The Effect of SARS-CoV-2 Infection on Incident Diabetes by Viral Variant: Findings from the National COVID Cohort Collaborative (N3C)

Objective: The COVID-19 pandemic has evolved over time by SARS-CoV-2 variant, disease severity, treatment and prevention. There is evidence of elevated risk of incident diabetes after COVID-19; our objective was to evaluate whether this association is consistent across time and with contemporary viral variants. Research Design and Methods: We conducted a retrospective cohort study using National COVID Cohort Collaborative data to evaluate incident diabetes risk among COVID positive adults compared to COVID negative patients or controls with acute respiratory illness (ARI). Cohorts were weighted on demographics, data site, and Charlson Comorbidity Index score. The primary outcome was the cumulative incidence ratio (CIR) of incident diabetes for each viral variant era. Results: Risk of incident diabetes one year after COVID-19 was increased for all viral variants compared to COVID negative (Ancestral CIR 1.16, 95% CI 1.12-1.21, Alpha CIR 1.14, 95% CI 1.11-1.17, Delta CIR 1.17, 95% CI 1.13-1.21 , Omicron CIR 1.13, 95% CI 1.10-1.17) and ARI controls (Ancestral CIR 1.17, 95% CI 1.11-1.22, Alpha CIR 1.14, 95% CI 1.09-1.19, Delta CIR 1.18, 95% CI 1.11-1.26, Omicron CIR 1.20, 95% CI 1.13-1.27). There was latency in the timing of incident diabetes risk with the Omicron variant; in contrast to other variants, the risk presented after 180 days. Conclusions: Incident diabetes risk after COVID-19 was similar across different SARS-CoV-2 variants. However, there was greater latency in diabetes onset in the Omicron variant era.