The associations between COVID-19 diagnosis, type 1 diabetes, and the risk of diabetic ketoacidosis: A nationwide cohort from the US using the Cerner Real-World Data

Abstract

Objective To assess the risk of new-onset type 1 diabetes mellitus (T1D) diagnosis following COVID-19 diagnosis and the impact of COVID-19 diagnosis on the risk of diabetic ketoacidosis (DKA) in patients with prior T1D diagnosis. Research design and methods Retrospective data consisting of 27,292,879 patients from the Cerner Real-World Data were used. Odds ratios, overall and stratified by demographic predictors, were calculated to assess associations between COVID-19 and T1D. Odds ratios from multivariable logistic regression models, adjusted for demographic and clinical predictors, were calculated to assess adjusted associations between COVID-19 and DKA. Multiple imputation with multivariate imputation by chained equations (MICE) was used to account for missing data. Results The odds of developing new-onset T1D significantly increased in patients with COVID-19 diagnosis (OR: 1.42, 95% CI: 1.38, 1.46) compared to those without COVID-19. Risk varied by demographic groups, with the largest risk among pediatric patients ages 0–1 years (OR: 6.84, 95% CI: 2.75, 17.02) American Indian/Alaskan Natives (OR: 2.30, 95% CI: 1.86, 2.82), Asian or Pacific Islanders (OR: 2.01, 95% CI: 1.61, 2.53), older adult patients ages 51–65 years (OR: 1.77, 95% CI: 1.66, 1.88), those living in the Northeast (OR: 1.71, 95% CI: 1.61, 1.81), those living in the West (OR: 1.65, 95% CI: 1.56, 1.74), and Black patients (OR: 1.59, 95% CI: 1.47, 1.71). Among patients with diagnosed T1D at baseline (n = 55,359), 26.7% (n = 14,759) were diagnosed with COVID-19 over the study period. The odds of developing DKA for those with COVID-19 were significantly higher (OR 2.26, 95% CI: 2.04, 2.50) than those without COVID-19, and the largest risk was among patients with higher Elixhauser Comorbidity Index. Conclusions COVID-19 diagnosis is associated with significantly increased risk of new-onset T1D, and American Indian/Alaskan Native, Asian/Pacific Islander, and Black populations are disproportionately at risk. In patients with pre-existing T1D, the risk of developing DKA is significantly increased following COVID-19 diagnosis.

COVID-19-related health outcomes in people with primary immunodeficiency: A systematic review

“…Whether COVID-19 could trigger auto-immunity in predisposed people remains unknown [ 57 ]. For example, a recent study showed an association between COVID-19 infection and development of type 1 diabetes, with a higher risk in younger (age 0–1) and older (51–65) people [ 89 ]. Whether this risk is higher in people with pro-inflammatory PI remains unknown.…”

Risk of incident diabetes after COVID-19 infection: A systematic review and meta-analysis

“…We included Xie's cohort because it had a larger sample size, longer follow-up duration, and more adequate data. Additionally, 10 articles, including 11 cohorts, proved eligible [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , of which two articles were pre-printed [28] , [32] .

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“…Table 1 summarizes the characteristics of all the included cohorts. Seven of the 11 retrospective cohorts included populations from the United States [27] , [29] , [30] , [31] , [33] , [34] , three from Europe (England, Scotland, and Germany) [32] , [35] , [36] , and one from the global population [28] . Among all cohorts, >4.5 million participants with COVID-19 during the pandemic (after December 2019) and >42 million people without either COVID-19 or diabetes were included.…”

Type 1 diabetes incidence increased during the COVID ‐19 pandemic years 2020–2021 in Czechia: Results from a large population‐based pediatric register

“…Kamrath et al 8 cautiously suggests that the incidence of T1D followed the peak incidence of COVID‐19 by approximately 3 months, we however do not think this could be interpreted as causation; moreover, neither Kamrath et al 8 nor we have individual COVID‐19 data. Studies using electronic medical records and medical claims might bring more insight ‐ of the published works, some 10 , 12 but not all 11 observed a link between COVID‐19 and an increase in pediatric diabetes incidence.…”

“… 8 , 9 Recently, studies have been published that utilized big collections of electronic health records or medical claims, reporting conflicting results. 10 , 11 , 12 …”