Risk of new diabetes diagnosis was higher compared with non-COVID respiratory infections

Children and teens had an increased risk of being diagnosed with type 2 diabetes after COVID-19 infection, a retrospective cohort study of over 600,000 youth suggested.

Adolescents 10 to 19 years old had a 55% higher risk for a new diagnosis of type 2 diabetes 1 month after a COVID diagnosis compared with peers diagnosed with a non-COVID respiratory bug (risk ratio [RR] 1.55, 95% CI 1.28-1.89), reported Pauline Terebuh, MD, MPH, of Case Western Reserve University in Cleveland, Ohio, and colleagues.

The risk of a new type 2 diabetes diagnosis remained elevated at 3 months (RR 1.48, 95% CI 1.24-1.76) and 6 months (RR 1.58, 95% CI 1.35-1.85) after COVID infection, the group detailed in JAMA Network Openopens in a new tab or window.

“Youth diagnosed with diabetes will carry the burden of diabetes-related complications and increased medical costs for many years,” Terebuh told. “All potential contributors to that trend are deserving of our attention, including COVID-19 and the increasing prevalence of obesity.”

“COVID-19 is becoming endemic and strategies for mitigating its impact are extremely important,” she said.

“SARS-CoV-2 may have the ability to selectively infect human pancreatic β cells, and if this triggers apoptosis, the ability of the pancreas to secrete insulin may be impaired,” the researchers suggested. “Though T2D [type 2 diabetes] is usually considered to be a disease of insulin resistance rather than insulin lack, for newly diagnosed patients, the origin may not be entirely clear or confined to a single pathobiologic cause.”

This wasn’t the first time research suggested a link between COVID infection and diabetes in youth, but up until this point, most research focused on the relationship with type 1 diabetes. However, these studies have shown mixed results, with some studies indicating a link, and others dismissing the association.

Terebuh said while data have indicated an overall increase in new diagnoses of type 2 diabetes among youth during the first year of the pandemic, this uptick has been a “worrisome trend” for decades.

“However, lots of things changed for youth during the pandemic from access to food to level of activity and stress,” she pointed out. “The association with a COVID-19 diagnosis, per se, was not clear.”

To delve further into the topic, the researchers reviewed electronic health records on 613,602 patients from the TriNetX analytics platforms between January 2020 and December 2022. This included 306,801 patients diagnosed with COVID-19 (mean age 14.9 years, 52.8% female) and 306,801 with other respiratory infections (mean age 14.9 years, 52.6% female), after propensity score-matching. Preexisting diabetes was grounds for exclusion.

In a subpopulation of adolescents with a BMI designating overweight or obesity (BMI in the 85th percentile for age or higher), a COVID diagnosis was tied with higher risks for developing type 2 diabetes at all three follow-up points compared with other respiratory infections:

• 1 month after: RR 2.07 (95% CI 1.12-3.83)
• 3 months after: RR 2.00 (95% CI 1.15-3.47)
• 6 months after: RR 2.27 (95% CI 1.38-3.75)

“New drugs for diabetes and obesity, such as GLP-1 receptor antagonists, provided they are safe, may have a role that should be studied,” Terebuh suggested.

Additionally, the researchers found the risk for developing type 2 diabetes was the highest for adolescents who were hospitalized within 1 month of a documented COVID infection:

• 1 month: RR 3.10 (95% CI 2.04-4.71)
• 3 months: RR 2.74 (95% CI 1.90-3.96)
• 6 months: RR 2.62 (95% CI 1.87-3.66)

Some diabetes diagnoses may have been preexisting and were discovered during the encounter for infection, the researchers pointed out. “Diagnoses made in the first month following infection may well represent preexisting disease, since the diagnosis of T2D is often confirmed by HbA1c measurements, which use mean blood glucose levels over the life span of the erythrocyte, or over 3 to 4 months,” they wrote.

It will be important to test whether patients diagnosed soon after COVID-19 infection continue to meet diagnostic criteria for type 2 diabetes to separate patients who had diabetes from those who became hyperglycemic only during the metabolic stress of infection, they added.

Other limitations included potential confounders like vaccination status, socioeconomic status, BMI, or insulin resistance. In addition, patients with obesity and overweight weren’t matched for obesity-specific treatments.

Primary Source JAMA Network Open

Source Reference: opens in a new tab or window Miller MG, et al “SARS-CoV-2 infection and new-onset type 2 diabetes among pediatric patients, 2020 to 2022” JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.39444.