Some studies have shown that the incidence of type 2 diabetes increases after a diagnosis of COVID-19, although the evidence is not conclusive. However, the effects of the COVID-19 vaccine on this association, or the effect on other diabetes subtypes, are not clear. We aimed to investigate the association between COVID-19 and incidence of type 2, type 1, gestational and non-specific diabetes, and the effect of COVID- 19 vaccination, up to 52 weeks after diagnosis. In this retrospective cohort study, we investigated the diagnoses of incident diabetes following COVID-19 diagnosis in England in a pre-vaccination, vaccinated, and unvaccinated cohort using linked electronic health records. People alive and aged between 18 years and 110 years, registered with a general practitioner for at least 6 months before baseline, and with available data for sex, region, and area deprivation were included. Those with a previous COVID-19 diagnosis were excluded. We estimated adjusted hazard ratios (aHRs) comparing diabetes incidence after COVID-19 diagnosis with diabetes incidence before or in the absence of COVID-19 up to 102 weeks after diagnosis. Results were stratified by COVID-19 severity (categorised as hospitalised or non-hospitalised) and diabetes type. 16 669 943 people were included in the pre-vaccination cohort (Jan 1, 2020–Dec 14, 2021), 12 279 669 in the vaccinated cohort, and 3 076 953 in the unvaccinated cohort (both June 1–Dec 14, 2021). In the pre-vaccination cohort, aHRs for the incidence of type 2 diabetes after COVID-19 (compared with before or in the absence of diagnosis) declined from 4·30 (95% CI 4·06–4·55) in weeks 1–4 to 1·24 (1·14–1.35) in weeks 53–102. aHRs were higher in unvaccinated people (8·76 [7·49–10·25]) than in vaccinated people (1·66 [1·50–1·84]) in weeks 1–4 and in patients hospitalised with COVID-19 (pre-vaccination cohort 28·3 [26·2–30·5]) in weeks 1–4 declining to 2·04 [1·72–2·42] in weeks 53–102) than in those who were not hospitalised (1·95 [1·78–2·13] in weeks 1–4 declining to 1·11 [1·01–1·22] in weeks 53–102). Type 2 diabetes persisted for 4 months after COVID-19 in around 60% of those diagnosed. Patterns were similar for type 1 diabetes, although excess incidence did not persist beyond 1 year after a COVID-19 diagnosis. Elevated incidence of type 2 diabetes after COVID-19 is greater, and persists for longer, in people who were hospitalised with COVID-19 than in those who were not, and is markedly less apparent in people who have been vaccinated against COVID-19. Testing for type 2 diabetes after severe COVID-19 and the promotion of vaccination are important tools in addressing this public health problem. UK National Institute for Health and Care Research, UK Research and Innovation (UKRI) Medical Research Council, UKRI Engineering and Physical Sciences Research Council, Health Data Research UK, Diabetes UK, British Heart Foundation, and the Stroke Association.

中文翻译：

---

英格兰 SARS-CoV-2 感染后糖尿病的发病率和 COVID-19 疫苗接种的影响：一项对 1600 万人的回顾性队列研究


一些研究表明，诊断为 COVID-19 后，2 型糖尿病的发病率会增加，尽管证据尚无定论。然而，COVID-19 疫苗对这种关联的影响或对其他糖尿病亚型的影响尚不清楚。我们旨在调查 COVID-19 与 2 型、1 型、妊娠和非特异性糖尿病发病率之间的关联，以及诊断后 52 周内 COVID-19 疫苗接种的影响。在这项回顾性队列研究中，我们使用链接的电子健康记录调查了英格兰疫苗接种前、接种疫苗和未接种疫苗队列中 COVID-19 诊断后新发糖尿病的诊断。包括活着且年龄在 18 岁至 110 岁之间的人，在基线前向全科医生登记至少 6 个月，并提供有关性别、地区和地区剥夺的可用数据。那些以前被诊断为 COVID-19 的人被排除在外。我们估计了调整后的风险比 （aHRs），将 COVID-19 诊断后的糖尿病发病率与诊断后 102 周内 COVID-19 之前或没有 COVID-19 的糖尿病发病率进行比较。结果按 COVID-19 严重程度（分类为住院或非住院）和糖尿病类型进行分层。疫苗接种前队列（2020 年 1 月 1 日至 2021 年 12 月 14 日）包括 16 669 943 人，接种疫苗队列中有 12 279 669 人，未接种疫苗队列中有 3 076 953 人（均为 2021 年 6 月 1 日至 12 月 14 日）。在疫苗接种前队列中，COVID-19 后 2 型糖尿病发病率的 aHR（与诊断前或无诊断相比）从第 1-4 周的 4·30（95% CI 4·06-4·55）下降到第 53-102 周的 1·24（1·14-1.35）。 未接种疫苗者 （8·76 [7·49–10·25]）的 aHR 高于未接种疫苗者 （1·66 [1·50–1·84]）第 1-4 周，以及第 1-4 周的 COVID-19 住院患者（疫苗接种前队列 28·3 [26·2–30·5]），在第 53-102 周下降至 2·04 [1·72–2·42]），高于未住院的患者（第 1-4 周的 1·95 [1·78–2·13]，下降至1·11 [1·01–1·22] 在第 53-102 周）。大约 60% 的确诊患者在 COVID-4 后持续了 19 个月。1 型糖尿病的模式相似，尽管超额发病率在 COVID-19 诊断后不会持续超过 1 年。COVID-19 住院患者感染 COVID-19 后 2 型糖尿病的发病率升高，且持续时间更长，并且在接种 COVID-19 疫苗的人群中明显不那么明显。重症 COVID-19 后检测 2 型糖尿病和促进疫苗接种是解决这一公共卫生问题的重要工具。英国国家健康与护理研究所、英国研究与创新 （UKRI） 医学研究委员会、UKRI 工程和物理科学研究委员会、英国健康数据研究、英国糖尿病协会、英国心脏基金会和中风协会。