The risk of type 2 diabetes mellitus in long COVID

It seems that I keep writing about COVID-19 being linked to type 1 and type 2 diabetes, but another paper has dropped about the risk of diabetes after COVID-19 infection. And this convincing new evidence that we should consider diabetes to be one of the long COVID sequelae.

Research like this debunks the idea that COVID-19 isn’t dangerous, despite the millions of people who have died from the disease. You might recover quickly from COVID-19 without too much effort only to find out you have type 1 or type 2 diabetes, a chronic illness that will affect your life in ways that you cannot comprehend (unless you have experienced diabetes).

Let’s take a look at this new study.

symbolism for world diabetes day awareness
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All about diabetes

Type 2 diabetes mellitus (or type 2 diabetes, T2DM) is a metabolic disorder that is characterized by high blood glucose with insulin resistance and relative insulin deficiency. In general, someone with T2DM produces low (or maybe even adequate) levels of insulin, but various cells and organs become resistant to insulin, so cells don’t remove or store blood glucose.

Although the cause of T2DM is not completely understood, it results from a complex interaction between diet, obesity, activity, genetics, age, and gender. Some of the causes of T2DM are under a person’s own control, like diet and obesity, but many of the factors aren’t.

The first warning signs and symptoms of both types of diabetes are fatigue, increased thirst, frequent urination, blurred vision, increased hunger, unexplained weight loss, and sores that don’t heal. Individuals with these signs and symptoms should visit a physician as soon as possible.

The long-term complications from diabetes include:

  • Eye disease, due to changes in fluid levels, swelling in the tissues, and damage to the blood vessels in the eyes
  • Foot problems, caused by damage to the nerves and reduced blood flow to your feet
  • Gum disease and other dental problems, because a high amount of blood sugar in your saliva helps harmful bacteria grow in your mouth.
  • Heart disease and stroke, caused by damage to your blood vessels and the nerves that control your heart and blood vessels
  • Kidney disease, due to damage to the blood vessels in your kidneys. Many people with diabetes develop high blood pressure, which can damage the kidneys.
  • Nerve problems (diabetic neuropathy), caused by damage to the nerves and the small blood vessels that nourish your nerves with oxygen and nutrients
  • Sexual and bladder problems, caused by damage to the nerves and reduced blood flow in the genitals and bladder
  • Skin conditions, some of which are caused by changes in the small blood vessels and reduced circulation.

The upshot of this is that diabetes, in either form, is a dangerous long-term outcome from COVID-19. You might want to dismiss COVID-19 as a rather benign disease that is easily treated, but it is neither easy to treat nor benign. Long COVID appears to include diabetes, a disease that can cause a lifetime of serious problems.

close up photo of survey spreadsheet
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COVID-19 and diabetes — new paper

The new paper, by Yan Xie, MPH, and Ziyad Al-Aly, MD, both from the VA Saint Louis Health Care System in Saint Louis, was published on 21 March 2022 in Lancet Diabetes & Endocrinology.

The cohort study examined 181,280 veterans who tested positive for COVID-19 in national databases of the US Department of Veterans Affairs. Here’s what they found:

  • There was a 40% higher risk for incident diabetes during the post-acute phase of the disease compared with a control group (HR 1.40, 95% CI 1.36-1.44).
  • Over 12 months, there was also a significantly higher excess burden of new diabetes among those with a positive COVID test — 13.46 excess cases of diabetes per 1,000 people.
  • Individuals who survived the post-acute phase of a COVID-19 infection (the first 30 days) had an 85% higher risk of needing a new antihyperglycemic medication, a sign of type 2 diabetes, following infection compared with controls (HR 1.85).
  • The 12-month burden of incident antihyperglycemic use was 12.35 per 1,000 people higher than controls.
  • The control group had an incident diabetes burden of 34.42 per 1,000 people over 12 months, individuals admitted to the intensive care unit (ICU) with COVID-19 had an incident diabetes burden of 123.48 per 1,000 people.
  • The researchers found several clinical and sociodemographic risk factors to be associated with a higher risk for developing diabetes after infection — age over 65 years, Black race, body mass index (BMI) of 25-30 or above 30, and presence of cardiovascular disease, hypertension, hyperlipidemia, or prediabetes.
  • The researchers determined that COVID survivors had a 46% increased risk for both incident diabetes and antihyperglycemic use and an excess burden of 18.03 per 1,000 more people for this composite outcome 12 months later.
  • Although the study was not powered to determine the risk differences between type 1 and type 2 diabetes, the researchers reported that in excess of 99% of the diabetes reported was type 2.

If these data hold up, you should think about this — approximately 80 million people have had COVID-19 in the USA alone. that would mean that there could be an additional 1 million diabetes cases as a result of the pandemic. That has an immense personal and economic cost to the country (and the world).

The evidence that diabetes (both type 1 and type 2) is one of the sequelae of long COVID is becoming overwhelming.


I know a lot of my readers (not a majority by any means) think that COVID-19 is a dangerous disease, but it can be treated easily with drugs or other therapies. A lot of you, after getting all of the vaccines, are out in the world without masks or anything.

But, I’m not sure that is wise. As a friend told me, “yeah, we’re tired of the pandemic, but the virus doesn’t give a shit about that.” Diabetes is a chronic disease that shortens your life, puts you at risk of a lot of comorbidities, and is a challenge to control. If you don’t think COVID-19 is deadly, and it is, you better know that diabetes is definitely a killer.

And diabetes is just one of the sequelae of long COVID-19. They all are scary to me.

Get vaccinated. Wear your damn mask. Try to avoid being around people who couldn’t care less about COVID-19. And maybe, just maybe, you can avoid diabetes.

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