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

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 HbA(1c) and T2D are unknown. We tested whether COVID-19 increased HbA(1c), risk of T2D, or diabetic ketoacidosis (DKA). We compared pre- and post-COVID-19 HbA(1c) 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, HbA(1c) increase post-COVID-19 (all patients Delta HbA(1c) = 0.06%; with T2D Delta HbA(1c) = 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 HbA(1c) 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.