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Observational Study

Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study

Freya Tyrer et al. Diabetes Obes Metab. 2025 Feb.

Abstract

Background: People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.

Methods: We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.

Results: Incidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.

Conclusion: Diabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.

Keywords: cohort study; population study; real‐world evidence; type 1 diabetes; type 2 diabetes.

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Conflict of interest statement

MJD has acted as consultant, advisory board member and speaker for Boehringer Ingelheim, Eli Lilly, Novo Nordisk and Sanofi, an advisory board member Pfizer, AstraZeneca, Zealand Pharma, Carmot/Roche and Medtronic and as a speaker for AstraZeneca and Amgen. She has received grants from AstraZeneca, Novo Nordisk, Boehringer Ingelheim, Janssen and Sanofi‐Aventis and Eli Lilly. TY has received investigator initiated funding from AstraZeneca for obesity related research. RAE declares that their institute was awarded a grant from UKRI/NIHR to complete this work; the author declares speaker fees from Boehringer Ingelheim and unpaid roles with European Respiratory Society Assembly 01.02 Pulmonary Rehabilitation secretary and American Thoracic Society Pulmonary Rehabilitation Assembly programme committee. JDC declares grants from AstraZeneca, Boehringer Ingelheim, Insmed, Novartis, Gilead Sciences, and Genentech; and consulting fees from AstraZeneca, Boehringer Ingelheim, Insmed, Novartis, Gilead Sciences, Chiesi, Zambon, and Genentech. LH‐W declares a grant from NIHR unrelated to the submitted work; acting as independent chair of the NIHR HTA Committee for Colour COPD trial; and membership of the American Thoracic Society Pulmonary Rehabilitation Assembly Web and Planning Committees. CEB has received grants and consultancy fees from 4D Pharma, Areteia, AstraZeneca, Chiesi, Genentech, GlaxoSmithKline, Mologic, Novartis, Regeneron Pharmaceuticals, Roche and Sanofi. British Lung Foundation, and Boehringer Ingleheim. AH declares that their institute was awarded a grant from UK Research and Innovation (UKRI) and NIHR to complete this work, and from NIHR Manchester Clinical Research Facility to support study delivery and NIHR Manchester Biomedical Research Centre (BRC) for personal funding and institutional payments to support grant‐funded research from NIHR, UK Medical Research Council (MRC), Cystic Fibrosis Trust, Cystic Fibrosis Foundation, North West Lung Centre Charity, and Moulton Trust; the author declares payment from Vertex Pharmaceuticals for educational presentation, participation on a clinical trials advisory board, and writing a review article. AH's non‐paid roles include chair of the Cystic Fibrosis Clinical Trials Accelerator Program, deputy chair of the NIHR Respiratory Translational Research Collaboration, and director of a university spin‐out company (Mi‐trial). NIL declares acting as director of research at the Intensive Care Society UK. PJMO declares co‐funding from MRC and GlaxoSmithKline (INFLAMMAGE), part of the EMINENT consortium to promote inflammation research; consulting fees from Janssen, Seqiris, and Valneva; payments for speaking from Janssen and Seqirus; and acting as member and vice‐chair of NERVTAG. LVW declares research funding unrelated to the submitted work from GlaxoSmithKline, Roche and Orion; consulting fees unrelated to the submitted work from Galapagos, GSK and Boehringer‐Ingelheim; travel support from Genentech; advisory board participation for Galapagos; and an associate editor role for the European Respiratory Journal. KK has acted as a consultant, speaker or received grants for investigator‐initiated studies for Astra Zeneca, Bayer, Novo Nordisk, Sanofi‐Aventis, Servier, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Oramed Pharmaceuticals, Pfizer, Roche, Daiichi‐Sankyo, Applied Therapeutics, Embecta and Nestle Health Science. KK is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre (BRC). BR is funded by a Wellcome Career Development Award fellowship (302210/Z/23/Z). AShi, ASi, and MM declare that their institute was awarded a grant from UKRI/NIHR to complete this work. All other authors declare no competing interests

Figures

FIGURE 1
FIGURE 1
Incidence rate ratio for diabetes in PHOSP‐COVID sample (n = 1050). Patients with missing body mass index (BMI) were excluded from this analysis. The findings were repeated for all participants (using unknown BMI category as a separate category); see Figure S2. Estimates adjusted for all covariates shown in graph. CI, confidence interval; IRR, incidence rate ratios; ITU, intensive therapy unit.
FIGURE 2
FIGURE 2
Comparison between PHOSP‐COVID incidence rate of diabetes (all) and clinical trials (Type 2 diabetes mellitus only). Please see Table S2 for details on inclusion/exclusion criteria for clinical trials and PHOSP‐COVID sample. CI, confidence interval; IRR, incidence rate ratios.
See this image and copyright information in PMC

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