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Diabetes following SARS-CoV-2 infection: Incidence, persistence, and implications of COVID-19 vaccination. A retrospective cohort study of sixteen million people in England.

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Taylor, Kirt 
Eastwood, Sophie 
Walker, Venexia 
Cezard, Genevieve 
Knight, Rochelle 


Background Type 2 diabetes (T2DM) incidence is increased after diagnosis of COVID-19. We investigated the the long-term effect of COVID-19 on the incidence of T2DM and other types of diabetes, and the impact of vaccination on the relationship.

Methods With NHS England approval, we studied incident diabetes diagnoses following COVID-19 diagnosis in pre-vaccination (N=16,674,867, January 2020-December 2021), vaccinated (N =12,279,669), and unvaccinated (N=3,076,953) cohorts (June-December 2021), using linked electronic health records. We estimated adjusted hazard ratios (aHRs) comparing diabetes incidence post-COVID-19 diagnosis with incidence before or without diagnosis up to 102 weeks post-diagnosis. Results were stratified by COVID-19 severity (hospitalised/non-hospitalised) and diabetes type.

Findings In the pre-vaccination cohort, aHRS for T2DM incidence after COVID-19 (compared to before or without diagnosis) declined from 4.30 (95% CI: 4.06,4.55) in weeks 1-4 to 1.24 (1.14,1.35) in weeks 53-102. aHRS were higher in unvaccinated than vaccinated people (8.76 (7.49,10.03)) versus 1.66 (1.50,1.84) in weeks 1-4) and for hospitalised COVID-19 (pre-vaccination cohort 28.3 (26.2,30.5) in weeks 1-4 declining to 2.04 (1.72,2.42) in weeks 53-102), than non-hospitalised COVID-19 (1.95 (1.78,2.13) in weeks 1-4, 1.11 (1.01,1.22) in weeks 53-102). T2DM persisted for 4 months after COVID-19 for ~60% of those diagnosed. Patterns were similar for Type 1 diabetes, though excess incidence did not persist beyond 6 months post-COVID-19



Journal Title

The Lancet Diabetes and Endocrinology

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British Heart Foundation (RG/18/13/33946)
British Heart Foundation (RE/18/1/34212)
National Institute for Health Research (NIHR) (via Cambridge University Hospitals NHS Foundation Trust (CUH)) (Unknown)
Alan Turing Institute (BDCSA 100005)