Long-term Risk of Prediabetes and Type 2 Diabetes Following SARS-CoV-2 Infection: A Nationwide Cohort Study.

OBJECTIVE

To assess the long-term association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the incidence of prediabetes and type 2 diabetes over a 5-year period.

METHODS

We conducted a nationwide, population-based cohort study including adults who had a positive coronavirus disease 2019 (COVID-19) test (599 744) and adults with a negative COVID-19 test (4 485 145) between January 1, 2020, and December 31, 2020. Participants did not have a history of prior SARS-CoV-2 infection, diagnosis of prediabetes or type 2 diabetes, and were followed for 5 years. Propensity score matching was used to control confounding, and time-to-event analyses were performed using Kaplan-Meier analysis and Cox proportional hazards models.

RESULTS

Among 5 084 889 individuals followed for a median of 2.6 years, those with confirmed SARS-CoV-2 infection exhibited a significantly increased risk of developing prediabetes (hazard ratio [HR] 1.23; 95% confidence interval [CI], 1.21-1.25) and type 2 diabetes (HR 1.40; 95% CI, 1.37-1.43) compared to uninfected individuals. The risk was most pronounced within the first month following infection (prediabetes: HR 1.87; 95% CI, 1.75-1.98; type 2 diabetes: HR 1.87; 95% CI, 1.79-1.96) and, although attenuated, remained significantly elevated over the subsequent 5 years (prediabetes: HR 1.23; 95% CI, 1.20-1.27; type 2 diabetes: HR 1.48; 95% CI, 1.43-1.53).

CONCLUSIONS

SARS-CoV-2 infection is associated with a significantly increased risk of developing prediabetes and type 2 diabetes, with the highest incidence observed during the acute postinfection phase and persistent elevation in risk extending up to 5 years.