In a cohort study published in Journal of the American Medical Association Network Open, researchers from Cedars-Sinai Health System in Los Angeles assessed a large adult patient population with one or more COVID-19 infections from March 2020 to June 2022.

The study’s objective was to identify the cardiometabolic diseases (hypertension, hyperlipidemia, and diabetes) newly reported before or after a patient’s first COVID-19 infection.

The researchers employed a self-controlled crossover design to approximate the odds of a new cardiometabolic diagnosis during the 90 days after versus 90 days before COVID-19 infection.

Moreover, the odds of new cardiometabolic diagnoses were compared with those of a new benchmark diagnosis (urinary tract infection and gastroesophageal reflux) to account for temporal confounders resulting from disruptions in healthcare use during the pandemic.

The study involved 23,709 patients with one or more COVID-19 infections treated within the Cedars-Sinai Health System from 2020 to 2022. The average patient age was 47.4 years, and 54% of participants were female.

The researchers discovered that in the 90 days after versus before COVID-19 infection, the rates of new-onset diabetes, hypertension, hyperlipidemia, and benchmark diagnoses were greater. The researchers also indicated that during the study period, the combined risk of type 2 diabetes mellitus (T2DM) post-COVID-19 exposure—accounting for both vaccinated and unvaccinated patients—was reported as 2.1%, with 70% occurring after COVID-19 infection versus 30% occurring before COVID-19 exposure. The risk of T2DM post-COVID-19 exposure for vaccinated patients was 1.0%, with 51% occurring after COVID-19 infection versus 49% occurring prior to COVID-19 exposure. The risk of T2DM after COVID-19 exposure for unvaccinated patients was reported as 2.7%, with 74% post-COVID-19 infection versus 26% prior to COVID-19 exposure.

The authors indicated that although the risk for diabetes after COVID-19 was greater among unvaccinated (OR, 1.78; 95% CI, 1.35-2.37; P <.001) than vaccinated (OR, 1.07; 95% CI, 0.64-1.77; P = .80) patients, the interaction term between vaccination status and diabetes diagnosis was not statistically significant (OR, 0.59; 95% CI, 0.34-1.06; P = .08).

The authors also indicated that their findings aligned with the conclusions of another meta-analysis, indicating that COVID-19 was correlated with an augmented risk of diabetes.

The authors concluded, “Our results suggest that this risk persisted as the Omicron variant became predominant, and the association remained even after accounting for temporal confounders. Diabetes risk after COVID-19 infection was higher in unvaccinated than in vaccinated patients, suggesting a benefit of vaccination. Mechanisms contributing to post-infection diabetes risk remain unclear, although persistent inflammation contributing to insulin resistance is a proposed pathway.”

The authors also revealed that additional studies are warranted to better understand the cardiometabolic sequelae of COVID-19 and whether COVID-19 vaccination mitigates the risk of cardiometabolic disease.

In a press release on the Cedars-Sinai website, Alan Kwan, lead author and cardiovascular physician at the Smidt Heart Institute at Cedars-Sinai, stated, “Our results validate early findings revealing a risk of developing type 2 diabetes after a COVID-19 infection and indicate that this risk has, unfortunately, persisted through the Omicron era.”

Dr. Kwan also noted, “This trend is concerning because most people in the United States will eventually experience a COVID-19 infection. This research study helps us understand—and better prepare for—the post-COVID-19 era of cardiovascular risk.”

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