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Background <p>Postacute sequelae of SARS-CoV-2 infection (PASC), including persistent symptoms and acute and chronic diagnoses, have become a major research focus. Diabetes mellitus, beyond its established link to COVID-19 severity, is increasingly recognized as a potential long-term outcome. This study investigated the association between SARS-CoV-2 infection and incident diabetes using population-level health administrative data (HAD) from the Agency for Health Protection of Milan, where the epicenter of the pandemic in Italy took place.</p> Methods <p>This retrospective cohort study included adult residents without a history of diabetes who underwent SARS-CoV-2 testing between 1 March and 31 December 2020. Test-positive individuals were matched 1:1 to test-negative individuals based on sex, age, and testing week. The cohort was followed through 31 December 2021. The incidence of diabetes, identified using an HAD-based case-detection algorithm, was compared between the two groups, and in stratified analyses by sex and age, using weighted Cox models adjusted for chronic comorbidities, area-level deprivation, influenza and pneumococcal vaccinations. Weights were calculated via the inverse probability weighting approach. Effect estimates are presented as hazard ratios (HRs).</p> Results <p>Our final cohort included 248,176 residents (124,026 test-negative, 124,150 test-positive). Over a median follow-up time of 415 days, 739 positive (0.60%) and 657 negative (0.53%) individuals were newly identified with diabetes. The incidence among positive individuals was 572.82 per 100,000 person-years (CI 531.52–614.12), and that among negative individuals was 509.50 per 100,000 person-years (CI 470.54–548.46). The overall HR was 1.13 (CI 1.02–1.25). In stratified analyses, this effect was prominent in women aged 41–60 years (HR 1.31; CI 1.02–1.68).</p> Conclusions <p>This study provides population-based evidence supporting an association between SARS-CoV-2 infection and newly detected diabetes. These findings contribute to understanding the long-term health impact of COVID-19 and may inform public health strategies for PASC prevention and management.</p>

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Incident diabetes within the first two years after SARS-CoV-2 infection: a population-based retrospective cohort study of the Agency for Health Protection of Milan, Italy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月11日

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  • Cristina Mazzali,
  • Pietro Magnoni,
  • Maria Grazia Valsecchi,
  • Daria Vigani,
  • Claudio Lucifora,
  • Antonio Giampiero Russo,
  • Claudio Lucifora,
  • Daria Vigani,
  • Federico Franzoni,
  • Gabriele Letta,
  • Laura Antolini,
  • Giuseppe Lapadula,
  • Elena Tassistro,
  • Maria Grazia Valsecchi,
  • Stefano Denicolai,
  • Marica Grego,
  • Diala Kabbara,
  • Costanza Baldrighi,
  • Antonio Giampiero Russo,
  • Pietro Magnoni,
  • Cristina Mazzali,
  • Alberto Milanese,
  • Rossella Murtas,
  • Andrea Salvatori,
  • Deborah Testa,
  • Sara Tunesi,
  • Adele Zanfino,
  • Simona Dalle Carbonare,
  • Federica Manzoni,
  • Simona Migliazza,
  • Pietro Giovanni Perotti,
  • Linda Guarda,
  • Marco Villa,
  • Silvia Tillati,
  • Giacomo Crotti,
  • Giuseppe Sampietro,
  • Alberto Zucchi,
  • Anita Andreano,
  • Luca Cavalieri d’Oro,
  • Elisabetta Merlo,
  • Magda Rognoni,
  • Piersimone Fontana,
  • Giovanni Maifredi,
  • Ivan Cometti,
  • Anna Clara Fanetti,
  • Maria Letizia Gambino,
  • Monica Lanzoni,
  • Giuseppe Emanuele La Piana,
  • Anna Bussi,
  • Vincenzo Belcastro,
  • Stefano Rusconi,
  • Luigi Magnani,
  • Maurizio Morlotti,
  • Andrea Patroni,
  • Raffaele Bruno,
  • Elisabetta Pagani,
  • Paolo Sacchi,
  • Valentina Zuccaro

摘要

Background

Postacute sequelae of SARS-CoV-2 infection (PASC), including persistent symptoms and acute and chronic diagnoses, have become a major research focus. Diabetes mellitus, beyond its established link to COVID-19 severity, is increasingly recognized as a potential long-term outcome. This study investigated the association between SARS-CoV-2 infection and incident diabetes using population-level health administrative data (HAD) from the Agency for Health Protection of Milan, where the epicenter of the pandemic in Italy took place.

Methods

This retrospective cohort study included adult residents without a history of diabetes who underwent SARS-CoV-2 testing between 1 March and 31 December 2020. Test-positive individuals were matched 1:1 to test-negative individuals based on sex, age, and testing week. The cohort was followed through 31 December 2021. The incidence of diabetes, identified using an HAD-based case-detection algorithm, was compared between the two groups, and in stratified analyses by sex and age, using weighted Cox models adjusted for chronic comorbidities, area-level deprivation, influenza and pneumococcal vaccinations. Weights were calculated via the inverse probability weighting approach. Effect estimates are presented as hazard ratios (HRs).

Results

Our final cohort included 248,176 residents (124,026 test-negative, 124,150 test-positive). Over a median follow-up time of 415 days, 739 positive (0.60%) and 657 negative (0.53%) individuals were newly identified with diabetes. The incidence among positive individuals was 572.82 per 100,000 person-years (CI 531.52–614.12), and that among negative individuals was 509.50 per 100,000 person-years (CI 470.54–548.46). The overall HR was 1.13 (CI 1.02–1.25). In stratified analyses, this effect was prominent in women aged 41–60 years (HR 1.31; CI 1.02–1.68).

Conclusions

This study provides population-based evidence supporting an association between SARS-CoV-2 infection and newly detected diabetes. These findings contribute to understanding the long-term health impact of COVID-19 and may inform public health strategies for PASC prevention and management.