Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study

PHOSP-COVID Collaborative Group; Freya Tyrer; Safoora  Gharibzadeh; Clare  Gillies; Claire Alexandra Lawson; Ash  Routen; Nazrul Islam; Cameron Razieh; Francesco Zaccardi; Tom Yates; Melanie J. Davies; Christopher E. Brightling; James Chalmers; Annemarie B Docherty; Omer Elneima; Rachael A. Evans; Neil J. Greening; Victoria C. Harris; Ewen M Harrison; Ling-Pei Ho; Alexander Horsley; Linzy Houchen-Wolloff; Olivia C. Leavy; Nazir I. Lone; Michael Marks; Hamish J. C. McAuley; Krisnah Poinasamy; Jennifer K. Quint; Betty Raman; Matthew Richardson; Ruth M. Saunders; Marco Sereno; Aarti Shikotra; Amisha Singapuri; Louise V. Wain; Kamlesh  Khunti

doi:10.1111/dom.16071

Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study

PHOSP-COVID Collaborative Group, Freya Tyrer (Lead / Corresponding author), Safoora Gharibzadeh, Clare Gillies, Claire Alexandra Lawson, Ash Routen, Nazrul Islam, Cameron Razieh, Francesco Zaccardi, Tom Yates, Melanie J. Davies, Christopher E. Brightling, James Chalmers, Annemarie B Docherty, Omer Elneima, Rachael A. Evans, Neil J. Greening, Victoria C. Harris, Ewen M Harrison, Ling-Pei HoAlexander Horsley, Linzy Houchen-Wolloff, Olivia C. Leavy, Nazir I. Lone, Michael Marks, Hamish J. C. McAuley, Krisnah Poinasamy, Jennifer K. Quint, Betty Raman, Matthew Richardson, Ruth M. Saunders, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Louise V. Wain, Kamlesh Khunti

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Abstract

Background
People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.

Methods
We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.

Results
Incidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.

Conclusion
Diabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.

Original language	English
Number of pages	10
Journal	Diabetes, Obesity and Metabolism
Early online date	20 Nov 2024
DOIs	https://doi.org/10.1111/dom.16071
Publication status	E-pub ahead of print - 20 Nov 2024

Keywords

cohort study,
population study
real-world evidence
type 1 diabetes
type 2 diabetes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/dom.16071Licence: CC BY

Final Published VersionFinal published version, 1 MBLicence: CC BY

PHOS-COVID (Joint with University of Leicester)
Chalmers, J. (Investigator) & Dicker, A. (Investigator)
Medical Research Council
1/04/21 → 31/03/26
Project: Research

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PHOSP-COVID Collaborative Group, Tyrer, F., Gharibzadeh, S., Gillies, C., Lawson, C. A., Routen, A., Islam, N., Razieh, C., Zaccardi, F., Yates, T., Davies, M. J., Brightling, C. E., Chalmers, J., Docherty, A. B., Elneima, O., Evans, R. A., Greening, N. J., Harris, V. C., Harrison, E. M., ... Khunti, K. (2024). Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study. Diabetes, Obesity and Metabolism. Advance online publication. https://doi.org/10.1111/dom.16071

@article{73815612a660424b962ca77992183573,

title = "Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study",

abstract = "BackgroundPeople hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.MethodsWe analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.ResultsIncidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.ConclusionDiabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.",

keywords = "cohort study,, population study, real-world evidence, type 1 diabetes, type 2 diabetes",

author = "{PHOSP-COVID Collaborative Group} and Freya Tyrer and Safoora Gharibzadeh and Clare Gillies and Lawson, {Claire Alexandra} and Ash Routen and Nazrul Islam and Cameron Razieh and Francesco Zaccardi and Tom Yates and Davies, {Melanie J.} and Brightling, {Christopher E.} and James Chalmers and Docherty, {Annemarie B} and Omer Elneima and Evans, {Rachael A.} and Greening, {Neil J.} and Harris, {Victoria C.} and Harrison, {Ewen M} and Ling-Pei Ho and Alexander Horsley and Linzy Houchen-Wolloff and Leavy, {Olivia C.} and Lone, {Nazir I.} and Michael Marks and McAuley, {Hamish J. C.} and Krisnah Poinasamy and Quint, {Jennifer K.} and Betty Raman and Matthew Richardson and Saunders, {Ruth M.} and Marco Sereno and Aarti Shikotra and Amisha Singapuri and Wain, {Louise V.} and Kamlesh Khunti and David Connell and J George and Janice Rowland",

note = "{\textcopyright} 2024 The Author(s).",

year = "2024",

month = nov,

day = "20",

doi = "10.1111/dom.16071",

language = "English",

journal = "Diabetes, Obesity and Metabolism",

issn = "1462-8902",

publisher = "Wiley",

}

PHOSP-COVID Collaborative Group, Tyrer, F, Gharibzadeh, S, Gillies, C, Lawson, CA, Routen, A, Islam, N, Razieh, C, Zaccardi, F, Yates, T, Davies, MJ, Brightling, CE, Chalmers, J, Docherty, AB, Elneima, O, Evans, RA, Greening, NJ, Harris, VC, Harrison, EM, Ho, L-P, Horsley, A, Houchen-Wolloff, L, Leavy, OC, Lone, NI, Marks, M, McAuley, HJC, Poinasamy, K, Quint, JK, Raman, B, Richardson, M, Saunders, RM, Sereno, M, Shikotra, A, Singapuri, A, Wain, LV & Khunti, K 2024, 'Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study', Diabetes, Obesity and Metabolism. https://doi.org/10.1111/dom.16071

TY - JOUR

T1 - Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom

T2 - A prospective observational study

AU - PHOSP-COVID Collaborative Group

AU - Tyrer, Freya

AU - Gharibzadeh, Safoora

AU - Gillies, Clare

AU - Lawson, Claire Alexandra

AU - Routen, Ash

AU - Islam, Nazrul

AU - Razieh, Cameron

AU - Zaccardi, Francesco

AU - Yates, Tom

AU - Davies, Melanie J.

AU - Brightling, Christopher E.

AU - Chalmers, James

AU - Docherty, Annemarie B

AU - Elneima, Omer

AU - Evans, Rachael A.

AU - Greening, Neil J.

AU - Harris, Victoria C.

AU - Harrison, Ewen M

AU - Ho, Ling-Pei

AU - Horsley, Alexander

AU - Houchen-Wolloff, Linzy

AU - Leavy, Olivia C.

AU - Lone, Nazir I.

AU - Marks, Michael

AU - McAuley, Hamish J. C.

AU - Poinasamy, Krisnah

AU - Quint, Jennifer K.

AU - Raman, Betty

AU - Richardson, Matthew

AU - Saunders, Ruth M.

AU - Sereno, Marco

AU - Shikotra, Aarti

AU - Singapuri, Amisha

AU - Wain, Louise V.

AU - Khunti, Kamlesh

AU - Connell, David

AU - George, J

AU - Rowland, Janice

PY - 2024/11/20

Y1 - 2024/11/20

N2 - BackgroundPeople hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.MethodsWe analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.ResultsIncidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.ConclusionDiabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.

AB - BackgroundPeople hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.MethodsWe analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.ResultsIncidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.ConclusionDiabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.

KW - cohort study,

KW - population study

KW - real-world evidence

KW - type 1 diabetes

KW - type 2 diabetes

U2 - 10.1111/dom.16071

DO - 10.1111/dom.16071

M3 - Article

C2 - 39563623

SN - 1462-8902

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

ER -

Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Projects

PHOS-COVID (Joint with University of Leicester)

Cite this