Environment and diabetes: Is there an association between the COVID-19 pandemic and phenotypic variation in diabetes?

Table 1 Data across age quartiles in men and women with diabetes, rate ratio in pandemic vs reference cohort (95% confidence interval)

	40-46 years	47-52 years	53-58 years	59-65 years
Men
2-year incidence (per 100000 men)	1.07 (1.01-1.14)	0.97 (0.93-1.02)	0.94 (0.93-1.00)	0.94 (0.90-0.96)
Hypertension	0.81 (0.68-0.94)	0.79 (0.71-0.87)	0.88 (0.83-0.93)	0.92 (0.88-0.96)
Cardiovascular disease	0.82 (0.57-1.07)	0.92 (0.77-1.06)	0.83 (0.73-0.92)	0.94 (0.87-1.01)
Hyperlipidemia	1.11 (0.74-1.47)	0.78 (0.53-1.02)	0.88 (0.69-1.06)	0.92 (0.78-1.06)
Cardiovascular risk factors	0.86 (0.75-0.97)	0.83 (0.76-0.89)	0.86 (0.82-0.91)	0.94 (0.91, 0.97)
ATC class C drugs	0.75 (0.64-0.85)	0.69 (0.47-0.78)	0.54 (0.47-0.61)	0.46 (0.39-0.53)
Mortality rate (1000 person-year)	1.08 (0.58-1.75)	0.89 (0.62-1.28)	1.15 (0.92-1.43)	1.04 (0.89-1.22)
Women
2-year incidence (per 100000 women)	1.00 (0.92-1.09)	0.98 (1.92-1.05)	0.97 (0.92-1.02)	0.94 (0.91-0.98)
Hypertension	0.72 (0.53-0.92)	0.84 (0.73-0.94)	0.86 (0.79-0.93)	0.93 (0.88-0.98)
Cardiovascular disease	1.02 (0.48-1.56)	0.88 (0.54-1.22)	0.93 (0.73-1.13)	0.92 (0.78-1.06)
Hyperlipidemia	1.05 (0.14-1.97)	1.24 (0.79;1.69)	1.14 (0.87-1.42)	0.88 (0.69-1.06)
Cardiovascular risk factors	0.76 (0.59-0.94)	0.87 (0.77-0.96)	0.88 (0.82-0.94)	0.93 (0.89-0.97)
ATC class C drugs	0.64 (0.47-0.82)	0.58 (0.46-0.70)	0.51 (0.41-0.60)	0.40 (0.32-0.49)
Mortality rate (1000 person-year)	0.54 (0.23-1.20)	1.08 (0.69-1.71)	0.92 (0.68-1.24)	1.01 (0.82-1.25)

ATC: Anatomical Therapeutic Chemical.

Table 2 Clinical features in men and women with exemption for diabetes, % (95% confidence interval)

	2018-2019	2020-2021	Size effect statistic	P value
Men	n = 18506	n = 18357
Hypertension	34.8 (33.7-36.0)	30.6 (29.4-31.8)	RR = 0.879 (0.849-0.908)	< 0.0001
Cardiovascular disease	14.6 (13.3-15.9)	13.1 (11.8-14.5)	RR = 0.897 (0.846-0.948)	< 0.001
Hyperlipidemia	4.39 (2.98-5.80)	3.90 (2.52-5.35)	RR = 0.894 (0.796-0.992)	< 0.05
Cardiovascular risk factors	45.5 (44.5-46.6)	40.7 (39.6-41.8)	RR = 0.893 (0.869-0.917)	< 0.0001
ATC class C drugs	32.3 (31.1-33.5)	18.1 (16.8: 19.4)	RR = 0.561 (0.524-0.599)	< 0.0001
DALYs, years (95%CI)	5.66 (5.61-5.71)	5.41 (5.36-5.45)	0.252 (0.184-0.320)	< 0.0001
Women	n = 10575	n = 10432
Hypertension	37.5 (36.0-39.0)	33.3 (31.7-34.9)	RR = 0.888 (0.851-0.925)	< 0.0001
Cardiovascular disease	6.26 (4.41-8.11)	5.79 (3.93-7.65)	RR = 0.925 (0.818-1.032)	0.15
Hyperlipidemia	3.52 (1.65-5.39)	3.42 (1.53-5.29)	RR = 0.970 (0.827-1.113)	0.67
Cardiovascular risk factors	42.4 (40.9-43.8)	38.1 (36.6-39.6)	RR = 0.899 (0.866-0.932)	< 0.0001
ATC class C drugs	31.9 (30.4-33.5)	15.4 (13.6-17.1)	RR = 0.481 (0.429-0.534)	< 0.0001
DALYs, years (95%CI)	6.46 (6.38-6.53)	6.32 (6.25-6.38)	0.138 (0.02-0.243)	< 0.05

ATC: Anatomical Therapeutic Chemical; DALYs: Disability-adjusted life years; RR: Rate ratio; CI: Confidence interval.