REVIEW article
Front. Endocrinol.
Sec. Clinical Diabetes
The mechanisms underlying COVID-19 induced insulin resistance: A narrative review
1. Shanghai Public Health Clinical Center, Shanghai, China
2. Shanghai Tenth People's Hospital, Shanghai, China
3. Tongji Hospital Affiliated to Tongji University, Shanghai, China
4. Beijing Jishuitan Hospital Affiliated to Capital Medical University, Beijing, China
5. Stanford University School of Medicine, Stanford, United States
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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.
Summary
Keywords
COVID - 19, Immune System, Inflammatory, Insulin Resistance, lifestyle change, Long Covid, Mechanism, Metabolism
Received
06 January 2026
Accepted
19 February 2026
Copyright
© 2026 Zhu, Qu, Li, Wei, Shen and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wen-Jun Shen; Jia Chen
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.