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

• Published in: BMC medicine Vol. 20; no. 1; pp. 444 - 10
• Main Authors: Zhang, Ting, Mei, Qimin, Zhang, Zhaocai, Walline, Joseph Harold, Liu, Yecheng, Zhu, Huadong, Zhang, Shuyang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.11.2022; BioMed Central; BMC
• Subjects: Adult; Bias; Cohort analysis; Cohort Studies; Complications; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diagnosis; Female; Health risks; Humans; Infections; Male; Medical diagnosis; Meta-analysis; Mortality; Respiratory diseases; Respiratory tract; Respiratory tract diseases; Respiratory Tract Infections; Risk assessment; Risk factors; SARS-CoV-2; SARS-CoV-2 virus; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Systematic review; Unmeasured confounders; Viral diseases; Young Adult; China; COVID-19; Diabetes mellitus; SARS-CoV-2 virus; Unmeasured confounders
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-022-02656-y

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. 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. 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. 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.