Association of SARS-CoV-2 infection with incident diabetes among U.S. Veterans in a prospective longitudinal cohort

OBJECTIVE: To assess care-seeking patterns and incident diabetes risk following SARS-CoV-2 infection in a prospective longitudinal cohort. RESEARCH DESIGN AND METHODS: We used data from the Veterans Health Administration (VHA)-based, prospective longitudinal study Epidemiology, Immunology, and Clinical Characteristics of COVID-19 (EPIC3) and electronic health records from participants with and without a history of SARS-CoV-2 infection who were free from diabetes at baseline and enrolled between June 2020 and September 2022 (n = 1,212); participants were followed prospectively for a median of approximately 4 years. We fit Cox proportional hazard models to examine associations of prior SARS-CoV-2 infection with incident diabetes. Models were adjusted for age, sex, race, smoking status, BMI, education, and comorbidities, as well as number of laboratory test days in the year prior. RESULTS: Men comprised 79.4% of the cohort. Median age was 50.1 (SARS-CoV-2-positive) and 57.2 (SARS-CoV-2-negative) years. After accounting for time-varying SARS-CoV-2 infection status, compared to participants with a negative test, participants with a positive test had fewer days/year with clinic visits (18.2 vs. 25.4, p < 0.001), laboratory tests of any kind (3.1 vs. 4.3, p < 0.001), and glucose tests (1.8 vs. 2.8, p < 0.001) post-enrollment; however, the number of days/year on which they had HbA1c tests was not significantly different (0.7 vs. 0.7, p = 0.094); diabetes incidence was 16.1 and 21.2 per 1,000 person-years in SARS-CoV-2 positive and negative groups, respectively. SARS-CoV-2 was not associated with adjusted diabetes-free survival overall, in inpatients or in outpatients (adjusted HRs: 0.82 [95% CI, 0.51-1.35], 1.03 [0.27-3.96], and 0.79 [0.44-1.39], respectively). CONCLUSION: Although SARS-CoV-2-positive participants used healthcare less often than those without, HbA1c testing rates were similar. We did not replicate prior reports of higher diabetes risk after SARS-CoV-2, although small sample size may have reduced power to detect modest associations. NCT: NCT05764083.