COVID-19 infection and incident diabetes in American Indian and Alaska Native people: a retrospective cohort study

Background Evidence suggests an increased risk of new -onset diabetes following COVID-19 infection. American Indian/Alaska Native (AI/AN) people were disparately impacted by the COVID-19 pandemic and historically have had higher diabetes incidence than other racial/ethnic groups in the US. We measured the association between COVID-19 infection and incident diabetes in AI/AN people. Methods We conducted a retrospective cohort study using de -identi fi ed patient data from the Indian Health Service ' s (IHS) National Patient Information Reporting System. We estimated age -adjusted diabetes incidence rates, incidence rate ratios, and adjusted hazard ratios among three cohorts spanning pre -pandemic (1/1/2018 - 2/28/2020) and pandemic (3/1/2020 - 12/31/2021) timeframes: 1) pre -pandemic cohort (1,503,085 individuals); 2) no-COVID-19 pandemic cohort (1,344,339 individuals); and 3) COVID-19 cohort (176,483 individuals). Findings The COVID-19 cohort had an increased hazard of diabetes compared to the no-COVID-19 group (adjusted hazard ratio (aHR) = 1.56; 95% CI: 1.50 - 1.62) and the pre -pandemic group (aHR = 1.27; 95% CI: 1.22 - 1.32). The association between COVID-19 infection and new -onset diabetes was stronger in those with severe COVID-19 illness. A sensitivity analysis comparing the COVID-19 cohort to members of other cohorts that had acute upper respiratory infections showed an attenuated but higher risk of new -onset diabetes in those with COVID-19. Interpretation AI/AN people diagnosed with COVID-19 had an elevated risk of a new diabetes diagnosis when compared to the no-COVID-19 group and the pre -pandemic group. The increased diabetes risk in the COVID-19 group remained in a sensitivity analysis that limited the comparator groups to individuals with an AURI diagnosis. Health 2024;33: Published https://doi.org/10. 1016/j.lana.2024. 100727 Copyright (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).