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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats: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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats: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\u2013614.12), and that among negative individuals was 509.50 per 100,000 person-years (CI 470.54\u2013548.46). The overall HR was 1.13 (CI 1.02\u20131.25). In stratified analyses, this effect was prominent in women aged 41\u201360 years (HR 1.31; CI 1.02\u20131.68).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-13467-4","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:23:34Z","timestamp":1778473414000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["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, 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It adhered to applicable legislation, the Guidelines for Ethics Committees in Italy by the Italian National Bioethics Committee (2014), and the Declaration of Helsinki. The protocol for the prospective component received approval from the relevant Ethics Committee (Comitato Etico Val Padana, ASST Cremona, Cremona, Italy; Study Code 83-2023-OSS_ALTRO-CR61). The retrospective component was conducted in accordance with the EU General Data Protection Regulation (Reg. EU 2016\/679, Articles 6(1)(e) and 9(2)(j)), the Italian Legislative Decree No. 196 of 30 June 2003, as amended by Legislative Decree No. 101 of 10 August 2018 (Personal Data Protection Code), and the Ethical Rules for Processing Personal Data for Statistical and Scientific Research Purposes adopted by the Italian Data Protection Authority on 5 June 2019. The legal basis for data processing was Article 6(1)(e) GDPR (public interest) and Article 9(2)(j) GDPR (scientific research). Consent to participate was not applicable, because analyses were based on data routinely collected by the Agency for Health Protection (\n                      Agenzia di Tutela della Salute\n                      , ATS) of Milan, a public body of the Regional Health Service of the Lombardy Region. Under Lombardy Regional Laws nos. 23\/2015 and 22\/2021, the institutional functions of the ATS include the evaluation of the health status of the population, the governance of individual care pathways within the regional social and health-care system, and the evaluation of services provided and patient outcomes among residents in the covered area. The study of the characteristics, determinants, and health outcomes of long Covid by the ATS is specifically grounded in the Deliberation of the Regional Government of Lombardy no. 3720\/2024. The data were accessed for research purposes on 18\u201323 October 2024. All datasets were anonymized and linked via a unique identifier before analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Owing to the nature of this study and data privacy constraints, patients and members of the public were not involved in the design, analysis, or interpretation of the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient and public involvement"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Claudio Lucifora\n                      3\n                      , Daria Vigani\n                      3,4\n                      , Federico Franzoni\n                      3\n                      , Gabriele Letta\n                      3\n                      , Laura Antolini\n                      2\n                      , Giuseppe Lapadula\n                      2\n                      , Elena Tassistro\n                      2\n                      , Maria Grazia Valsecchi\n                      2\n                      , Stefano Denicolai\n                      4\n                      , Marica Grego\n                      4\n                      , Diala Kabbara\n                      4\n                      , Costanza Baldrighi\n                      4\n                      , Antonio Giampiero Russo\n                      1\n                      , Pietro Magnoni\n                      1\n                      , Cristina Mazzali\n                      1\n                      , Alberto Milanese\n                      1\n                      , Rossella Murtas\n                      1\n                      , Andrea Salvatori\n                      1\n                      , Deborah Testa\n                      1\n                      , Sara Tunesi\n                      1\n                      , Adele Zanfino\n                      1\n                      , Simona Dalle Carbonare\n                      5\n                      , Federica Manzoni\n                      5\n                      , Simona Migliazza\n                      5\n                      , Pietro Giovanni Perotti\n                      5\n                      , Linda Guarda\n                      6\n                      , Marco Villa\n                      6\n                      , Silvia Tillati\n                      7\n                      , Giacomo Crotti\n                      7\n                      , Giuseppe Sampietro\n                      7\n                      , Alberto Zucchi\n                      7\n                      , Anita Andreano\n                      8\n                      , Luca Cavalieri d\u2019Oro\n                      8\n                      , Elisabetta Merlo\n                      8\n                      , Magda Rognoni\n                      8\n                      , Piersimone Fontana\n                      9\n                      , Giovanni Maifredi\n                      9\n                      , Ivan Cometti\n                      10\n                      , Anna Clara Fanetti\n                      10\n                      , Maria Letizia Gambino\n                      11\n                      , Monica Lanzoni\n                      11\n                      , Giuseppe Emanuele La Piana\n                      12\n                      , Anna Bussi\n                      13\n                      , Vincenzo Belcastro\n                      14\n                      , Stefano Rusconi\n                      15\n                      , Luigi Magnani\n                      16\n                      , Maurizio Morlotti\n                      17\n                      , Andrea Patroni\n                      17\n                      , Raffaele Bruno\n                      18\n                      , Elisabetta Pagani\n                      18\n                      , Paolo Sacchi\n                      18\n                      and Valentina Zuccaro\n                      18\n                      .\n                      1\n                      Epidemiology Unit, Agency for Health Protection Milan, Milan, Italy.\n                      2\n                      University of Milano-Bicocca, School of Medicine and Surgery and Bicocca Bioinformatics Biostatistics and Bioimaging Centre (B4), Milan, Italy.\n                      3\n                      Department of Economics and Finance, Catholic University of the Sacred Heart, Milan, Italy.\n                      4\n                      Department of Economics and Management, University of Pavia, Pavia, Italy.\n                      5\n                      Epidemiology Unit, Agency for Health Protection Pavia, Pavia, Italy.\n                      6\n                      Epidemiology Unit, Agency for Health Protection Val Padana, Cremona, Italy.\n                      7\n                      Epidemiology Unit, Agency for Health Protection Bergamo, Bergamo, Italy.\n                      8\n                      Epidemiology Unit, Agency for Health Protection Brianza, Monza, Italy.\n                      9\n                      Epidemiology Unit, Agency for Health Protection Brescia, Brescia, Italy.\n                      10\n                      Epidemiology Unit, Agency for Health Protection Montagna, Sondrio, Italy.\n                      11\n                      Epidemiology Unit, Agency for Health Protection Insubria, Varese, Italy.\n                      12\n                      Respiratory Rehabilitation Unit, ASST Crema \u2013 Ospedale Santa Marta Rivolta D\u2019Adda, Crema, Italy.\n                      13\n                      General Medicine Unit, ASST del Garda \u2013 Presidio Ospedaliero di Manerbio\/Leno.\n                      14\n                      Neurology Unit, ASST Lodi \u2013 Ospedale Maggiore di Lodi, Lodi, Italy.\n                      15\n                      Infectious Diseases Unit, ASST Ovest Milanese \u2013 Ospedale di Legnano, Legnano, Italy.\n                      16\n                      Internal Medicine Unit, ASST Pavia \u2013 Ospedale Civile di Voghera, Voghera, Italy.\n                      17\n                      ASST Valcamonica, Brescia, Italy.\n                      18\n                      Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"PASCNET (Post-Acute Sars-Cov-2 syndrome NETwork) study group composition"}}],"article-number":"1240"}}