicine in St. Louis, Missouri.
Millions more with new diabetes as a late sign of COVID-19
“Millions of people in the United States are infected with COVID-19, so this will literally lead to millions of new diabetics. It’s better to identify early for proper treatment. Probably, “Al-Aly said. Medscape Medical News..
“The long-term effects of SARS-CoV-2 infection on increasing the risk of diabetes are serious,” said Benkat Narayan, MD and Lisa R., both Emory’s Rollins School of Public Health and Emory’s Global Diabetes Research Center. Dr. Steimes said. University, Atlanta, An accompanying editorial.
“As the number of people infected with SARS-CoV-2 continues to increase worldwide (cumulative number of cases 434,154,739 by February 28, 2022), the increased incidence of diabetes associated with COVID-19 is It can lead to unprecedented cases of diabetes worldwide, a globally over-expanded and resource-deficient clinical and public health system at the catastrophic cost of death and suffering. ” They add.
Medscape Medical News Dr. Eric Topol, MD, contributor to the Scripps Research Institute in La Jolla, California, agrees. He also said that these new data are “the most profound. Researchers found a 40% increase in diabetes that was not present one month after COVID-19, but was present one year later. Some kind of late symptoms are happening here. “”
Alary said Medscape Medical News The mechanism of association is unknown and likely to be heterogeneous.Among those who already have risk factors Type 2 diabeteslike that obesity Also metabolic syndromeSARS-CoV-2 can simply “put them on the edge” to accelerate the process and manifest diabetes.
However, for those who do not have a risk factor for diabetes, “COVID-19 with all the inflammation caused in the body can lead to new illnesses.” (The diabetic status was confirmed by the ICD-10 code, and only about 0.70% of the total was recorded as follows: Type 1 diabetes.. However, it is unclear how many cases of type 1 diabetes are misclassified as type 2 diabetes because autoantibody tests are not routinely performed. Al-Aly admits. )
Significantly increased risk of diabetes after COVID-19 in all analyses
Analysis included 4,118,441 people diagnosed with COVID-19 in the U.S. Department of Veterans Affairs Healthcare database, survived at least 30 days from March 2020 to September 30, 2021, and did not have COVID-19 in 2019. Included 181,280 people who saw modern contrasts. A historical contrast group of 4,286,911 people seen at the Department of Veterans Affairs in 2017. The average follow-up was about a year.
Compared to modern controls, the COVID-19 group had an excess diabetes burden of 13.46 per 1000 person-years and a hazard ratio of 1.40. They were also at high risk of accidental use of 12.35 glucose-lowering drugs per 1000 person-years, with a hazard ratio of 1.85. Similar results were seen when compared to past controls.
Subgroup analysis showed diabetes after COVID-19 infection by age (65+ and 65+), race (white and black), gender (male and female), and BMI category (18.5-25kg / m²). Increased risk has been shown. ,> 25 ~ ≤ 30kg / m², and> 30kg / m²), and the quartile of the area deprivation index. Increased risk was also seen in the quartile of the diabetes risk score.
In particular, COVID-19 significantly increased the risk of diabetes by 59% even in the subgroup with a BMI of 18-25 kg / m.2And 38% of patients with the lowest quartile of diabetes risk score.
The COVID-19 population included 162,096 who were not hospitalized, 15,078 who were hospitalized, and 4106 who were admitted to the intensive care unit. Here, the hazard ratios for diabetes compared to modern controls were 1.25, 2.73, and 3.76, respectively (all significant).
Al-Aly said his group is further analyzing VA data for cardiovascular and kidney disease, as well as long-term COVID symptoms such as fatigue, pain and neurocognitive dysfunction.
The group is also investigating the effects of the COVID-19 vaccine to see if the risk is reduced in the event of a breakthrough infection. “We have an extensive systematic assessment, and the next treatise will be more comprehensive,” Al-Aly said.
Narayan and Staymez wrote: “The potential relationship between COVID-19 and diabetes indicates that infectious diseases (such as SARS-CoV-2) and chronic diseases (such as diabetes) cannot be seen in silos. Ignored, such as type 2 diabetes. The prone non-infectious disease continues its relentless trajectory, perhaps accelerating, as a major burden on global health. ”
Al-Aly is supported by the US Department of Veterans Affairs for the work submitted. He reports that he has received a consultation fee from Gilead Sciences and funding from Tonix Pharmaceuticals (not related to this work). He is a member of the Board of Directors of the St. Louis Veterans Research and Education Foundation, Deputy Editor-in-Chief of the Journal of the American Society of Nephrology, and a member of several editorial boards. Narayan and Staimez report that they are receiving support from the National Institutes of Health.
Lancet diabetic endoclinol. Published online on March 21, 2022. Full text, editorial
Miriam E. Tucker is a freelance journalist based in the Washington, DC region. She is a regular contributor to Medscape, and her other works have been published in The Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.
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