Risk of incident diabetes post-COVID-19: A systematic review and meta-analysis

Abstract

It remains undetermined whether burden of diabetes newly detected during acute COVID-19 persist in post-acute COVID phase. This meta-analysis was conducted to summarize the available literature and provide a pooled estimate of the risk of developing incident diabetes following hospital discharge or at least 28 days after the COVID-19 diagnosis compared to matched controls or severity matched influenza/ non-COVID-19 acute upper respiratory tract infections (AURI). Pooled analysis of 5787,027 subjects from four observational studies showed 59 % higher risk of developing incident diabetes in post-acute COVID-19 phase versus healthy controls (HR:1.59; 95 % CI:1.40-1.81, p < 0.001, I²=94 %, random-effects model). The high degree of heterogeneity in pooled estimate can be attributed to difference in demographic characteristics, hospitalization rates or disease severity between study subjects. Pooling data from three studies, higher risk of incident diabetes was also observed following COVID-19 versus severity matched non-COVID-19 respiratory tract infections (moderate-severe/hospitalized cases, HR 1.52; 95 % CI: 1.36-1.70, p < 0.01, I²=0 %, fixed-effects model; mild cases, HR 1.22; 95 % CI: 1.14-1.31, p < 0.001; I²=0 %, fixed-effects model). Majority of studies had median follow-up period of around 4 months. In view of several limitations due to retrospective design of these studies, prospective studies with long term follow-up are warranted.

Fig. 1

(1A) Forest plot depicting the risk of incident diabetes in post-COVID-19 subjects as compared to controls (HR 1.59; 95 % CI: 1.40–1.81, p < 0.001, I²=94 %, random-effects model). (1B) Forest plot depicting the risk of incident diabetes in moderate-to-severe post-COVID-19 subjects as compared to patients with moderate-to-severe/hospitalized influenza (HR 1.52; 95 % CI: 1.36–1.70, p < 0.01, I²=0 %, fixed-effects model). (1C) Forest plot depicting the risk of incident diabetes in mild post-COVID-19 subjects as compared to patients with mild flu or acute upper respiratory infection (HR 1.22; 95 % CI: 1.14–1.31, p < 0.001, I²=0 %, fixed-effects model).