Glucose metabolism across COVID-19 and Long COVID: A longitudinal study
Daher, J; Koberssy, Z; Diaz, M; et al., Journal of the Endocrine Society, September 2026
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Publication Details
Abstract
Background: COVID-19 has been associated with new-onset diabetes. Prior studies are limited by lack of pre-infection data and preexisting cardiometabolic factors. Clarifying how COVID-19 and Long COVID (LC) affect glucose metabolism is essential to guide prevention. We evaluated longitudinal changes in glycemic and cardiometabolic markers after SARS-CoV-2 infection in a prospective cohort with pre-infection baseline measurements.
Methods: We included 821 uninfected adult participants from the RECOVER cohort who subsequently developed COVID-19, characterizing participants in their pre-COVID state. Data from up to 12 months post-infection were compared to pre-infection baseline. Participants with preexisting diabetes or pregnancy were excluded. The primary endpoint was change in HbA1c up to 12 months after infection. Analysis was stratified by LC status using the 2024 RECOVER Adult Long COVID Research Index (LCRI).
Results: HbA1c remained stable from pre-infection to 12 months post-infection (5.39% vs 5.40%; P = .435). Non-HDL cholesterol and blood pressure decreased modestly, while cystatin C increased slightly; absolute changes were small. High-sensitivity C-reactive protein (hs-CRP), troponin, pro-brain natriuretic peptide (pro-BNP), body mass index, and waist circumference remained stable. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk increased slightly (6.7% to 7.3%; P < .001). Trends were similar across LC groups. New-onset metabolic syndrome incidence was comparable across LC categories (18%-20%), although persistent metabolic syndrome was more frequent in participants with more severe LC.
Conclusion: In this cohort with pre-infection baseline data, we found no significant changes in HbA1c or cardiometabolic biomarkers through 12 months after infection, although 10-year ASCVD risk slightly increased. These findings emphasize the importance of longitudinal assessment in differentiating transient physiological changes from persistent cardiometabolic disease after COVID-19.
Authors
Joviane Daher, Ziad Koberssy, Mireya Diaz, Sokratis N Zisis, Clifford J Rosen, Grace A McComsey
Keywords
COVID-19; cardiometabolic disease; hemoglobin A1c (HbA1c); inflammation; long COVID