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People with COVID-19 were more likely to be diagnosed with diabetes in the year following their infection, according to a cohort study using national Department of Veterans Affairs databases.

Among 181,280 veterans who tested positive for COVID-19, there was a 40% higher risk for incident diabetes during the post-acute phase of the disease compared with a contemporary control group (HR 1.40, 95% CI 1.36-1.44), reported Yan Xie, MPH, and Ziyad Al-Aly, MD, both of the VA Saint Louis Health Care System in Saint Louis.

Over 12 months, there was also a significantly higher excess burden of new diabetes among those with a positive COVID test (13.46 excess cases of diabetes per 1,000 people, 95% CI 12.11-14.84), the researchers wrote in .

In addition, they found, individuals who survived the post-acute phase of a COVID-19 infection (i.e., the first 30 days) had an 85% higher risk of needing a new antihyperglycemic medication following infection compared with controls (HR 1.85, 95% CI 1.78-1.92). Also following a similar pattern, the 12-month burden of incident antihyperglycemic use was 12.35 per 1,000 people higher than contemporary controls.

Putting this together, Xie and Al-Aly determined that COVID survivors had a 46% increased risk for both incident diabetes and antihyperglycemic use and an excess burden of 18.03 per 1,000 more people for this composite outcome 12 months later.

"Beyond the acute phase of COVID-19, survivors are at an increased risk of developing incident diabetes and antihyperglycemic use," the researchers wrote. "Therefore diabetes should be considered as a component of the multifaceted long COVID."

Not surprisingly, these risks followed a pattern of COVID severity but were still significant across all case settings: non-hospitalized patients, hospitalized patients, and those admitted to intensive care. For example, while the controls had an incident diabetes burden of 34.42 per 1,000 people over 12 months, individuals admitted to the intensive care unit (ICU) with COVID-19 had an incident diabetes burden of 123.48 per 1,000 people.

The researchers also found the following clinical and sociodemographic risk factors to be associated with a higher risk for developing diabetes after infection: age over 65 years, Black race, body mass index (BMI) of 25-30 or above 30, and presence of cardiovascular disease, hypertension, hyperlipidemia, or prediabetes.

"Post-acute care strategies of people with COVID-19 should also integrate screening and management of diabetes," argued Xie and Al-Aly.

"[These data] have major implications for clinical policy and public health," according to K.M. Venkat Narayan, MD, MSc, MBA, and Lisa Staimez, PhD, MPH, both of Emory University in Atlanta, writing in an . They suggested that if indeed COVID-19 is a risk factor for new-onset diabetes, that screening and management of dysglycemia should be included as an "integral part of clinical guidelines" for post-COVID care, particularly against the background of rising global diabetes rates.

"With large and growing numbers of people worldwide infected with SARS-CoV-2 ... any COVID-19-related increases in diabetes incidence could lead to unprecedented cases of diabetes worldwide -- wreaking havoc on already over-stretched and under-resourced clinical and public health systems globally, with devastating tolls in terms of deaths and suffering," the commentators warned.

As of March 22, there have been more than 470 million confirmed cases of COVID-19 globally, including over 6 million deaths reported to the .

This isn't the first study to link COVID infection with new-onset diabetes. CDC data released earlier this year reported that kids who tested positive had an increased risk for all types of diabetes as well.

For the new study, Xie and Al-Aly used data from the Department of Veterans Affairs on 181,280 COVID-19 survivors, as well as 4,118,441 contemporary controls and 4,286,911 historical controls.

All the findings were similar when the researchers compared COVID survivors with historical controls, the investigators reported.

Among the COVID group, 162,096 individuals were not hospitalized, 15,078 were hospitalized, and 4,106 were admitted to an ICU during the acute phase of the disease. Only patients who were alive 30 days after a positive COVID test were included.

Incident diabetes was classified as an HbA1c over 6.4% (46 mmol/mol) or an ICD-10 diabetes diagnosis. Antihyperglycemic use was based on a prescription record of diabetes medications for more than 30 days.

Narayan and Staimez said that additional "carefully designed multi-ethnic prospective epidemiological studies" will be needed to confirm the findings. Additionally, they suggested that future studies try to hone in on potential mechanisms driving this link, such as autonomic dysfunction, immune response or induced autoimmunity, and low grade inflammation.

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