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Meta-Analysis
. 2022 Nov 15;20(1):444.
doi: 10.1186/s12916-022-02656-y.

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

Ting Zhang  1   2 , Qimin Mei  1 , Zhaocai Zhang  3 , Joseph Harold Walline  4 , Yecheng Liu  5 , Huadong Zhu  6 , Shuyang Zhang  7
Affiliations
Meta-Analysis

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

Ting Zhang et al. BMC Med. .

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.

Keywords: COVID-19; Diabetes mellitus; SARS-CoV-2 virus; Unmeasured confounders.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of included studies. The number of articles which were identified, screened by abstract, screened by full text, and ultimately selected for inclusion is displayed. The numerical breakdown of the rationale for removal after the full-text review is also displayed
Fig. 2
Fig. 2
Forest plot of diabetes incidence among COVID-19 people. CI confidence interval
Fig. 3
Fig. 3
Forest plot comparing COVID-19 and non-COVID-19 for the outcome of diabetes. RR risk ratio, CI confidence interval
Fig. 4
Fig. 4
Sunset power-enhanced funnel plot for included studies. Egger’s test: p = 0.104. Different colors represent different ranges of statistical power. All studies included in the meta-analysis had statistical power greater than 90%
Fig. 5
Fig. 5
Sensitivity analysis for unmeasured confounding. RR risk ratio. The figure shows the potential impact of unmeasured confounding on the reported association of after-COVID-19 with diabetes mellitus. Specifically, it shows the change in the proportion of individual studies that would report a “true” association, defined as relative risk >1.1, between after-COVID-19 and diabetes mellitus under different scenarios
See this image and copyright information in PMC

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