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

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 center dot 30 (95% CI 4 center dot 06-4 center dot 55) in weeks 1-4 to 1 center dot 24 (1 center dot 14-1.35) in weeks 53-102. aHRs were higher in unvaccinated people (8 center dot 76 [7 center dot 49-10 center dot 25]) than in vaccinated people (1 center dot 66 [1 center dot 50-1 center dot 84]) in weeks 1-4 and in patients hospitalised with COVID-19 (pre-vaccination cohort 28 center dot 3 [26 center dot 2-30 center dot 5]) in weeks 1-4 declining to 2 center dot 04 [1 center dot 72-2 center dot 42] in weeks 53-102) than in those who were not hospitalised (1 center dot 95 [1 center dot 78-2 center dot 13] in weeks 1-4 declining to 1 center dot 11 [1 center dot 01-1 center dot 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. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.