You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.


Does COVID Infection Affect Risk For Incident Diabetes?

  • Authors: News Author: Miriam Tucker; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 3/17/2023
  • Valid for credit through: 3/17/2024, 11:59 PM EST
Start Activity

  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, endocrinologists, nurses, nurse practitioners, pharmacists, physician assistants and other clinicians who treat and manage adults with COVID-19 infection.

The goal of this activity is for members of the healthcare team to be better able to evaluate the risk for cardiometabolic disease after COVID-19 infection, particularly with the Omicron variant.

Upon completion of this activity, participants will:

  • Analyze the association, if any, between COVID-19 and incident diabetes
  • Evaluate the risk for cardiometabolic disease after COVID-19 infection, particularly with the Omicron variant
  • Outline implications for the healthcare team


Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

News Author

  • Miriam Tucker

    Freelance writer, Medscape


    Miriam Tucker has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements


Interprofessional Continuing Education

In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    The European Union of Medical Specialists (UEMS)-European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 credit™ into European CME credit (ECMEC) should contact the UEMS (

    College of Family Physicians of Canada Mainpro+® participants may claim certified credits for any AMA PRA Category 1 credit(s)™, up to a maximum of 50 credits per five-year cycle. Any additional credits are eligible as non-certified credits. College of Family Physicians of Canada (CFPC) members must log into Mainpro+® to claim this activity.

    Contact This Provider

    For Nurses

  • Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.

    Contact This Provider

    For Pharmacists

  • Medscape designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number: JA0007105-0000-23-095-H01-P).

    Contact This Provider

  • For Physician Assistants

    Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 03/17/2024. PAs should only claim credit commensurate with the extent of their participation.

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


Does COVID Infection Affect Risk For Incident Diabetes?

Authors: News Author: Miriam Tucker; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 3/17/2023

Valid for credit through: 3/17/2024, 11:59 PM EST


Clinical Context

One of the many startling revelations regarding infection with SARS-CoV-2 was the effect of infection on glucose metabolism. Early in the pandemic, clinicians were unprepared for the serious hyperglycemia associated with COVID-19. Moreover, data emerged that COVID-19 was a risk factor for incident diabetes. A previous systematic review and meta-analysis by Zhang and colleagues, published in the November 15, 2022, issue of BMC Medicine, assessed this issue.[1]

Researchers focused on the results of 9 studies, which included nearly 40 million participants. The incidence of diabetes after COVID-19 was 15.53 cases per 1000 person-years, and the odds ratio for diabetes after COVID-19 was 1.62 (95% CI, 1.45-1.80). COVID-19 was associated with significant increases in the risk for both type 1 and type 2 diabetes, and it was associated with a higher risk for diabetes among children and adolescents, young and middle-aged adults, and older adults. Finally, more severe COVID-19 infections were associated with an even higher risk for diabetes.

The Omicron variant of SARS-CoV-2 has generally been associated with less severe infections. Does it still carry a higher risk for diabetes? The current study addresses this question.

Study Synopsis and Perspective

The increased risk for diabetes after COVID-19 infection has persisted into the Omicron era, but vaccination against SARS-CoV-2 appears to diminish that likelihood, new data suggest.

The findings, from more than 20,000 patients in the Cedars-Sinai Health System in Los Angeles, California, suggest that “continued efforts to prevent COVID-19 infection may be beneficial to patient health until we develop better understanding of the effects of potential long-term effects of COVID-19,” lead author Alan C. Kwan, MD, from the Department of Cardiology at Cedars Sinai’s Smidt Heart Institute, told Medscape Medical News.

Several studies conducted early in the pandemic suggested increased risks for both new-onset diabetes and cardiometabolic diseases after COVID-19 infection, possibly as a result of persistent inflammation contributing to insulin resistance.[2,3]

However, it has not been clear whether those risks have persisted with the more recent predominance of the less-virulent Omicron variant or whether the COVID-19 vaccine influences the risk. This new study suggests that both are the case.

“Our results verify that the risk of developing type 2 diabetes after a COVID-19 infection was not just an early observation but, in fact, a real risk that has, unfortunately, persisted through the Omicron era,” Dr Kwan noted.

“While the level of evidence by our study and others may not reach the degree needed to affect formal guidelines at this time, we believe it is reasonable to have increased clinical suspicion for diabetes after COVID-19 infection and a lower threshold for testing,” he added.

Moreover, “We believe that our study and others suggest the potential role of COVID-19 to affect cardiovascular risk, and so both prevention of COVID-19 infection, though reasonable personal practices and vaccination, and an increased attention to cardiovascular health after COVID-19 infection is warranted.”

The findings were published online February 14 in JAMA Network Open.[4]

Diabetes Risk After COVID-19 Persists, Lower With Vaccination

Dr Kwan and colleagues analyzed data for a total of 23,709 patients treated (inpatient and outpatient) for at least 1 COVID-19 infection between March 2020 and June 2022.

Rates of new-onset diabetes (using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes primarily type 2 diabetes), hypertension, and hyperlipidemia were all elevated in the 90 days after COVID-19 infection compared with the 90 days prior. The same was true of 2 diagnoses unrelated to COVID-19: urinary tract infection and gastroesophageal reflux, used as benchmarks of healthcare engagement.

The highest odds for post versus pre infection were for diabetes (odds ratio [OR], 2.35; P<.001), followed by hypertension (OR, 1.54; P<.001), the benchmark diagnoses (OR, 1.42; P<.001), and hyperlipidemia (OR, 1.22; P=.03).

After adjustments, the risk versus the benchmark conditions for new-onset diabetes before versus after COVID-19 was significantly elevated (OR, 1.58; P<.001), whereas the risks for hypertension and hyperlipidemia versus benchmark diagnoses were not (OR, 1.06 [P=.52] and 0.91 [P=.43], respectively).

The diabetes risk after versus before COVID-19 infection was higher among those who had not been vaccinated (OR, 1.78; P<.001) compared with those who had received the vaccine (OR, 1.07; P=.80).

However, there was no significant interaction between vaccination and diabetes diagnosis (P=.08). “For this reason, we believe our data are suggestive of a protective effect in the population who received vaccination prior to infection, but [this is] not definitive,” Dr Kwan said.

There were no apparent interactions by age, sex, or preexisting cardiovascular risk factors, including hypertension or hyperlipidemia. Age, sex, and timing of index infection regarding the Omicron variant were not associated with an increased risk for a new cardiometabolic diagnosis before or after COVID-19 infection in any of the models.

Dr Kwan told Medscape Medical News: “We have continued to be surprised by the evolving understanding of the SARS-Cov-2 virus and the effects on human health. In the beginning of the pandemic it was framed as a purely respiratory virus, which we now know to be a severely limited description of all of its potential effects on the human body. We believe that our research and others raise a concern for increased cardiometabolic risk after COVID infection.”

He added, “while knowledge is incomplete on this topic, we believe that clinical providers may wish to have a higher degree of suspicion for both diabetes and risk of future cardiac events in patients after COVID infection, and that continued efforts to prevent COVID infection may be beneficial to patient health until we develop better understanding of the effects of potential long-term effects of COVID.”

This study was funded by the Erika J. Glazer Family Foundation, the Doris Duke Charitable Foundation, and grants from the National Institutes of Health. Dr Kwan has reported receiving grants from the Doris Duke Charitable Foundation during the conduct of the study.

JAMA Netw Open. Published online February 14, 2023.

Study Highlights

  • Researchers used a database of patient data from a major tertiary medical center in Los Angeles, California, to address their study question. Adult patients with at least 1 infection with COVID-19 between March 2020 and June 2022 were eligible for analysis.
  • The analysis compared the risk for incident diabetes, as well as incident hypertension and hyperlipidemia, in the 90 days before and after the diagnosis of COVID-19. They also evaluated the risks for incident urinary tract infection and gastroesophageal reflux disease to address the possible confounding variable of increased contact with the health care system after the diagnosis of COVID-19.
  • Researchers adjusted their results to account for demographic variables, as well as the timing of infection and COVID-19 infection.
  • The study cohort totaled 23,709 patients, and 54% were female. The mean age of patients was 47.4 years.
  • In the first analysis, all cardiometabolic outcomes were significantly increased after COVID-19 infection. However, after multivariable adjustment, only the OR for diabetes was elevated post-COVID-19 (1.58; 95% CI, 1.24-2.02).
  • There was a trend toward a higher risk for diabetes after COVID-19 among patients who were unvaccinated vs those who were vaccinated.
  • Subgroup analyses based on age, sex, and cardiovascular risk factors failed to alter the study’s main conclusions.
  • The higher risk for diabetes associated with COVID-19 persisted into the period of Omicron dominance in 2022.

Clinical Implications

  • A previous study found that COVID-19 was associated with more than a 60% increased chance of developing diabetes, regardless of age. COVID-19 was associated with a higher risk for both type 1 and type 2 diabetes, and more severe COVID-19 was related to an even higher risk for diabetes.
  • The current study suggests that the risk for diabetes, but not hypertension or hyperlipidemia, was increased after COVID-19 infection, including infection with the omicron variant.
  • Implications for the healthcare team: The health care team should work to prevent COVID-19 infection, advising patients that the infection can raise the risk for diabetes.


Earn Credit

  • Print