Diabetes and the COVID-19 pandemic

Almost immediately after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus emerged, it was evident that people with chronic diseases, including diabetes, were disproportionately affected, with an increased risk of hospitalisation and mortality. Over the ensuing 2 years, the indirect effects of the pandemic on healthcare delivery in the short term have become prominent, along with the lingering effects of the virus in those directly infected. In the wake of the pandemic and without any evidence from high quality studies, a number of national and international consensus recommendations were published, which were subsequently rapidly updated based on observational studies. There have been unprecedented disruptions from both direct and indirect impacts of coronavirus disease-2019 (COVID-19) in people with diabetes. In this review, we summarise the impact of acute COVID-19 in people with diabetes, discuss how the presentation and epidemiology during the pandemic, including presentation of diabetic ketoacidosis and new-onset diabetes, has changed, and we consider the wider impact of the pandemic on patients and healthcare service delivery, including some of the areas of uncertainty. Finally, we make recommendations on prioritising patients as we move into the recovery phase and also how we protect people with diabetes for the future, as COVID-19 is likely to become endemic.

Automated summary

The emergence of SARS-CoV-2 virus has disproportionately affected people with chronic diseases, including diabetes, with a higher risk of hospitalization and mortality. The pandemic has had significant indirect effects on healthcare delivery, as well as lasting impacts on those directly infected. This review summarizes the impact of acute COVID-19 on people with diabetes, discusses changes in presentation and epidemiology during the pandemic, and considers the broader impact on patients and healthcare service delivery, highlighting areas of uncertainty. Recommendations are provided for prioritizing patients during the recovery phase and protecting people with diabetes in the future, as COVID-19 is expected to become endemic.