The study covered in this summary was published in medRxiv.org as a preprint and has not yet been peer reviewed.
Key Takeaways
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The incidence of diabetes mellitus (DM) remains elevated for up to 1 year following COVID-19.
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The incidence of cardiovascular disease (CVD) is increased for up to 3 months after COVID-19, mainly from pulmonary embolism, atrial arrhythmias, and venous thromboses.
Why This Matters
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Clinicians should advise patients recovering from COVID-19 to take measures to reduce their risk for incident DM and CVD events, including diet modification, weight management, and physical activity.
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Future research studies should attempt to characterize phenotypic characteristics and underlying mechanisms of COVID-19 that are associated with developing DM and CVD incidents to better identify the patients at greatest risk and to examine whether prophylactic measures can reduce these complications.
Study Design
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The study used data from the CPRD Aurum database, which contains longitudinal, routinely collected EHR data from UK primary care practices. Currently, more than 13 million UK residents (20% of the population) are active in this database.
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The study included data for all 516,895 patients with a “confirmed” or “suspected” diagnosis of COVID-19 included in the February 2021 release of data from CPRD Aurum. The researchers compiled a control group of 516,895 people from the dataset without COVID-19 who each individually matched an infected person. Follow-up was through October 2021.
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The study outcomes were first CVD and DM diagnoses. The researchers further subcategorized the CVD diagnoses as follows: myocardial infarction and ischemic heart disease; atrial arrhythmias, including atrial fibrillation and supraventricular tachycardia; heart failure; cardiomyopathy and myocarditis; pulmonary embolism; venous thrombosis; and stroke.
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The DM diagnosis included diagnoses for type 1 or type 2 diabetes mellitus and initiation of oral antidiabetic drugs or insulin. Two or more electronic medical records of A1c levels of 48 mmol/mol (6.5%) or greater also indicated diabetes.
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The study applied previously described phases of COVID-19 of “acute” for the first 4 weeks of infection, “post-acute” for the period of 5 weeks to 12 weeks, and “long” for the period of 13 weeks to 1 year.
Key Results
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After adjusting for baseline differences between COVID-19 patients and controls, new DM diagnoses significantly increased by 71% compared with controls during acute COVID-19 and remained significantly elevated during both the post-acute (by 17%) and chronic (by 21%) phases of infection relative to controls.
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New CVD events significantly increased relative to controls by sixfold during acute COVID-19 and by a significant 68% during the post-acute phase of infection. CVD events returned to baseline levels during the extended follow-up phase.
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Pulmonary embolism was the primary reason for increase in CVD events, but increases also occurred for atrial arrythmias, venous thrombosis, myocardial infarction, stroke, and heart failure.
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The estimated incidence rate ratios were adjusted for age, gender, ethnicity, smoking, body mass index, systolic blood pressure, and Charlson comorbidity index score.
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Patients diagnosed with COVID-19 had a slightly higher baseline risk of DM compared with controls.
Limitations
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A sensitivity analysis focused on those people with COVID-19 confirmed with a polymerase chain reaction (PCR) test, but PCR testing was associated with patient characteristics and hence reliance on PCR confirmation for participant selection might have led to bias.
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Comprehensive recording of all covariates was not available, and no values were available to gauge patient “deprivation.”
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The analysis did not account for the severity of COVID-19.
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Exposure to glucocorticoids might have been underestimated because data were not available on prescribing for secondary conditions.
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The observational nature of the study prevents causal inferences on whether the increased rates of new CVD and DM diagnoses result from COVID-19, whether undiagnosed CVD and DM were more prevalent among COVID-19 patients, or whether COVID-19 aggravated or altered the natural history of preexisting disease.
Disclosures
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The study received no commercial funding.
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None of the authors had disclosures.
This is a summary of a preprint research study, “Differential Impact of COVID-19 on Incidence of Diabetes Mellitus and Cardiovascular Diseases in Acute, Post-Acute and Long COVID-19: Population-Based Cohort Study in the United Kingdom,” written by authors based primarily at King’s College London on medRxiv provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on medRxiv.org.
Mitchel L. Zoler is a reporter with Medscape and MDedge based in the Philadelphia region. @mitchelzoler.
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