09/11/2026 | Medicina S/A via Agência Fapesp

https://medicinasa.com.br/diabetes-covid-longa/ 

People with diabetes who contracted COVID-19 experience slower recovery and are more prone to long COVID-related complications and poorer quality of life; consequently, they require closer and more prolonged medical monitoring. This was the finding of a study conducted at the University of São Paulo (USP) involving 870 individuals monitored for up to seven months following hospitalization.

"Diabetes is not merely a risk factor for the acute phase of COVID-19; it is also a factor that prolongs recovery time and degrades long-term quality of life. The study highlights the clear need for a healthcare framework designed to care for this diabetic population infected with SARS-CoV-2, in order to prevent survivors from becoming trapped in a cycle of hospital readmissions," states Maria Elizabeth Rossi da Silva, head of the Diabetes Unit at the University of São Paulo Medical School Hospital (HCFMUSP) and one of the authors of the study published in the journal *Scientific Reports*.

In addition to confirming that people with diabetes took longer to recover from COVID-19, the research found a higher risk of cardiovascular complications—such as heart attack and angina—compared to non-diabetics. Furthermore, seven months after hospital discharge, the group with diabetes exhibited high levels of frailty, a higher incidence of falls, and poorer quality of life, characterized by mobility issues, an inability to perform daily activities, and lower performance in physical and cognitive domains.

First phase of the pandemic

The study, which compared 320 patients with diabetes and 550 without the disease, is part of a larger project supported by FAPESP. It recruited over 3,000 individuals hospitalized at the Hospital das Clínicas between March and September 2020—a period corresponding to the first phase of the pandemic in Brazil, before vaccines were available.

Participants underwent an extensive in-person assessment (including physical and laboratory exams) approximately seven months after hospital discharge.

While 94.3% of patients without diabetes reported a full recovery, that figure dropped to 89.8% among those with diabetes. "It is a considerable difference," says Silva.

As the researcher explains, SARS-CoV-2 infection places the cardiovascular systems of diabetic patients under significant stress. "The systemic inflammation caused by diabetes compounds the virus's direct toxicity, creating a scenario where the heart becomes a primary target for severe complications. And the risk increases with the number of comorbidities a patient has," she states.

The consequences of this cascade effect are far-reaching. In the group with diabetes, the virus severely compromised mobility; 21.1% of these patients reported falls after discharge—nearly double the rate observed in the group without the disease (11.1%).

"This combination of altered metabolism and length of hospital stay—which was longer for individuals with diabetes [16 days versus 13]—creates a cycle of muscle mass loss and vulnerability that hinders the return to daily independence," Silva notes.

According to the researcher, it is essential to understand these metabolic specificities, as well as the socioeconomic challenges associated with diabetes, when providing clinical care. "The chronic inflammatory state associated with diabetes and obesity, combined with the accelerated progression of cardiac and functional damage, makes this group more susceptible to severe complications. Furthermore, the virus can directly affect pancreatic cells or trigger insulin resistance, worsening the clinical picture," she explains. She also highlights that social inequalities influence disease outcomes—such as limited access to medical care, stress, unhealthy diets, and a lack of time for physical activity. “Health policies must take these specific factors into account by offering tailored follow-up care for post-COVID patients with diabetes,” the scientist argues.

The virus as a trigger

Another significant finding was that 7.3% of non-diabetic participants developed the disease following SARS-CoV-2 infection. However, the researcher notes that while the virus’s direct role in destroying pancreatic cells cannot be ruled out, it is likely that COVID-19 either unmasked pre-existing cases or that the severe inflammation acted as a trigger in individuals who were already predisposed.

“We need to interpret this information carefully; although the infection can catalyze the onset of diabetes, the pandemic situation and social isolation may also have influenced factors such as stress, poor diet, a sedentary lifestyle, and obesity—all of which can trigger diabetes,” she says.

The study involving patients hospitalized at the HC during the first phase of the pandemic is ongoing, and researchers are analyzing data collected three years after infection. “It is important to understand how COVID-19 impacts diabetes over time,” concludes Silva.