An observational study of 614,000 US patients suggests a higher risk of new-onset type 2 diabetes (T2D) after COVID-19 than after other respiratory infections in patients aged 10 to 19 years.
For the study, published today in JAMA Network Open, Case Western Reserve University researchers used electronic medical records to retrospectively analyze rates of incident T2D in 613,602 hospitalized or nonhospitalized pediatric patients 1, 3, and 6 months after infection with either SARS-CoV-2 or another respiratory pathogen from January 2020 to December 2022.
The median patient age was 14.9 years, 53% were girls, and 57% were White. Half of the patients had COVID-19, and half had another respiratory infection.
The risk of new-onset T2D was significantly higher from the day of infection to 1, 3, and 6 months after a COVID-19 diagnosis than other infections (risk ratio [RR],1.55, 1.48, and 1.58, respectively). Boys and girls were at similar risk.
The additional metabolic stress imposed by COVID-19 may have pushed frank disease in an already susceptible child.
Similar results were seen in patients who were overweight or obese (RR at 1, 3, and 6 months, 2.07, 2.00, and 2.27, respectively) and those who were hospitalized (RR, 3.10, 2.74, and 2.62, respectively). A comparable elevation in risk was found 3 and 6 months postinfection after excluding patients diagnosed from diagnosis to 1 month postinfection.
The researchers said several factors may be at play. "The additional metabolic stress imposed by COVID-19 may have pushed frank disease in an already susceptible child," the study authors wrote. "In addition, attention has focused recently on possible autoimmune components of T2D, and it has been reported that genetically susceptible children have increased development of anti-β cell antibodies following COVID-19."
SARS-CoV-2 may also be able to selectively infect human pancreatic β cells, and if this triggers programmed cell death, it may impair insulin secretion. "Though T2D is usually considered to be a disease of insulin resistance rather than insulin lack, for newly diagnosed patients, the origin may not be entirely clear or confined to a single pathobiologic cause," the researchers wrote.
While the excess risk for new-onset T2D after COVID-19 infection is modest overall (4.8 per 10,000 in the general population but 17.0 per 10,000 in overweight or obese children), the authors said it represents many patients at a high cost.
"The estimated cost of diabetes in the US in 2022 was $412.9 billion, with $306.6 billion in direct medical costs and $106.3 billion in indirect costs due to disability, absenteeism, and lost productivity," the investigators wrote. "Individuals with diabetes face annual mean medical expenses of $19,736 per year, about 2.6 times higher than those who do not have diabetes."
The costs are even higher when considering patients diagnosed as having T2D as children because they will face higher disease-related costs over a lifetime. "In addition, children may have a more severe T2D disease process than adults, and complications of T2D come even sooner in those who are diagnosed as children," the authors said. "Moreover, new drugs and interventions to control T2D such as weight control are more available."