New-Onset Diabetes and COVID-19: Evidence from a Global Clinical Registry (preprint)

Background Mounting evidence shows association between COVID-19 and new diagnoses of diabetes. It is unclear, however, if COVID-19 increases detection of pre-existing diabetes or if it can induce new-onset of the disease. Methods We established a global online registry of COVID-19-related diabetes (CoviDIAB) using a web-enabled data capture system (Dendrite Clinical Systems). In this study we aimed to investigate whether COVID-19 can induce new-onset diabetes, its subtypes and clinical manifestations. To this end, we analyzed clinical and laboratory data from cases of newly-diagnosed diabetes occurring during or within four weeks from an episode of COVID-19. To exclude pre-existing hyperglycaemia, new-onset diabetes was defined as: blood sugar levels above diabetes thresholds (fasting glycaemia ≥ 126 mg/dL or non-fasting glycemia > 200 mg/dL), no prior history of the disease or use of glucose-lowering medications, and HbA1c < 6·5% at presentation. Results Between October 2020 and April 2022, 67 contributors from 61 hospitals in 25 countries entered data on 537 eligible cases of newly-diagnosed diabetes. New-onset diabetes was identified in 102 of 473 newly-diagnosed cases with recorded HbA1c (22%). Among adults, diabetes subtypes were type 2 (59%) and “not-yet known” (41%). There were two cases of new-onset type 1 diabetes among children. Hyperglycaemia persisted beyond resolution of the infection in 39 of 89 (45%) patients with new-onset diabetes who survived the episode of COVID-19. Further follow-up data beyond 3-months was available for 28 such cases, showing remission of diabetes in five and persistent diabetes in 23 cases (82%). Conclusions This study shows clinical plausibility for a diabetogenic effect of COVID-19, supporting screening for diabetes in people who contract the infection. Further investigation is warranted to confirm mechanisms of viral interference with glucose metabolism. The CoviDIAB registry is accessible online at http://covidiab.e-dendrite.com.

COVID-19, Type-2 Diabetes, and Associated Health Outcomes in China: Results from a Nationwide Survey of 10,545 Adults (preprint)

ObjectiveThis study examined the associations between type-2 diabetes (T2DM) and self-reported/familial COVID-19 infection and investigated health-related outcomes among those with diabetes during Chinas nationwide quarantine. MethodsThe 2020 China COVID-19 Survey was administered anonymously via social media (WeChat) across China. It was completed by 10,545 adults in all of mainland Chinas 31 provinces. The survey consisted of 74 items covering sociodemographic characteristics, preventive measures for COVID-19, lifestyle behaviors, and health-related outcomes during the period of quarantine. Regression models examined associations among study variables, adjusting for covariates. ResultsDiabetes was associated with a six-fold increased risk of reporting COVID-19 infection among respondents or their family members. Among patients with diabetes, individuals who rarely wore masks had double the risk of suspected COVID-19 infection compared with those who always wore masks, with an inverse J-shaped relationship between face mask wearing and suspected COVID-19 infection. People with T2DM tended to have both poor knowledge of COVID-19 and poor compliance with preventive measures, despite perceiving a high risk of personal infection (40.0% among respondents reporting T2DM and 8.0% without T2DM). Only 54-55% of these respondents claimed to consistently practice preventive measures, including wearing face masks. Almost 60% of those with T2DM experienced food or medication shortages during the quarantine period, which was much higher than those without T2DM. Importantly, respondents who experienced medication shortages reported a 63% higher COVID-19 infection rate. ConclusionsT2DM was associated with an increased risk of self-reported personal and family member COVID-19 infection, which is mitigated by consistent use of face masks. FundingThe project is supported in part by research grants from the China Medical Board (Grant number: 16-262), the National Key Research and Development Program of China (Grant Number: 2017YFC0907200 & 2017YFC0907201), the University Alliance of the Silk Road (Grant number: 2020LMZX002), and Xian Jiaotong University Global Health Institute. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSDuring the COVID-19 pandemic, it has become increasingly clear that the risk factors for initial infection and subsequent poor health outcomes include, but are not limited to, social vulnerability, economic status, older age, and obesity. While community-wide masking has been recommended by the World Health Organization to control COVID-19, its overall effectiveness has not been clearly evaluated. Added value of this studyThrough an anonymous survey disseminated and promoted through WeChat, the largest social media platform in China, we sought to understand the impact of COVID-19 on the health, wellbeing, and health-related behaviors of adults in China. Specifically, this study examined how individuals with chronic diseases managed the threat, including their COVID-19 related knowledge, attitudes, and adherence to preventive measures such as wearing face masks, and their disease-related self-care. Implications of the available evidenceThis study demonstrates that type-2 diabetes mellitus is associated with an increased risk of COVID-19 infection, which is mitigated by consistent use of face masks.