COVID-19 Vaccination and Diabetes Risk
There is no evidence that COVID-19 vaccines cause diabetes, but SARS-CoV-2 infection itself is associated with a 66% higher risk of developing new-onset diabetes. 1
COVID-19 Infection and Diabetes Risk
- SARS-CoV-2 infection is associated with significantly higher risk of incident diabetes (HR = 1.225 [1.150 to 1.305]), primarily type 2 diabetes, regardless of the predominant circulating variants 2
- The risk of developing diabetes after COVID-19 infection is lower with Omicron variants but still statistically significant 2
- For every 406 people infected with COVID-19, there is one additional case of diabetes within 6 months 2
- Recent reports indicate development of new-onset diabetes in people who have had COVID-19, though the precise mechanisms are not fully understood 3
- Systematic review and meta-analysis data show that COVID-19 is associated with a 66% higher risk of incident diabetes among survivors 1
COVID-19 Vaccination and Diabetes Risk
- Population-based cohort studies show no evidence of increased risks of incident diabetes following COVID-19 vaccination 2
- Neither mRNA (BNT162b2) nor inactivated (CoronaVac) COVID-19 vaccines were associated with increased diabetes risk in large population studies 2
- Fully vaccinated individuals might actually be protected from the risk of incident diabetes following SARS-CoV-2 infection 2
Rare Case Reports and Considerations
- While large population studies show no increased risk, there have been isolated case reports of new-onset type 1 diabetes after COVID-19 vaccination in individuals with genetic predisposition 4, 5
- These cases typically involve individuals with disease-susceptible HLA haplotypes (genetic risk factors for autoimmune diabetes) 4, 5
- The time from vaccination to development of type 1 diabetes in these rare cases was typically several weeks (4-8 weeks) 5
Clinical Recommendations
- New-onset diabetes cases following COVID-19 infection should receive routine clinic follow-up to determine if the condition is transient 3
- People with diabetes should be prioritized and offered SARS-CoV-2 vaccines and vaccine boosters due to their higher risk of severe COVID-19 outcomes 3
- Active monitoring of glucose dysregulation after recovery from SARS-CoV-2 infection is warranted 1
- People with diabetes who have been infected with SARS-CoV-2 should be followed up in the longer term to assess complications and symptoms of long COVID-19 3
Common Pitfalls and Caveats
- Do not confuse the association between COVID-19 infection and diabetes with vaccination effects - the evidence clearly shows it's the infection, not the vaccine, that increases diabetes risk 2, 1
- Individual case reports should not override population-level evidence when assessing vaccine safety 2
- The benefits of COVID-19 vaccination for people with diabetes far outweigh any potential risks, as diabetes is a significant risk factor for severe COVID-19 outcomes 3
- When evaluating new-onset diabetes after COVID-19 infection, consider that it may be previously undiagnosed diabetes presenting early or related to pandemic lifestyle changes (reduced physical activity, increased stress) 3