What is the clinical evidence from this study?

Study design: Cohort. Population: New diabetes mellitus after COVID-19 testing (n=26936). Intervention: Positive COVID-19 test vs. Negative COVID-19 test. Primary outcome: HbA1c at DM diagnosis (MD 0.09, 95% CI 0.01-0.16).

What does this research mean for the field?

A prior COVID-19 infection before a new diabetes diagnosis is associated with slightly higher HbA1c at shorter latencies and modest differences in healthcare utilization, but does not affect the need for long-acting insulin compared to patients without prior COVID-19. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate diabetes-related outcomes in patients with and without prior COVID-19 infection.

June 7, 2026

2342-P: Natural History of New Diabetes after COVID-19 Infection: The COVID-19 and Diabetes Assessment (CODA) Study

Key Result

A positive COVID-19 test prior to a new diabetes diagnosis was associated with a slightly higher mean HbA1c (mean difference 0.09; 95% CI 0.01-0.16) compared to a negative test.

Key Points

This study aims to evaluate diabetes-related outcomes in patients with and without prior COVID-19 infection.
Conducted a retrospective cohort study using data from 31 healthcare systems.
Included patients aged 20-80 with COVID-19 tests prior to new diabetes diagnosis.
Used adjusted multivariable regression analyses to assess the association between COVID-19 and diabetes outcomes.
Found little association between COVID-19 test result and mean HbA1c (mean difference: 0.09, 95% CI: 0.01, 0.16).
Positive COVID-19 test linked to lower risk of inpatient encounters (OR: 0.84, 95% CI: 0.78 - 0.90).
No significant difference in long-acting insulin use (OR: 1.02, 95% CI: 0.88 - 1.18).

Study Design

Type

Cohort (n=26,936)

Multicenter

Yes

Structured PICO

Does a positive COVID-19 test prior to a new diabetes diagnosis affect disease severity (HbA1c, healthcare utilization, insulin use) compared to a negative test?

Population

26,936 patients aged 20-80 years with a new diabetes diagnosis following a COVID-19 test, evaluated for diabetes-related outcomes in the 365 days after diagnosis.

Exposure

Positive COVID-19 test prior to new diabetes diagnosis

Comparator

Negative COVID-19 test prior to new diabetes diagnosis

Outcome

HbA1c at DM diagnosis, healthcare utilization, and long-acting insulin use in the 365 days after diagnosissurrogate

A positive COVID-19 test prior to a new diabetes diagnosis is associated with slightly higher HbA1c if diagnosed within 50-200 days and modest differences in healthcare utilization, but no difference in long-acting insulin use.

Main Result

Mean Difference: 0.09 (95% CI 0.01–0.16)

Abstract

Introduction and Objective: COVID-19 infection has been associated with an increased risk of diabetes mellitus (DM). Limited data is available regarding whether patients with COVID-19 infection preceding DM have different disease severity than those without a prior infection. The goal of this study was to assess diabetes-related outcomes among patients with positive vs. negative COVID-19 tests prior to a new diagnosis. Methods: We conducted a retrospective cohort study using electronic health record data from 31 healthcare systems participating in the PCORnet national research network and the NIH RECOVER program. Eligible patients were 20-80 years old with a COVID-19 test (positive or negative) prior to a new DM diagnosis from March 2020 to December 2022. Outcomes were HbA1c at DM diagnosis, healthcare utilization, and long-acting insulin use in the 365 days after diagnosis. Adjusted multivariable linear and logistic regression analyses evaluated the association between COVID-19 infection (i.e., positive test) and these outcomes. Results: A total of 26,936 patients were diagnosed with new DM after a COVID-19 test (19% positive, 81% negative). We found little association between test result and mean HbA1c (estimated mean HbA1c difference: 0.09, 95% CI: 0.01, 0.16), though HbA1c was higher among patients diagnosed 50-200 days after testing positive. A positive test was associated with a lower risk of an inpatient encounter (OR: 0.84, 95% CI: 0.78 - 0.90) and a higher risk of an emergency department encounter (OR: 1.15, 95% CI: 1.08, 1.23). No difference was evident in long-acting insulin use (OR: 1.02, 95% CI: 0.88 - 1.18). Conclusion: Shorter latency between COVID-19 infection and DM diagnosis was associated with slightly higher HbA1c. COVID-19 infection was associated with modest differences in health care utilization, but no difference in long-acting insulin use. More research is needed to further evaluate the nature of the association between COVID-19 and DM progression. Disclosure J.G. Lyons: None. S. Rifas-Shiman: None. J.G. Young: None. T. Eggerman: None. B. French: None. M. Hivert: None. S. McGrath: None. A.C. Powers: None. B. Rasouli: None. R.L. Rothman: Research Support; Current; Dexcom, Inc. J.S. Schildcrout: None. J.P. Block: None. Funding National Institutes of Health, NIDDK (U01DK137533)

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