Systematic review and meta-analysis links COVID-19 infection to 41% higher new-onset diabetes risk

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Frontiers in Medicine Published May 21, 2026 Medically reviewed May 21, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider metabolic monitoring for post-COVID patients given 41% higher diabetes risk.

This systematic review and meta-analysis examined the association between COVID-19 infection and the risk of new-onset diabetes. The analysis included sixteen studies comparing COVID-19 survivors and non-infected individuals with follow-up of at least three months after recovery from COVID-19. The primary outcome was the risk of new-onset diabetes, with secondary outcomes including HbA1c, Homeostatic Model Assessment of Insulin Resistance, and fasting blood glucose.

The pooled results indicated a 41% increased risk of new-onset diabetes. The relative risk was 1.41 with a 95% CI of 1.38 to 1.44. Standardized mean differences showed higher HbA1c with an SMD of 1.44 and higher HOMA-IR with an SMD of 0.96. Fasting blood glucose results were inconsistent and highly heterogeneous with an SMD of 0.77 and a 95% CI of minus 0.40 to 1.94.

The authors acknowledge limitations including a limited number of studies contributing to pooled risk estimates and the influence of large registry-based data. Substantial heterogeneity across outcomes was also noted. The authors caution that the estimate was predominantly driven by a single large-scale study. Causality is not definitively established, and the association warrants cautious interpretation.

Practice relevance supports consideration of metabolic monitoring and longitudinal follow-up in post-COVID care, particularly among individuals at elevated cardiometabolic risk. Safety data regarding adverse events, serious adverse events, discontinuations, or tolerability were not reported.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundCOVID-19 has been associated with persistent metabolic disturbances; however, the magnitude, consistency, and underlying mechanisms of post-infection alterations in glucose regulation remain incompletely characterized.MethodsWe conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed and Embase were searched on December 18, 2024, for studies published from 2020 onward. Eligible studies included observational cohort and cross-sectional designs assessing metabolic outcomes at least three months after recovery from COVID-19.ResultsSixteen studies met inclusion criteria. Pooled analysis suggested a 41% increased risk of new-onset diabetes among COVID-19 survivors compared with non-infected individuals (RR 1.41, 95% CI: 1.38–1.44); however, this estimate was predominantly driven by a single large-scale study. Quantitative synthesis demonstrated higher HbA1c (SMD 1.44, 95% CI: 0.36–2.52) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (SMD 0.96, 95% CI: 0.33–1.58), consistent with impaired glycemic control and increased insulin resistance. In contrast, fasting blood glucose (FBG) findings were inconsistent and highly heterogeneous (SMD 0.77, 95% CI: −0.40–1.94). Substantial heterogeneity was observed across outcomes.ConclusionCOVID-19 may be associated with an increased risk of incident diabetes and persistent metabolic dysregulation. However, the limited number of studies contributing to pooled risk estimates and the influence of large registry-based data warrant cautious interpretation. These findings support consideration of metabolic monitoring and longitudinal follow-up in post-COVID care, particularly among individuals at elevated cardiometabolic risk.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42025630971.