Post-COVID diabetes driving a surge in admissions at Mulago Hospital

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Seven years after the COVID-19 pandemic, health experts are warning of a sharp rise in diabetes cases linked to previous coronavirus infection, contributing to growing hospital admissions and deaths at the country’s national referral hospital.

Health experts say diabetes, once largely managed through outpatient clinics, has evolved into a system-wide crisis, cutting across heart care, kidney treatment, and transplant services, and placing mounting pressure on an already stretched health system.

Speaking during a diabetes awareness meeting at Mulago National Referral Hospital on February 5, Dr Fredrick Nelson Nakwagala, Head of the Endocrinology Department of Medicine, said clinicians are increasingly seeing patients whose diabetes began after they contracted COVID-19.

While diabetes has been on the rise in Uganda for years, doctors say COVID-19 appears to have worsened the trend. Emerging global evidence suggests coronavirus infection may trigger metabolic changes that increase the risk of new-onset diabetes or worsen existing disease.

“What we are seeing clinically is worrying. The pandemic may be over, but its health effects are not. We have many patients whose diabetes started when they got COVID-19. We have a big problem in this country,” Dr Nakwagala said. “If we do not act differently, the cost to families and the health system will be far greater than we can afford.”

Hospital data from Mulago showed that the growing diabetes burden is translating into serious clinical admissions, with more than 100 patients now attending the diabetes clinic every Friday, up from fewer than 40 in previous years, reflecting a steady and worrying rise in cases.

Uncontrolled high blood sugar is the leading cause of diabetes-related admissions, accounting for nearly half of all cases, while infections such as pneumonia and urinary tract infections contribute more than a quarter, according to Dr Nakwagala.

According to Mulago Hospital, about 10.8% of admitted diabetic patients die, and more than half already have long-term complications by the time they reach hospital care. Hypertension and peripheral neuropathy are among the most common, while many patients present with advanced kidney disease, frequently linked to poor treatment adherence.

“These are patients arriving late, with complications that are expensive and difficult to treat. Treating advanced complications, including heart disease, kidney failure, dialysis, and transplants, places enormous pressure on a health system operating with limited resources,” Dr Nakwagala said.

He highlighted that women account for nearly three-quarters of patients attending the clinic, and more than half are aged over 49. The hospital also manages around 100 children living with type 1 diabetes, underscoring the lifelong nature of the condition.

Dr Nakwagala said the scale of the crisis becomes clearer when diabetes is viewed beyond clinic walls. At the Uganda Heart Institute, the country’s leading centre for cardiac care, diabetes is a major underlying condition among patients presenting with heart disease. The same pattern is evident in renal units and transplant programmes.

“We are having transplants right now, but again, the problem that is killing the kidneys is diabetes. This work cannot be left to doctors alone. We need people to come on board. We need the government to come on board,” he said.

Diabetes is a chronic metabolic disease characterised by persistently high blood sugar levels, occurring when the body does not produce enough insulin or cannot use it effectively. Without proper management, it damages blood vessels and vital organs, including the heart, kidneys, eyes, and nerves.

Health leaders are now calling for a shift away from late-stage treatment towards prevention, early detection, and long-term support, beginning long before patients reach hospitals.

“We need everybody on board. Right from the village, from breastfeeding and pregnancy, we need a new way of addressing diabetes,” Dr Nakwagala said.

Dr Rosemary Byanyima, Executive Director of Mulago National Referral Hospital, stressed that awareness, education, and advocacy are central to controlling the disease.

“You already have the disease; you need to be supported. "You still can be productive," Dr Byanyima said. “When you are mobile, when you are active, that is exercise. You live longer.”

Dr Byanyima noted that while diabetes is manageable with lifestyle changes, regular monitoring, and medication, late diagnosis remains a common factor that continues to drive complications, admissions, and preventable deaths.