Background

There is growing evidence suggesting that beyond the acute phase of SARS-CoV-2 infection, people with COVID-19 could experience a wide range of post-acute sequelae, including diabetes. However, the risks and burdens of diabetes in the post-acute phase of the disease have not yet been comprehensively characterised. To address this knowledge gap, we aimed to examine the post-acute risk and burden of incident diabetes in people who survived the first 30 days of SARS-CoV-2 infection.

Methods

In this cohort study, we used the national databases of the US Department of Veterans Affairs to build a cohort of 181 280 participants who had a positive COVID-19 test between March 1, 2020, and Sept 30, 2021, and survived the first 30 days of COVID-19; a contemporary control (n=4 118 441) that enrolled participants between March 1, 2020, and Sept 30, 2021; and a historical control (n=4 286 911) that enrolled participants between March 1, 2018, and Sept 30, 2019. Both control groups had no evidence of SARS-CoV-2 infection. Participants in all three comparison groups were free of diabetes before cohort entry and were followed up for a median of 352 days (IQR 245–406). We used inverse probability weighted survival analyses, including predefined and algorithmically selected high dimensional variables, to estimate post-acute COVID-19 risks of incident diabetes, antihyperglycaemic use, and a composite of the two outcomes. We reported two measures of risk: hazard ratio (HR) and burden per 1000 people at 12 months.

Findings

In the post-acute phase of the disease, compared with the contemporary control group, people with COVID-19 exhibited an increased risk (HR 1·40, 95% CI 1·36–1·44) and excess burden (13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes; and an increased risk (1·85, 1·78–1·92) and excess burden (12·35, 11·36–13·38) of incident antihyperglycaemic use. Additionally, analyses to estimate the risk of a composite endpoint of incident diabetes or antihyperglycaemic use yielded a HR of 1·46 (95% CI 1·43–1·50) and an excess burden of 18·03 (95% CI 16·59–19·51) per 1000 people at 12 months. Risks and burdens of post-acute outcomes increased in a graded fashion according to the severity of the acute phase of COVID-19 (whether patients were non-hospitalised, hospitalised, or admitted to intensive care). All the results were consistent in analyses using the historical control as the reference category.

Interpretation

In the post-acute phase, we report increased risks and 12-month burdens of incident diabetes and antihyperglycaemic use in people with COVID-19 compared with a contemporary control group of people who were enrolled during the same period and had not contracted SARS-CoV-2, and a historical control group from a pre-pandemic era. Post-acute COVID-19 care should involve identification and management of diabetes.

Funding

US Department of Veterans Affairs and the American Society of Nephrology.

中文翻译：

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长期新冠肺炎期间发生糖尿病的风险和负担：一项队列研究

 背景

越来越多的证据表明，在 SARS-CoV-2 感染的急性期之后，COVID-19 患者可能会出现多种急性后后遗症，包括糖尿病。然而，糖尿病在疾病后急性期的风险和负担尚未得到全面表征。为了弥补这一知识差距，我们的目的是检查 SARS-CoV-2 感染后 30 天幸存的人发生糖尿病的急性后风险和负担。

 方法

在这项队列研究中，我们使用美国退伍军人事务部的国家数据库建立了一个由 181,280 名参与者组成的队列，这些参与者在 2020 年 3 月 1 日至 2021 年 9 月 30 日之间进行了阳性的 COVID-19 检测，并在前 30 个月中幸存下来。 COVID-19 的天数；当代对照（n=4 118 441）在2020年3月1日至2021年9月30日期间招募了参与者；以及历史对照组 (n=4 286 911)，在 2018 年 3 月 1 日至 2019 年 9 月 30 日期间招募参与者。两个对照组均没有 SARS-CoV-2 感染的证据。所有三个比较组的参与者在进入队列前均未患有糖尿病，并随访中位时间为 352 天（IQR 245-406）。我们使用逆概率加权生存分析，包括预定义和算法选择的高维变量，来估计急性 COVID-19 后发生糖尿病、抗高血糖药物的使用以及两种结果的综合风险。我们报告了两种风险衡量标准：风险比 (HR) 和 12 个月每 1000 人的负担。

 发现

在疾病的急性后阶段，与当代对照组相比，COVID-19 患者表现出风险增加（HR 1·40，95% CI 1·36–1·44）和负担过重（13·46 ，发生糖尿病的 95% CI 12·11–14·84，每 1000 人，12 个月）；服用降糖药的风险增加（1·85、1·78–1·92）和额外负担（12·35、11·36–13·38）。此外，估计糖尿病或抗高血糖药物使用复合终点风险的分析得出的 HR 为 1·46 (95% CI 1·43–1·50)，超额负担为 18·03 (95% CI 16· 59–19·51) 每 1000 人在 12 个月时。根据 COVID-19 急性期的严重程度（无论患者是非住院、住院还是入住重症监护室），急性后结局的风险和负担以分级方式增加。使用历史对照作为参考类别的分析中所有结果都是一致的。

 解释

在急性后阶段，我们报告，与同期入组且未感染 SARS-CoV 的当代对照组人群相比，COVID-19 患者发生糖尿病和使用降血糖药物的风险和 12 个月负担增加-2，以及大流行前时代的历史对照组。 COVID-19 急性后护理应包括糖尿病的识别和管理。

 资金

美国退伍军人事务部和美国肾脏病学会。