归因于SARS-CoV-2感染的2型糖尿病全球负担。
完整摘要 · 中文译文
目的：我们旨在量化严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染与新发糖尿病风险之间的关联。我们还旨在估计归因于SARS-CoV-2感染的全球新发2型糖尿病（T2D）负担。方法：我们对通过PubMed、Embase、Web of Science和CENTRAL从建库至2026年1月29日检索到的队列研究进行了系统综述和荟萃分析。采用随机效应模型汇总SARS-CoV-2感染后新发T2D和1型糖尿病（T1D）的校正相对危险度（RR）。通过将汇总风险估计与全球疾病负担（GBD）2023年关于COVID-19患病率和T2D发病率的数据相结合，估计人群归因分数（PAF）和归因T2D病例数。结果：共纳入15项队列研究，涉及约4890万名参与者。SARS-CoV-2感染与新发T2D风险增加相关（13项研究；汇总RR，1.25 [95% CI，1.16-1.34]），尽管观察到显著异质性，且95%预测区间（PI）包含无效值（0.94-1.66）。在亚组分析中，该关联仅限于混合变异株研究（RR，1.29 [95% CI，1.23-1.36]；95% PI，1.09-1.54），而评估单一变异株（Delta或Omicron）的研究未显示超额风险（RR，1.00 [95% CI，0.97-1.03]）。与新发T1D的关联未达到常规统计学显著性（10项研究；汇总RR，1.13 [95% CI，0.99-1.30]）。全球范围内，2023年发生了2453万例新发T2D病例。归因于……的PAF 归因于COVID-19的T2D发病率为1.12%（95% CI 0.90, 1.35），对应于274,889例（95% CI 220,360, 331,698）归因于SARS-CoV-2感染的T2D新发病例。归因负担最大的地区为印度、美国和中国。 结论：SARS-CoV-2感染与合并T2D风险的轻度升高相关。该关联主要在混合变异株研究中观察到，其95% PI不包含无效值。然而，总体合并估计伴随显著的研间异质性，且其95% PI跨越无效值，提示该关联在不同人群和环境中存在不确定性。在人群层面，该超额风险转化为2023年全球估计275,000例归因于COVID-19的T2D新发病例，凸显了感染后持续代谢监测的必要性。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261307969，标识符CRD420261307969。
完整摘要 · 英文原文
OBJECTIVE: We aimed to quantify the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk of incident diabetes. We also aimed to estimate the global burden of incident type 2 diabetes (T2D) attributable to SARS-CoV-2 infection. METHODS: We conducted a systematic review and meta-analysis of cohort studies identified through PubMed, Embase, Web of Science and CENTRAL from inception to 29 January 2026. Adjusted relative risks (RRs) for incident T2D and type 1 diabetes (T1D) following SARS-CoV-2 infection were pooled using random-effects models. Population attributable fractions (PAFs) and attributable T2D cases were estimated by integrating pooled risk estimates with Global Burden of Disease (GBD) 2023 data on COVID-19 prevalence and T2D incidence. RESULTS: Fifteen cohort studies involving approximately 48.9 million participants were included. SARS-CoV-2 infection was associated with an increased risk of incident T2D (13 studies; pooled RR, 1.25 [95% CI, 1.16-1.34]), although substantial heterogeneity was observed and the 95% prediction interval (PI) included the null (0.94-1.66). In subgroup analysis, the association was confined to mixed-variant studies (RR, 1.29 [95% CI, 1.23-1.36]; 95% PI, 1.09-1.54), whereas studies evaluating a single variant (Delta or Omicron) showed no excess risk (RR, 1.00 [95% CI, 0.97-1.03]). The association with incident T1D did not reach conventional statistical significance (10 studies; pooled RR, 1.13 [95% CI, 0.99-1.30]). Globally, 24.53 million incident T2D cases occurred in 2023. The PAF attributable to COVID-19 of 1.12% (95% CI 0.90, 1.35), corresponding to 274,889 (95% CI 220,360, 331,698) incident T2D cases attributable to SARS-CoV-2 infection. The largest attributable burdens were observed in India, the USA, and China. CONCLUSIONS: SARS-CoV-2 infection was associated with a modest increase in pooled T2D risk. This association was primarily observed in mixed-variant studies, for which the 95% PI excluded the null. However, the overall pooled estimated was accompanied by substantial between-study heterogeneity, and its 95% PI crossing the null, indicating uncertainty in the association across populations and settings. At the population level, this excess risk translated into an estimated 275,000 incident T2D cases attributable to COVID-19 worldwide in 2023, highlighting the need for ongoing metabolic surveillance following infection. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261307969, identifier CRD420261307969.