Impacts of COVID-19 on Glycemia and Risk of Diabetic Ketoacidosis

  1. Anukriti Sharma
  2. Anita D. Misra-Hebert
  3. Arshiya Mariam
  4. Alex Milinovich
  5. Anthony Onuzuruike
  6. Wilhemina Koomson
  7. Michael W. Kattan
  8. Kevin M. Pantalone
  9. Daniel M. Rotroff

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Abstract

Reports indicate that coronavirus disease 2019 (COVID-19) may impact pancreatic function and increase type 2 diabetes (T2D) risk, although real-world COVID-19 impacts on HbA1c and T2D are unknown. We tested whether COVID-19 increased HbA1c, risk of T2D, or diabetic ketoacidosis (DKA). We compared pre– and post–COVID-19 HbA1c and T2D risk in a large real-world clinical cohort of 8,755 COVID-19(+) patients and 11,998 COVID-19(−) matched control subjects. We investigated whether DKA risk was modified in COVID-19(+) patients with type 1 diabetes (T1D) (N = 701) or T2D (N = 21,830), or by race and sex. We observed a statistically significant, albeit clinically insignificant, HbA1c increase post–COVID-19 (all patients ΔHbA1c = 0.06%; with T2D ΔHbA1c = 0.1%) and no increase among COVID-19(−) patients. COVID-19(+) patients were 40% more likely to be diagnosed with T2D compared with COVID-19(−) patients and 28% more likely for the same HbA1c change as COVID-19(−) patients, indicating that COVID-19–attributed T2D risk may be due to increased recognition during COVID-19 management. DKA in COVID-19(+) patients with T1D was not increased. COVID-19(+) Black patients with T2D displayed disproportionately increased DKA risk (hazard ratio 2.46 [95% CI 1.48–6.09], P = 0.004) compared with White patients, suggesting a need for further clinical awareness and investigation.

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  1. Version published to 10.2337/db22-0264
  2. Version published to 10.2337/figshare.21038467
  3. Version published to 10.2337/figshare.21038467.v1
  4. ScreenIT

    SciScore for 10.1101/2022.03.08.22272041: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study improves upon limitations of previous studies by (1) utilizing a large cohort of 8,755 COVID-19(+) patients, (2) investigating pre- and post-infection HbA1c levels with respect to T2D status, and (3) including a large, matched cohort of 11,998 COVID-19(-) patients for comparison. Our findings indicate that there is an approximate 0.1% increase post-infection HbA1c among patients with and without T2D, which is statistically significant but clinically insignificant (Figure 1a). Although COVID-19(+) patients were 40% more likely to be diagnosed with T2D compared to COVID-19(-) patients (P<.001), we also found that COVID-19(+) patients were 274% more likely to get diagnosed with T2D for the same pre-COVID-19 test HbA1c and 28% more likely for the same increase in HbA1c after their COVID-19 test (Figure 1c) (P<.001). A possible explanation for this is that COVID-19(+) patients are receiving more intensive care that results in better identification of patients that have underlying T2D. Interestingly, among patients with pre-existing T2D, we observed a 35% increased risk of developing DKA in COVID-19(+) patients compared to COVID-19(-) patients (P=.002). Importantly, this observation seems to be driven in part by patients that were on insulin at the time of their COVID-19 diagnosis (HR=1.34, P=.02), whereas the increase in DKA in patients with T2D that were not on insulin failed to reach significance (HR:1.30, P=.29 ) (Figure 4). Notably, COVID-19 infection did not increa...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  5. Version published to 10.1101/2022.03.08.22272041v1 on medRxiv