{
  "abstract": "Background: Coronavirus disease 2019 (COVID-19) can disrupt glucose regulation through inflammation, adipose-tissue dysfunction, impaired insulin signaling, and variable β-cell compensation. These evidence domains remain incompletely integrated.\n\nObjective: To synthesize evidence on glycemic dysregulation and insulin resistance or insulin sensitivity across acute and post-acute COVID-19, including metabolic trajectories and associations with adverse clinical outcomes.\n\nMethods: PubMed, Embase, Scopus, Web of Science, and ScienceDirect were searched. Eligible studies evaluated glucose regulation and at least one insulin-resistance or insulin-sensitivity measure during or after COVID-19. Etiological and prognostic evidence was analyzed as related but distinct domains. Prognostic meta-analysis evaluated study-defined acute hyperglycemic phenotypes; insulin-resistance or insulin-sensitivity assessment was a study-level eligibility criterion rather than part of a participant-level composite exposure. Unadjusted risk ratios (RRs) from event counts were pooled using restricted maximum-likelihood random-effects models with Hartung–Knapp adjustment. Non-combinable evidence was synthesized according to Synthesis Without Meta-analysis principles. Risk of bias was assessed using design-appropriate tools, and certainty was evaluated with GRADE. The protocol and analytical plan were retrospectively registered in OSF on August 21, 2026 ( https://doi.org/10.17605/OSF.IO/K5FWU ).\n\nResults: Twenty independent studies represented by 23 reports. Acute hyperglycemic phenotypes were associated with increased short-term all-cause mortality (four studies; 1,079 participants; RR 2.09, 95% confidence interval [CI] 1.21–3.64; I ² =31.3%; 95% prediction interval 0.96–4.56) and invasive mechanical ventilation (three studies; 679 participants; RR 3.64, 95% CI 1.74–7.61; I ² =0%). Mortality estimates remained directionally stable in sensitivity analysis. Adding a large study using peak in-hospital glucose preserved the mortality association but produced substantial heterogeneity for ventilation. Etiological evidence showed no uniform post-COVID trajectory: insulin resistance or glycemic abnormalities resolved in some populations, persisted in others, and progressed toward newly diagnosed diabetes in a subset. Mechanistic evidence implicated inflammatory stress, adipose-tissue dysfunction, impaired insulin signaling, and variable β-cell responses.\n\nConclusions: Study-defined acute hyperglycemic phenotypes were associated with adverse COVID-19 outcomes in studies that also assessed insulin resistance or insulin sensitivity. These unadjusted estimates should not be interpreted as effects of a combined phenotype or as causal associations. Persistent metabolic abnormalities occurred heterogeneously, supporting standardized participant-level definitions and controlled longitudinal studies.\n\nSystematic review registration: https://doi.org/10.17605/OSF.IO/K5FWU , identifier 10.17605/OSF.IO/K5FWU.",
  "abstract_shown": true,
  "affiliations": [
    "Laboratorio de Inmunología, Centro Universitario de los Lagos, Universidad de Guadalajara, Jalisco",
    "Centro de Investigación e Innovación, Global University, Aguascalientes",
    "Facultad de Medicina, Unidad de Ciencias de la Salud, Universidad Veracruzana, Veracruz",
    "Ingenieria Bioquímica, Centro Universitario de los Lagos, Universidad de Guadalajara, Jalisco",
    "Departamento de Ciencias de la Tierra y de la Vida, Centro Universitario de Los Lagos, Universidad de Guadalajara, Jalisco",
    "Programa de Estancias Posdoctorales por Mexico, Secretaría de Ciencia, Humanidades, Tecnología e Innovación, Centro Universitario de Los Lagos, Universidad de Guadalajara, Jalisco"
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
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        0,
        1
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      "name": "José Luis Muñoz-Carrillo"
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    {
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        0
      ],
      "name": "Oscar Gutiérrez-Coronado"
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    {
      "affs": [
        2
      ],
      "name": "Edrei Lopez-Hernandez"
    },
    {
      "affs": [
        3
      ],
      "name": "Sandra Estefanía Rodríguez López"
    },
    {
      "affs": [
        3
      ],
      "name": "Miriam Alejandra Olivares Mendoza"
    },
    {
      "affs": [
        1
      ],
      "name": "Diego Octavio Ramírez Águila"
    },
    {
      "affs": [
        0
      ],
      "name": "Paola Trinidad Villalobos-Gutiérrez"
    },
    {
      "affs": [
        4
      ],
      "name": "Cesar Soria-Fregozo"
    },
    {
      "affs": [
        5
      ],
      "name": "Gilberto Uriel Rosas-Sánchez"
    },
    {
      "affs": [
        0
      ],
      "name": "Alejandro David Soriano-Hernández"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6exe0t6avj9gt.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1975728",
  "fulltext_url": "https://europepmc.org/articles/PMC13713293",
  "id": "6exe0t6avj9gt",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1975728/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "heading",
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      "openalex",
      "2725|COVID-19 Clinical Research Studies"
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  "pdf_url": "https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1975728/pdf",
  "pmcid": "PMC13713293",
  "pmid": "42952500",
  "published": "2026-10-14",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/6exe0t6avj9gt.ris",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|COVID-19 Clinical Research Studies",
      "subfield": "infectious-disease"
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  ],
  "title": "Glycemic dysregulation and insulin resistance across acute and post-acute COVID-19: a systematic review and meta-analysis of etiologic and prognostic evidence",
  "title_text": "Glycemic dysregulation and insulin resistance across acute and post-acute COVID-19: a systematic review and meta-analysis of etiologic and prognostic evidence",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:20:59Z",
  "url": "https://research.draconitic.com/paper/6exe0t6avj9gt",
  "venue": "Frontiers in Endocrinology",
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}