Risk of New-Onset Diabetes Before and During the COVID-19 Pandemic: A Real-World Cohort Study

Abstract

Background: Studies of new-onset diabetes as a post-acute sequela of SARS-CoV-2 infection are difficult to generalize to all socio-demographic subgroups. Objective: To study the risk of new-onset diabetes after SARS-CoV-2 infection in a socio-demographically diverse sample. Design: Retrospective cohort study of electronic health record (EHR) data available from the OneFlorida + clinical research network within the National Patient-Centered Clinical Research Network (PCORnet). Subjects: Persons aged 18 or older were included as part of an Exposed cohort (positive SARS-CoV-2 test or COVID-19 diagnosis between 1 March 2020 and 29 January 2022; n = 43,906), a contemporary unexposed cohort (negative SARS-CoV-2 test; n = 162,683), or an age-sex matched historical control cohort (index visits between 2 Mar 2018 and 30 Jan 2020; n = 40,957). Main Measures: The primary outcome was new-onset type 2 diabetes ≥ 30 days after index visit. Hazard ratios and cases per 1000 person-years of new-onset diabetes were studied using target trial approaches for observational data. Associations were reported by sex, race/ethnicity, age, and hospitalization status subgroups. Key Results: The sample was 62% female, 21.4% non-Hispanic Black, and 21.4% Hispanic; mean age was 51.8 (SD, 18.9) years. Relative to historical controls (cases, 28.2 [26.0–30.5]), the unexposed (HR, 1.28 [95% CI, 1.18–1.39]; excess cases, [5.1–10.3]), and exposed cohorts (HR, 1.64 [95% CI, 1.50–1.80]; excess cases, 17.3 [13.7–20.8]) had higher risk of new-onset T2DM. Relative to the unexposed cohort, the exposed cohort had a higher risk (HR, 1.28 [1.19–1.37]); excess cases, 9.5 [6.4–12.7]). Findings were similar across subgroups. Conclusion: The pandemic period was associated with increased T2DM cases across all socio-demographic subgroups; the greatest risk was observed among individuals exposed to SARS-CoV-2.