Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people
Kurt Taylor, Sophie V. Eastwood, Venexia Walker, Geneviève Cézard, Rochelle Knight, Marwa Al Arab, Yinghui Wei, Elsie Horne, Lucy Teece, Harriet Forbes, Alex J Walker, Louis Fisher, Jon Massey, Lisa Hopcroft, Tom Palmer, Jose Cuitun Coronado, Samantha Ip, Simon Davy, Iain Dillingham, Caroline E Morton, Felix Greaves, John Macleod, Ben Goldacre, Angela Wood, Nish Chaturvedi, Jonathan A C Sterne, Rachel Denholm, Marwa Al Arab, Fatima Almaghrabi, Colm Andrews, Ellena Badrick, Sarah Akhtar Baz, Chelsea Beckford, Samantha Berman, Tom Bolton, Charlotte Booth, Ruth C. E. Bowyer, Andy Boyd, Charis Bridger-Staatz, Sinéad Brophy, Archie Campbell, Kirsteen C Campbell, Alisia Carnemolla, JD Carpentieri, Geneviève Cézard, Nish Chaturvedi, Nathan J. Cheetham, Ruth Costello, Thomas E. Cowling, Matthew A. Crane, Jose Ignacio Cuitun Coronado, Helen J Curtis, Spiros Denaxas, Rachel Denholm, Giorgio Di Gessa, Richard Dobson, Ian Douglas, Katharine Evans, Chao Fang, Vanessa M. Ferreira, Lucy Finnigan, Louis Fisher, Robin Flaig, Amos Folarin, Harriet Forbes, Diane Foster, María Laura Fox, Maxim Freydin, Paz Garcia, Andy Gibson, Fiona Glen, Ben Goldacre, Ana Gonçalves Soares, Felix Greaves, Amelia Green, Mark Green, Michael J. Green, Gareth J Griffith, Lee Hamill Howes, Olivia KL Hamilton, Annie Herbet, Emily Herrett, Lisa Hopcroft, Elsie Horne, Bo Hou, Alun D. Hughes, William Hulme, Lizzie Huntley, Samantha Ip, Jacques Wels, Peter Jezzard, Louise Jones, Arun Kanagaratnam, Arun Karthikeyan Suseeladevi, Vittal Katikireddi, John Kellas, Jonathan Kennedy, Milla Kibble, Rochelle Knight, Anika Knueppel
Abstract
BACKGROUND: Some studies have shown that the incidence of type 2 diabetes increases after a diagnosis of COVID-19, although the evidence is not conclusive. However, the effects of the COVID-19 vaccine on this association, or the effect on other diabetes subtypes, are not clear. We aimed to investigate the association between COVID-19 and incidence of type 2, type 1, gestational and non-specific diabetes, and the effect of COVID- 19 vaccination, up to 52 weeks after diagnosis. METHODS: In this retrospective cohort study, we investigated the diagnoses of incident diabetes following COVID-19 diagnosis in England in a pre-vaccination, vaccinated, and unvaccinated cohort using linked electronic health records. People alive and aged between 18 years and 110 years, registered with a general practitioner for at least 6 months before baseline, and with available data for sex, region, and area deprivation were included. Those with a previous COVID-19 diagnosis were excluded. We estimated adjusted hazard ratios (aHRs) comparing diabetes incidence after COVID-19 diagnosis with diabetes incidence before or in the absence of COVID-19 up to 102 weeks after diagnosis. Results were stratified by COVID-19 severity (categorised as hospitalised or non-hospitalised) and diabetes type. FINDINGS: 16 669 943 people were included in the pre-vaccination cohort (Jan 1, 2020-Dec 14, 2021), 12 279 669 in the vaccinated cohort, and 3 076 953 in the unvaccinated cohort (both June 1-Dec 14, 2021). In the pre-vaccination cohort, aHRs for the incidence of type 2 diabetes after COVID-19 (compared with before or in the absence of diagnosis) declined from 4·30 (95% CI 4·06-4·55) in weeks 1-4 to 1·24 (1·14-1.35) in weeks 53-102. aHRs were higher in unvaccinated people (8·76 [7·49-10·25]) than in vaccinated people (1·66 [1·50-1·84]) in weeks 1-4 and in patients hospitalised with COVID-19 (pre-vaccination cohort 28·3 [26·2-30·5]) in weeks 1-4 declining to 2·04 [1·72-2·42] in weeks 53-102) than in those who were not hospitalised (1·95 [1·78-2·13] in weeks 1-4 declining to 1·11 [1·01-1·22] in weeks 53-102). Type 2 diabetes persisted for 4 months after COVID-19 in around 60% of those diagnosed. Patterns were similar for type 1 diabetes, although excess incidence did not persist beyond 1 year after a COVID-19 diagnosis. INTERPRETATION: Elevated incidence of type 2 diabetes after COVID-19 is greater, and persists for longer, in people who were hospitalised with COVID-19 than in those who were not, and is markedly less apparent in people who have been vaccinated against COVID-19. Testing for type 2 diabetes after severe COVID-19 and the promotion of vaccination are important tools in addressing this public health problem. FUNDING: UK National Institute for Health and Care Research, UK Research and Innovation (UKRI) Medical Research Council, UKRI Engineering and Physical Sciences Research Council, Health Data Research UK, Diabetes UK, British Heart Foundation, and the Stroke Association.