# The mechanisms underlying COVID-19 induced insulin resistance: a narrative review

**Authors:** Bing Zhu, Shen Qu, Jue Li, Wei Deng, Wen-Jun Shen, Jia Chen

PMC · DOI: 10.3389/fendo.2026.1781679 · Frontiers in Endocrinology · 2026-03-11

## TL;DR

This paper reviews how COVID-19 can cause insulin resistance and diabetes, exploring factors like inflammation, lifestyle changes, and gut health.

## Contribution

The paper provides a comprehensive overview of the mechanisms linking SARS-CoV-2 infection to insulin resistance and new-onset diabetes.

## Key findings

- Immune activation and inflammation are key contributors to insulin resistance in post-COVID-19 patients.
- Disruptions in amino acid metabolism and gut microbiome imbalances are linked to metabolic complications.
- Dietary interventions and ACE2 activators may help mitigate insulin resistance caused by SARS-CoV-2.

## Abstract

The COVID-19 pandemic, caused by SARS-CoV-2, has resulted in a significant increase in insulin resistance and new-onset diabetes among recovered individuals. This review examines the multifactorial mechanisms underlying these metabolic complications, including activation of the immune system and inflammatory cascades, lifestyle changes, nutritional deficiencies, imbalances in amino acid metabolism, alterations in ketogenesis, disruptions in the gut microbiome, psychological impacts, and COVID-19 vaccines. We discuss how these factors collectively contribute to insulin resistance, particularly in the context of COVID-19, and highlight potential therapeutic strategies, such as dietary interventions and ACE2 activators, that may mitigate these effects. Our analysis underscores the need for targeted approaches to prevent and treat insulin resistance in post-COVID-19 patients, emphasizing the importance of understanding the pandemic’s long-term metabolic consequences.

## Linked entities

- **Diseases:** diabetes (MONDO:0005015)

## Full-text entities

- **Genes:** ACE2 (angiotensin converting enzyme 2) [NCBI Gene 59272] {aka ACEH}
- **Diseases:** nutritional deficiencies (MESH:D044342), insulin resistance (MESH:D007333), COVID-19 (MESH:D000086382), diabetes (MESH:D003920), inflammatory (MESH:D007249), post-COVID-19 (MESH:D000094024)
- **Species:** gut metagenome (species) [taxon 749906], Severe acute respiratory syndrome coronavirus 2 (no rank) [taxon 2697049], Homo sapiens (human, species) [taxon 9606]

## Full text

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## Figures

2 figures with captions in the complete paper: https://tomesphere.com/paper/PMC13012986/full.md

## References

150 references — full list in the complete paper: https://tomesphere.com/paper/PMC13012986/full.md

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Source: https://tomesphere.com/paper/PMC13012986