Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; an ssRNA virus), which mainly affects the respiratory system but can also cause damage to other body systems. Acute respiratory distress syndrome (ARDS) is a serious complication of COVID-19 that requires early recognition and comprehensive management. ARDS is a diffuse inflammatory process that causes diffuse alveolar damage in the lung.Aim: The study aimed to assess the effect of uncomplicated diabetes mellitus on ARDS among COVID-19 patients in the Aseer region.Methodology: A retrospective cohort study was conducted in Aseer Central Hospital between July 10, 2021 to Jan 15, 2022 where confirmed inpatient COVID-19 cases in the Aseer region were classified into two groups. The first group was diabetic patients without any diabetes-related complications and confirmed for COVID-19 infection (diabetes group). The second group was confirmed COVID-19 patients free from any chronic disease. Extracted data included patients' diabetes status, medical history, socio-demographic data, COVID-19 infection data and vaccination, experienced signs and symptoms, tachypnea, use of accessory muscles of respiration, nasal flaring, grunting, cyanosis, need for hospitalization, need for mechanical ventilation and ICU admission.Results: The study included 144 patients with uncomplicated diabetes and 323 healthy patients with COVID-19 infection. The mean age of the diabetic group was 65.4 ± 12.9 years old compared to 40.2 ± 11.9 years old for the healthy group. Only one case of the diabetic group was vaccinated against COVID-19 at the study period versus two cases of the healthy group (P=.925). Also, 14 (9.7%) of the diabetic group were contacted with confirmed COVID-19 cases in comparison to 44 (13.6%) healthy cases (P=.238). A total of five (3.5%) diabetic cases needed mechanical ventilation during hospitalization compared to 23 (7.1%) healthy cases with no statistical significance (P=.125). Also, 12 (8.3%) diabetic cases admitted to ICU versus 42 (13%) of healthy cases (P=.145).Conclusions: In conclusion, there is a great controversy regarding the effect of diabetes on the progression of COVID-19 infection to ARDS. The current study showed that there was no significant difference between diabetic and healthy COVID-19 infected cases regarding ARDS related clinical factors mainly need of ICU admission and mechanical ventilation.