Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 36380329 · doi:10.1186/s12916-022-02656-y
What was done
A systematic review and meta-analysis of cohort studies evaluated the risk of new-onset diabetes following COVID-19. Searches across PubMed, Embase, Web of Science, and Cochrane databases covered inception to June 10, 2022. Three evaluators independently extracted data and assessed risk of bias. Random-effects models estimated pooled incidence rates and relative risks (RR) comparing post-COVID-19 patients to non-COVID-19 controls.
What was found
Nine cohort studies with nearly 40 million participants were included. Overall post-COVID-19 diabetes incidence was 15.53 (95% CI: 7.91–25.64) per 1000 person-years, with an elevated relative risk of 1.62 (95% CI: 1.45–1.80) compared to non-COVID-19 controls. The RR was 1.48 (95% CI: 1.26–1.75) for type 1 diabetes and 1.70 (95% CI: 1.32–2.19) for type 2 diabetes. Risk was elevated across all ages (<18 years: RR 1.72 [1.19–2.49]; ≥18 years: RR 1.63 [1.26–2.11]; >65 years: RR 1.68 [1.22–2.30]) and sexes (males: RR 2.08 [1.27–3.40]; females: RR 1.99 [1.47–2.80]). Compared to upper respiratory tract infection controls, diabetes risk increased 1.17-fold (95% CI: 1.02–1.34). Severe COVID-19 patients had higher risk (RR 1.67 [1.25–2.23]), and the highest risk occurred in the first 3 months post-infection (RR 1.95 [1.85–2.06]).
Why it matters
This study provides large-scale evidence that COVID-19 infection is associated with an elevated risk of new-onset diabetes across age and sex groups, highlighting the need for metabolic surveillance during the initial 3 months of recovery.
Limits
The underlying evidence consists entirely of observational cohort studies, which are susceptible to detection bias from increased clinical encounters post-infection and unmeasured confounding. The abstract does not detail specific diagnostic criteria used across studies, the persistence of hyperglycemia over longer follow-up, or the modifying effect of vaccination.
Cited by
- supports COVID-19 infection has been shown to potentially trigger the onset of type 2 diabetes.