Patients with type 1 diabetes are at elevated risk of developing new hypertension, chronic kidney disease and diabetic ketoacidosis after COVID-19: Up to 40 months' follow-up

Shiv Mehrotra-Varma; Justin Y Lu; Montek Singh Boparai; Sonya Henry; Stephen H Wang; Tim Q Duong

doi:10.1111/dom.15900

Patients with type 1 diabetes are at elevated risk of developing new hypertension, chronic kidney disease and diabetic ketoacidosis after COVID-19: Up to 40 months' follow-up

Diabetes Obes Metab. 2024 Sep 2. doi: 10.1111/dom.15900. Online ahead of print.

Authors

Shiv Mehrotra-Varma¹, Justin Y Lu¹, Montek Singh Boparai¹, Sonya Henry¹, Stephen H Wang^{1

2}, Tim Q Duong¹

Affiliations

¹ Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Centre, New York City, New York, USA.
² Department of Surgery, Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, Massachusetts, USA.

PMID: 39223870
DOI: 10.1111/dom.15900

Abstract

Aim: The aim was to investigate whether COVID-19 increases new incidence of hypertension (HTN), chronic kidney disease (CKD) and diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) up to 40 months post-infection.

Materials and methods: Three groups of patients from the Montefiore Health System in the Bronx (1 March 2020 to 1 July 2023) were studied: T1D patients hospitalized for COVID-19 (H-COVID-19, n = 511), T1D patients with COVID-19 but not hospitalized for COVID-19 (NH-COVID-19, n = 306) and T1D patients without a positive COVID-19 test on record (non-COVID-19, n = 1547). COVID-19 patients were those with a positive polymerase-chain-reaction test on record, and non-COVID-19 patients were either tested negative or not tested on record. Cumulative incidences and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were computed with adjustment for competing risks.

Results: Compared to non-COVID-19 patients, both H-COVID-19 (unadjusted 19.72% vs. 3.14%, p < 0.001; aHR = 7.55 [3.33, 17.06], p < 0.001) and NH-COVID-19 (10.26% vs. 3.14%, p = 0.004; aHR = 5.08 [2.19, 11.78], p < 0.001) patients were more likely to develop new HTN. Compared to non-COVID-19 patients, both H-COVID-19 (11.41% vs. 1.14%, p < 0.001; aHR = 9.76 [4.248, 22.25], p < 0.001) and NH-COVID-19 (7.69% vs. 1.14%, p < 0.001; aHR = 6.54 [2.91, 14.67], p < 0.001) patients were more likely to develop new CKD. Compared to non-COVID-19 patients, both H-COVID-19 (4.09% vs. 1.06%, p < 0.001; aHR = 12.24 [4.09, 36.59], p < 0.001) and NH-COVID-19 (3.06% vs. 1.06%, p = 0.035; aHR = 12.94 [4.09, 40.89], p < 0.001) patients were more likely to develop new DKA at follow-up.

Conclusion: T1D patients with COVID-19 are at higher risk of developing new HTN, CKD and DKA compared to T1D patients without COVID-19.

Keywords: acute kidney injury; cytokine storm; diabetic ketoacidosis; high blood pressure; inflammation; long COVID; type 1 diabetes mellitus.