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Cedars-Sinai Study Said to Confirm Increased Risk of New-onset T2D After COVID-19 Infection


The EHR analysis found greater risk of type 2 diabetes after COVID regardless of vaccination status although odds were greater for those unvaccinated before infection.

In a research letter published February 13, 2023, in JAMA Network Open, investigators from the Smidt Heart Institute at Cedars Sinai in Los Angeles state their recent study findings confirm the increased risk for new onset diabetes among persons with a documented COVID-19 infection that has been observed and documented in earlier analyses of post-acute sequelae.

The conclusion is based on analysis of electronic health record data from more than 20 000 adults who had at least 1 documented COVID-19 infection and were treated within the Cedars Sinai Health System from 2020-2022. The research team found elevated risk for new-onset type 2 diabetes (T2D) regardless of COVID-19 vaccination status, however unvaccinated individuals were at greater risk, according to the findings.

“Although we don’t yet know for certain, the trends and patterns that we see in the data suggest that COVID-19 infection could be acting in certain settings like a disease accelerator, amplifying risk for a diagnosis that individuals might have otherwise received later in life,” senior investigator Susan Cheng, MD, MPH, professor of cardiology and director for Cardiovascular Population Sciences in the Smidt Heart Institute, in a Cedars-Sinai statement

“So, it could be that instead of being diagnosed with diabetes by age 65, a person with preexisting risk for diabetes might—after a COVID-19 infection—be more likely to develop diabetes by age 45 or 55.”

The risk of post-COVID new onset cardiometabolic disease has been documented since the early phases of the pandemic, primarily T2D, hypertension, and hyperlipidemia, the authors point out. Moreover, all 3 conditions, and particularly T2D, have been widely linked to the risk for more severe infection. There has been less data generated during the current Omicron-dominant phase, say Cheng and colleagues, leaving open the question of whether risks of post-COVID cardiometabolic disease remain or have attenuated and, importantly, whether COVID-19 vaccination status impacts the risk.

“So, it could be that instead of being diagnosed with diabetes by age 65, a person with preexisting risk for diabetes might—after a COVID-19 infection—be more likely to develop diabetes by age 45 or 55.”

Tapping the Cedars-Sinai EHR data, Cheng and colleagues used a self-controlled exposure-crossover design to estimate the odds of a new cardiometabolic diagnosis occurring 90 days after compared to 90 days before COVID-19 infection. Given the potential for temporal confounders related to health care disruptions during the pandemic, the research team compared the odds of a new cardiometabolic diagnosis with those of a new benchmark diagnosis, ie, urinary tract infection and gastroesophageal reflux, as a marker of health care engagement.

In analyses using multivariable logistic regression models, researchers estimated the odds ratio (OR) for a new cardiometabolic diagnosis vs a new benchmark diagnosis occurring 90 days after vs 90 days before infection. Adjustments were made for age, sex, timing of infection, and COVID-19 vaccination status. Timing of infection was identified as either before or after the emergence of the Omicron variant.


The final cohort numbered 23 709. Half (54%) were women, and the mean age was 47.4 years.

In the 90 days post COVID-19 infection, rates of new onset cardiometabolic disease and benchmark diagnoses both were higher than before infection, according to the published results.

Specifically Cheng and colleagues report the highest odds postinfection were observed for new-onset diabetes (2.35, 95% CI 1.94-2.89; P <.001), followed by hypertension (1.54, 95% CI, 1.35-1.76; P <.001), benchmark diagnoses (1.42, 95% CI 1.25-1.61; P <.001), and hyperlipidemia (1.22, 95% CI, 1.03-1.47]; P=.03).

In multivariable-adjusted models, when compared to the risk observed for new benchmark diagnoses after and before COVID-19 infection, the risk of new-onset T2D was significantly elevated (OR, 1.58, 95% CI, 1.24-2.02; <.001). There was no increase in risk observed for either new-onset hypertension and hyperlipidemia relative to benchmark diagnoses.

Vaccination status did make a difference, the team found, with risk for new onset T2D after infection higher among unvaccinated patients (OR, 1.78, 95% CI, 1.35-2.37; P <.001) than vaccinated (OR 1.07, 95% CI, 0.64-1.77; P=.80). The interaction between vaccination status and diabetes diagnosis, however, did not reach statistical significance (OR, 0.59, 95% CI, 0.34-1.06; P=.08). Further analyses found no evidence of interaction by age, sex, or preexisting cardiovascular risk factors nor were any associations observed in any model between increased risk of new cardiometabolic diagnoses before or after COVID-19 diagnosis and age, sex, and timing of infection.

“Our results verify that the risk of developing Type 2 diabetes after a COVID-19 infection was not just an early observation but, in fact, a real risk that has, unfortunately, persisted through the Omicron era,” added lead investigator Alan Kwan, MD, a cardiovascular physician in the Smidt Heart Institute at Cedars-Sinai.

Reference: Kwan AC, Ebinger JE, Botting P, et al. Association of COVID-19 Vaccination With Risk for Incident Diabetes After COVID-19 InfectionJAMA Netw Open. 2023;6:e2255965. doi:10.1001/jamanetworkopen.2022.55965

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