Mechanisms for Activation of Beige Adipose Tissue in Humans; Supplement

Abstract This proposal is a supplement to "Mechanisms for Activation of Beige Adipose Tissue in Humans", R01 DK124626 in response to NOT-DK-22-017. The supplement is titled: "Impact of COVID-19 on diabetes incidence and severity in the United States and Kentucky". There is mounting evidence that COVID-19 is associated with increased risk of incident diabetes. This supplement assembles a team of Endocrinologists, Pulmonary intensivists, Informaticians, Epidemiologists and Statisticians who will perform a detailed analysis of linked comprehensive data sets to identify key factors (and putative mechanisms) that relate COVID-19 infection to incident diabetes. In the proposed project, the team will explore the COVID and incident diabetes relationship among adults and children using three distinct data sources: 1) a large, nationwide database of commercially insured individuals (MarketScan), 2) Kentucky state Medicaid claims data, and 3) detailed clinical data from the University of Kentucky HealthCare (UKHC) electronic health record (EHR). Our overall hypothesis is that new onset diabetes is greater in subjects with the most severe COVID infections and in areas of Kentucky with the health disparities. To address these hypotheses, we propose the following Specific Aims, 1) to compare population-level trends in the incidence and severity of new onset diabetes during the COVID-19 pandemic (2020-2021) to historical data (2018-2019) in three distinct study populations, and 2) to examine the association between COVID infection and incident diabetes at the individual level using a matched, retrospective cohort design. We will also examine factors that modify this association, including severity of diabetes, diabetes type, sociodemographics (age, race/ethnicity, region), BMI, severity of COVID infection, vaccination status, timing of diabetes onset following COVID-19, and overall health from diagnosis codes, lab values, medications and clinical notes. In summary, this study will examine the relationship between COVID-19 and incident diabetes in very different populations, including rural Kentucky, which has high health disparities. In addition, we will examine the effects of prior vaccination, which may lessen the severity of disease and decrease diabetes incidence.