Persistent glycemic deterioration after the COVID-19 pandemic: A large cohort analysis stratifying by care settings, specialties, and gender disparities in Chengdu, China

Objective: This study aimed to quantify the sustained impact of the Coronavirus Disease 2019(COVID-19) pandemic on glycemic control across distinct healthcare settings, medical specialties, and demographic groups. Methods: We conducted a retrospective analysis of 274,909 glycated hemoglobin(HbA1c) records from a tertiary hospital in Chengdu,China between 2013 and 2025. Non-parametric tests were used to compare median HbA1c levels across pre-pandemic, pandemic, peak-infection, and post-pandemic phases, stratified by Healthcare Settings, specialty, age, and gender. Results: < 0.01). Outpatient settings demonstrated the poorest glycemic control (median 6.4 %). The most pronounced deteriorations occurred in critical care unit (ICU: Δ + 3.0 %) and surgical departments (Δ + 0.7 %), while Endocrinology maintained better outcomes (Δ-0.3 %). Older adults (≥76 years, Δ + 0.6 %) and male patients showed greatest vulnerability to glycemic deterioration. Conclusion: The COVID-19 pandemic resulted in persistent glycemic deterioration, particularly affecting outpatient management, acute care settings, and vulnerable demographic groups. These findings highlight critical gaps in diabetes care resilience and underscore the need for targeted interventions in high-risk settings and strengthened support systems for susceptible populations.