Long-term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes:   Two cohorts in the UK and Hong Kong

Eric Yuk Fai Wan; Sukriti Mathur; Ran Zhang; Athene Hoi Ying Lam; Boyuan Wang; Vincent Ka Chun Yan; Celine Sze Ling Chui; Xue Li; Carlos King Ho Wong; Francisco Tsz Tsun Lai; Ching Lung Cheung; Esther Wai Yin Chan; Kathryn Choon Beng Tan; Ian Chi Kei Wong

doi:10.1111/dom.15279

Long-term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes: Two cohorts in the UK and Hong Kong

Eric Yuk Fai Wan, Sukriti Mathur, Ran Zhang, Athene Hoi Ying Lam, Boyuan Wang, Vincent Ka Chun Yan, Celine Sze Ling Chui, Xue Li, Carlos King Ho Wong, Francisco Tsz Tsun Lai, Ching Lung Cheung, Esther Wai Yin Chan, Kathryn Choon Beng Tan, Ian Chi Kei Wong

Research output: Contribution to journal › Article › peer-review

Abstract

AIM: To evaluate the long-term associations between coronavirus disease 2019 (COVID-19) and diabetes complications and mortality, in patients with diabetes.

MATERIALS AND METHODS: People with diabetes diagnosed with COVID-19 infection (exposed group), from 16 March 2020 to 31 May 2021 from the UK Biobank (UKB cohort; n = 2456), and from 1 April 2020 to 31 May 2022 from the electronic health records in Hong Kong (HK cohort; n = 80 546), were recruited. Each patient was randomly matched with participants with diabetes but without COVID-19 (unexposed group), based on age and sex (UKB, n = 41 801; HK, n = 391 849). Patients were followed for up to 18 months until 31 August 2021 for UKB, and up to 28 months until 15 August 2022 for HK. Characteristics between cohorts were further adjusted with Inverse Probability Treatment Weighting. Long-term association of COVID-19 with multi-organ disease complications and all-cause mortality after 21 days of diagnosis was evaluated by Cox regression.

RESULTS: Compared with uninfected participants, patients with COVID-19 infection with diabetes were consistently associated with higher risks of cardiovascular diseases (coronary heart disease [CHD]: hazard ratio [HR] [UKB]: 1.6 [95% confidence interval {CI}: 1.0, 2.4], HR [HK]: 1.2 [95% CI: 1.0, 1.5]; and stroke: HR [UKB]: 2.0 [95% CI: 1.1, 3.6], HR [HK]: 1.5 [95% CI: 1.3, 1.8]), microvascular disease (end stage renal disease: HR [UKB]: 2.1 [95% CI: 1.1, 4.0], HR [HK]: 1.2 [95% CI: 1.1, 1.4]) and all-cause mortality (HR [UKB]: 4.6 [95% CI: 3.8, 5.5], HR [HK]: 2.6 [95% CI: 2.5, 2.8]), in both cohorts.

CONCLUSIONS: COVID-19 infection is associated with long-term increased risks of diabetes complications (especially cardiovascular complications, and mortality) in people with diabetes. Monitoring for signs/symptoms of developing these long-term complications post-COVID-19 infection in the infected patient population of people with diabetes may be beneficial in minimizing their morbidity and mortality.

Original language	English
Pages (from-to)	3807-3816
Number of pages	10
Journal	Diabetes, Obesity and Metabolism
Volume	25
Issue number	12
Early online date	21 Sept 2023
DOIs	https://doi.org/10.1111/dom.15279
Publication status	Published - 1 Dec 2023

Bibliographical note

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Keywords

Humans
COVID-19/complications
Hong Kong/epidemiology
Diabetes Complications/epidemiology
Proportional Hazards Models
United Kingdom/epidemiology
Diabetes Mellitus/epidemiology

Access to Document

10.1111/dom.15279Licence: CC BY-NC-ND 4.0

Long-term effects of coronavirus disease 2019 on diabetes
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
Final published version, 925 KBLicence: CC BY-NC-ND 4.0

Cite this

Wan, E. Y. F., Mathur, S., Zhang, R., Lam, A. H. Y., Wang, B., Yan, V. K. C., Chui, C. S. L., Li, X., Wong, C. K. H., Lai, F. T. T., Cheung, C. L., Chan, E. W. Y., Tan, K. C. B., & Wong, I. C. K. (2023). Long-term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes: Two cohorts in the UK and Hong Kong. Diabetes, Obesity and Metabolism, 25(12), 3807-3816. https://doi.org/10.1111/dom.15279

@article{03d6fe67c91a4d31bf8ee26bb526699b,

title = "Long-term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes: Two cohorts in the UK and Hong Kong",

abstract = "AIM: To evaluate the long-term associations between coronavirus disease 2019 (COVID-19) and diabetes complications and mortality, in patients with diabetes.MATERIALS AND METHODS: People with diabetes diagnosed with COVID-19 infection (exposed group), from 16 March 2020 to 31 May 2021 from the UK Biobank (UKB cohort; n = 2456), and from 1 April 2020 to 31 May 2022 from the electronic health records in Hong Kong (HK cohort; n = 80 546), were recruited. Each patient was randomly matched with participants with diabetes but without COVID-19 (unexposed group), based on age and sex (UKB, n = 41 801; HK, n = 391 849). Patients were followed for up to 18 months until 31 August 2021 for UKB, and up to 28 months until 15 August 2022 for HK. Characteristics between cohorts were further adjusted with Inverse Probability Treatment Weighting. Long-term association of COVID-19 with multi-organ disease complications and all-cause mortality after 21 days of diagnosis was evaluated by Cox regression.RESULTS: Compared with uninfected participants, patients with COVID-19 infection with diabetes were consistently associated with higher risks of cardiovascular diseases (coronary heart disease [CHD]: hazard ratio [HR] [UKB]: 1.6 [95% confidence interval {CI}: 1.0, 2.4], HR [HK]: 1.2 [95% CI: 1.0, 1.5]; and stroke: HR [UKB]: 2.0 [95% CI: 1.1, 3.6], HR [HK]: 1.5 [95% CI: 1.3, 1.8]), microvascular disease (end stage renal disease: HR [UKB]: 2.1 [95% CI: 1.1, 4.0], HR [HK]: 1.2 [95% CI: 1.1, 1.4]) and all-cause mortality (HR [UKB]: 4.6 [95% CI: 3.8, 5.5], HR [HK]: 2.6 [95% CI: 2.5, 2.8]), in both cohorts.CONCLUSIONS: COVID-19 infection is associated with long-term increased risks of diabetes complications (especially cardiovascular complications, and mortality) in people with diabetes. Monitoring for signs/symptoms of developing these long-term complications post-COVID-19 infection in the infected patient population of people with diabetes may be beneficial in minimizing their morbidity and mortality.",

keywords = "Humans, COVID-19/complications, Hong Kong/epidemiology, Diabetes Complications/epidemiology, Proportional Hazards Models, United Kingdom/epidemiology, Diabetes Mellitus/epidemiology",

author = "Wan, {Eric Yuk Fai} and Sukriti Mathur and Ran Zhang and Lam, {Athene Hoi Ying} and Boyuan Wang and Yan, {Vincent Ka Chun} and Chui, {Celine Sze Ling} and Xue Li and Wong, {Carlos King Ho} and Lai, {Francisco Tsz Tsun} and Cheung, {Ching Lung} and Chan, {Esther Wai Yin} and Tan, {Kathryn Choon Beng} and Wong, {Ian Chi Kei}",

note = "This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. {\textcopyright} 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.",

year = "2023",

month = dec,

day = "1",

doi = "10.1111/dom.15279",

language = "English",

volume = "25",

pages = "3807--3816",

journal = "Diabetes, Obesity and Metabolism",

issn = "1462-8902",

publisher = "Wiley-Blackwell",

number = "12",

}

Wan, EYF, Mathur, S, Zhang, R, Lam, AHY, Wang, B, Yan, VKC, Chui, CSL, Li, X, Wong, CKH, Lai, FTT, Cheung, CL, Chan, EWY, Tan, KCB & Wong, ICK 2023, 'Long-term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes: Two cohorts in the UK and Hong Kong', Diabetes, Obesity and Metabolism, vol. 25, no. 12, pp. 3807-3816. https://doi.org/10.1111/dom.15279

TY - JOUR

T1 - Long-term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes

T2 - Two cohorts in the UK and Hong Kong

AU - Wan, Eric Yuk Fai

AU - Mathur, Sukriti

AU - Zhang, Ran

AU - Lam, Athene Hoi Ying

AU - Wang, Boyuan

AU - Yan, Vincent Ka Chun

AU - Chui, Celine Sze Ling

AU - Li, Xue

AU - Wong, Carlos King Ho

AU - Lai, Francisco Tsz Tsun

AU - Cheung, Ching Lung

AU - Chan, Esther Wai Yin

AU - Tan, Kathryn Choon Beng

AU - Wong, Ian Chi Kei

N1 - This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

PY - 2023/12/1

Y1 - 2023/12/1

N2 - AIM: To evaluate the long-term associations between coronavirus disease 2019 (COVID-19) and diabetes complications and mortality, in patients with diabetes.MATERIALS AND METHODS: People with diabetes diagnosed with COVID-19 infection (exposed group), from 16 March 2020 to 31 May 2021 from the UK Biobank (UKB cohort; n = 2456), and from 1 April 2020 to 31 May 2022 from the electronic health records in Hong Kong (HK cohort; n = 80 546), were recruited. Each patient was randomly matched with participants with diabetes but without COVID-19 (unexposed group), based on age and sex (UKB, n = 41 801; HK, n = 391 849). Patients were followed for up to 18 months until 31 August 2021 for UKB, and up to 28 months until 15 August 2022 for HK. Characteristics between cohorts were further adjusted with Inverse Probability Treatment Weighting. Long-term association of COVID-19 with multi-organ disease complications and all-cause mortality after 21 days of diagnosis was evaluated by Cox regression.RESULTS: Compared with uninfected participants, patients with COVID-19 infection with diabetes were consistently associated with higher risks of cardiovascular diseases (coronary heart disease [CHD]: hazard ratio [HR] [UKB]: 1.6 [95% confidence interval {CI}: 1.0, 2.4], HR [HK]: 1.2 [95% CI: 1.0, 1.5]; and stroke: HR [UKB]: 2.0 [95% CI: 1.1, 3.6], HR [HK]: 1.5 [95% CI: 1.3, 1.8]), microvascular disease (end stage renal disease: HR [UKB]: 2.1 [95% CI: 1.1, 4.0], HR [HK]: 1.2 [95% CI: 1.1, 1.4]) and all-cause mortality (HR [UKB]: 4.6 [95% CI: 3.8, 5.5], HR [HK]: 2.6 [95% CI: 2.5, 2.8]), in both cohorts.CONCLUSIONS: COVID-19 infection is associated with long-term increased risks of diabetes complications (especially cardiovascular complications, and mortality) in people with diabetes. Monitoring for signs/symptoms of developing these long-term complications post-COVID-19 infection in the infected patient population of people with diabetes may be beneficial in minimizing their morbidity and mortality.

AB - AIM: To evaluate the long-term associations between coronavirus disease 2019 (COVID-19) and diabetes complications and mortality, in patients with diabetes.MATERIALS AND METHODS: People with diabetes diagnosed with COVID-19 infection (exposed group), from 16 March 2020 to 31 May 2021 from the UK Biobank (UKB cohort; n = 2456), and from 1 April 2020 to 31 May 2022 from the electronic health records in Hong Kong (HK cohort; n = 80 546), were recruited. Each patient was randomly matched with participants with diabetes but without COVID-19 (unexposed group), based on age and sex (UKB, n = 41 801; HK, n = 391 849). Patients were followed for up to 18 months until 31 August 2021 for UKB, and up to 28 months until 15 August 2022 for HK. Characteristics between cohorts were further adjusted with Inverse Probability Treatment Weighting. Long-term association of COVID-19 with multi-organ disease complications and all-cause mortality after 21 days of diagnosis was evaluated by Cox regression.RESULTS: Compared with uninfected participants, patients with COVID-19 infection with diabetes were consistently associated with higher risks of cardiovascular diseases (coronary heart disease [CHD]: hazard ratio [HR] [UKB]: 1.6 [95% confidence interval {CI}: 1.0, 2.4], HR [HK]: 1.2 [95% CI: 1.0, 1.5]; and stroke: HR [UKB]: 2.0 [95% CI: 1.1, 3.6], HR [HK]: 1.5 [95% CI: 1.3, 1.8]), microvascular disease (end stage renal disease: HR [UKB]: 2.1 [95% CI: 1.1, 4.0], HR [HK]: 1.2 [95% CI: 1.1, 1.4]) and all-cause mortality (HR [UKB]: 4.6 [95% CI: 3.8, 5.5], HR [HK]: 2.6 [95% CI: 2.5, 2.8]), in both cohorts.CONCLUSIONS: COVID-19 infection is associated with long-term increased risks of diabetes complications (especially cardiovascular complications, and mortality) in people with diabetes. Monitoring for signs/symptoms of developing these long-term complications post-COVID-19 infection in the infected patient population of people with diabetes may be beneficial in minimizing their morbidity and mortality.

KW - Humans

KW - COVID-19/complications

KW - Hong Kong/epidemiology

KW - Diabetes Complications/epidemiology

KW - Proportional Hazards Models

KW - United Kingdom/epidemiology

KW - Diabetes Mellitus/epidemiology

UR - https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.15279

U2 - 10.1111/dom.15279

DO - 10.1111/dom.15279

M3 - Article

C2 - 37735816

SN - 1462-8902

VL - 25

SP - 3807

EP - 3816

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

IS - 12

ER -