Incident Diabetes Risk Increased in COVID-19 Survivors

Nurse is checking a covid patient’s drip needle at the ICU
Investigators conducted a cohort study to identify the risk of diabetes following the acute phase of COVID-19 infection.

Survivors of COVID-19 were found to have an increased risk and burden of incident diabetes and antihyperglycemic use after the first 30 days of SARS-CoV-2 infection, according to the results of a study published in The Lancet Diabetes & Endocrinology.

Investigators evaluated the postacute risk and burden of diabetes in patients with SARS-CoV-2 infection with use of data from the US Department of Veterans Affairs.

The analysis included 3 cohorts: 181,280 participants (mean age, 60.92 years; 88% men) who had a positive COVID-19 test from March 1, 2020, to September 30, 2021, and survived the first 30 days of COVID-19 (the COVID-19 group); a contemporary control group (n=4,118,441; mean age, 61.5 years; 89% men) of participants enrolled from March 1, 2020, to September 30, 2021; and a historical control group (n=4,286,911; mean age, 61.49 years; 89% men) of participants enrolled from March 1, 2018, to September 30, 2019. Participants in all 3 groups did not have diabetes, and the 2 control groups had no evidence of SARS-CoV-2 infection.

Postacute COVID-19 diabetes outcomes were examined from 30 days after participants tested positive to the end of follow-up. Median follow-up was 352 days for all 3 groups. Antihyperglycemic use was defined based on documentation of a prescription for diabetes medication for more than 30 days. A composite endpoint was also defined as the first occurrence of diabetes or antihyperglycemic use.

Compared with the contemporary control group, 30-day survivors of COVID-19 were found to have increased risk (hazard ratio [HR] 1.40; 95% CI, 1.36-1.44) and excess burden (13.46; 95% CI, 12.11-14.84 per 1000 individuals at 12 months) of incident diabetes, as well as increased risk (HR 1.85; 1.78-1.92) and excess burden (12.35; 11.36-13.38) of incident antihyperglycemic use.

The HR for the risk of the composite endpoint of incident diabetes or antihyperglycemic use was 1.46 (95% CI, 1.43-1.50), with an excess burden of 18.03 (16.59-19.51) per 1000 individuals at 12 months.

The risks and burdens of postacute incident diabetes, antihyperglycemic use, and the composite outcome increased based on the severity of the acute infection in the COVID-19 group compared with the contemporary control group.

COVID-19 was also found to be associated with increased risk of diabetes outcomes in comparisons with the overall historical control group and for all the subgroups examined, and the findings were consistent with analyses assessing the COVID-19 group vs the contemporary control group.

Study limitations include the population of mostly White men, which could limit generalizability of the results. Also, it is possible that some of the participants in the contemporary control group could have contracted COVID-19 and were not tested for it. Furthermore, it is possible that some study participants with undiagnosed diabetes were formally diagnosed having COVID-19.

“Diabetes should be considered as a facet of the multifaceted long COVID syndrome,” the researchers stated. “Postacute care strategies of people with COVID-19 should integrate screening and management of diabetes.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol. Published online March 21, 2022. doi:10.1016/S2213-8587(22)00044-4