Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis

Abstract

Background There is growing evidence that patients recovering after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have a variety of acute sequelae including newly diagnosed diabetes. However, the risk of diabetes in the post-acute phase is unclear. To solve this question, we aimed to determine if there was any association between status post-coronavirus disease (COVID-19) infection and a new diagnosis of diabetes. Methods We performed a systematic review and meta-analysis of cohort studies assessing new-onset diabetes after COVID-19. PubMed, Embase, Web of Science, and Cochrane databases were all searched from inception to June 10, 2022. Three evaluators independently extracted individual study data and assessed the risk of bias. Random-effects models estimated the pooled incidence and relative risk (RR) of diabetes compared to non-COVID-19 after COVID-19. Results Nine studies with nearly 40 million participants were included. Overall, the incidence of diabetes after COVID-19 was 15.53 (7.91–25.64) per 1000 person-years, and the relative risk of diabetes after COVID-19 infection was elevated (RR 1.62 [1.45–1.80]). The relative risk of type 1 diabetes was RR=1.48 (1.26–1.75) and type 2 diabetes was RR=1.70 (1.32–2.19), compared to non-COVID-19 patients. At all ages, there was a statistically significant positive association between infection with COVID-19 and the risk of diabetes: <18 years: RR=1.72 (1.19–2.49), ≥18 years: RR=1.63 (1.26–2.11), and >65 years: RR=1.68 (1.22–2.30). The relative risk of diabetes in different gender groups was about 2 (males: RR=2.08 [1.27–3.40]; females: RR=1.99 [1.47–2.80]). The risk of diabetes increased 1.17-fold (1.02–1.34) after COVID-19 infection compared to patients with general upper respiratory tract infections. Patients with severe COVID-19 were at higher risk (RR=1.67 [1.25–2.23]) of diabetes after COVID-19. The risk (RR=1.95 [1.85–2.06]) of diabetes was highest in the first 3 months after COVID-19. These results remained after taking confounding factors into account. Conclusions After COVID-19, patients of all ages and genders had an elevated incidence and relative risk for a new diagnosis of diabetes. Particular attention should be paid during the first 3 months of follow-up after COVID-19 for new-onset diabetes.

Association of COVID-19 Vaccination With Risk for Incident Diabetes After COVID-19 Infection

“…In this cohort study, COVID-19 infection was associated with increased risk of diabetes, consistent findings of a meta-analysis . Our results suggest that this risk persisted as the Omicron variant became predominant, and the association remained even after accounting for temporal confounders.…”

“…In early phases of the COVID-19 pandemic, persons who recovered from infection had increased risks for new-onset cardiometabolic diseases, including diabetes, hypertension, and hyperlipidemia. 1 , 2 , 3 In the current pandemic phase, which is dominated by less virulent Omicron variants, 4 it remains unclear whether risks of cardiometabolic disease after COVID-19 infection persist or have become attenuated and whether vaccination status is associated with these risks.…”

Incident autoimmune diseases in association with a SARS-CoV-2 infection: A matched cohort study

“…There is growing consensus regarding the relevance of long-term studies on this matter [23, 38]. Two recently conducted systematic reviews and meta-analyses for example show the association between diabetes mellitus and SARS-CoV-2 infection and conclude that the excess risk of type 1 diabetes is small but relevant from a public health perspective although the underlying mechanisms remain to be elucidated in order to prove a causal relationship [39, 40]. Results of the present study regarding the excess risk of newly diagnosed type 1 diabetes in relation to documented SARS-CoV-2 infection are in line with these previous findings.…”

SARS‐CoV‐2 infection alters the gut microbiome in diabetes patients: A cross‐sectional study from Bangladesh

“…4 Clinical research in many countries established that severe forms of COVID-19 are interconnected with obesity and type 2 diabetes mellitus (T2DM), irrespective of ethnicity. 4,5 Recently, a bidirectional relationship has been reported between COVID-19 and diabetes. 6 Several COVID-19 incidences were found with new onset of diabetes and severe metabolic complications of pre-existing diabetes, like diabetic ketoacidosis and hyperosmolar hyperglycemic state.…”