Department of Bioinformatics, Harvard Medical School, Boston, MA.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
Diabetes Care. 2023 Dec 1;46(12):2193-2200. doi: 10.2337/dc23-0936.
Previous studies have indicated a bidirectional correlation between diabetes and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, no investigation has comprehensively explored the potential of coronavirus disease 2019 (COVID-19) vaccination to reduce the risk of new-onset diabetes in infected individuals.
In the first of 2 cohorts, we compared the risk of new-onset diabetes between individuals infected with SARS-CoV-2 and noninfected individuals (N = 1,562,606) using the TriNetX database to validate findings in prior literature. For the second cohort, we identified 83,829 vaccinated and 83,829 unvaccinated COVID-19 survivors from the same period. Diabetes, antihyperglycemic drug use, and a composite of both were defined as outcomes. We conducted Cox proportional hazard regression analysis for the estimation of hazard ratios (HRs) and 95% CIs. Kaplan-Meier analysis was conducted to calculate the incidence of new-onset diabetes. Subgroup analyses based on age (18-44, 45-64, ≥65 years), sex (female, male), race (White, Black or African American, Asian), and BMI categories (<19.9, 20-29, 30-39, ≥40), sensitivities analyses, and a dose-response analysis were conducted to validate the findings.
The initial cohort of patients infected with SARS-CoV-2 had a 65% increased risk (HR 1.65; 95% CI 1.62-1.68) of developing new-onset diabetes relative to noninfected individuals. In the second cohort, we observed that vaccinated patients had a 21% lower risk of developing new-onset diabetes in comparison with unvaccinated COVID-19 survivors (HR 0.79; 95% CI 0.73-0.86). Subgroup analyses by sex, age, race, and BMI yielded similar results. These findings were consistent in sensitivity analyses and cross-validation with an independent data set from TriNetX.
In conclusion, this study validates a 65% higher risk of new-onset diabetes in SARS-CoV-2-infected individuals compared to noninfected counterparts. Furthermore, COVID-19 survivors who received COVID-19 vaccinations experienced a reduced risk of new-onset diabetes, with a dose-dependent effect. Notably, the protective impact of COVID-19 vaccination is more pronounced among the Black/African American population than other ethnic groups. These findings emphasize the imperative of widespread vaccination to mitigate diabetes risk and the need for tailored strategies for diverse demographic groups to ensure equitable protection.
先前的研究表明，糖尿病与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染之间存在双向关联。然而，尚无研究全面探讨 2019 年冠状病毒病（COVID-19）疫苗接种降低感染个体新发糖尿病风险的潜力。
在第一个队列研究中，我们使用 TriNetX 数据库比较了 SARS-CoV-2 感染个体与未感染个体（N=1562606 人）新发糖尿病的风险，以验证先前文献中的发现。对于第二个队列研究，我们从同一时期确定了 83829 例接种疫苗和 83829 例未接种疫苗的 COVID-19 幸存者。糖尿病、抗高血糖药物使用以及两者的组合定义为结局。我们进行 Cox 比例风险回归分析估计风险比（HR）和 95%置信区间（CI）。Kaplan-Meier 分析用于计算新发糖尿病的发生率。进行了基于年龄（18-44、45-64、≥65 岁）、性别（女性、男性）、种族（白种人、黑种人或非裔美国人、亚洲人）和 BMI 类别（<19.9、20-29、30-39、≥40）的亚组分析、敏感性分析和剂量-反应分析，以验证发现。
感染 SARS-CoV-2 的患者最初队列新发糖尿病的风险增加了 65%（HR 1.65；95%CI 1.62-1.68），与未感染个体相比。在第二个队列中，我们观察到与未接种 COVID-19 疫苗的幸存者相比，接种疫苗的患者新发糖尿病的风险降低了 21%（HR 0.79；95%CI 0.73-0.86）。按性别、年龄、种族和 BMI 进行的亚组分析得出了相似的结果。这些发现与来自 TriNetX 的独立数据集的敏感性分析和交叉验证一致。
总之，本研究验证了与未感染对照相比，SARS-CoV-2 感染个体新发糖尿病的风险增加了 65%。此外，接种 COVID-19 疫苗的 COVID-19 幸存者新发糖尿病的风险降低，且存在剂量依赖性效应。值得注意的是，COVID-19 疫苗接种对黑种人/非裔美国人的保护作用强于其他族裔。这些发现强调了广泛接种疫苗以降低糖尿病风险的必要性，以及为确保不同人群的平等保护而制定针对不同人群的策略的必要性。
