#16,642
While it has become increasingly popular to equate COVID infection with the flu, we continue to see evidence that the long-term impact of SARS-CoV-2 on patients can be far greater than that from seasonal influenza. Even among COVID patients who only experienced mild illness.
Last month, in American Heart Assoc: Stroke Risk Among Older Adults Highest in First 3 Days After COVID-19 Diagnosis, we looked at a study that found the risk of stroke increased 10-fold in the week following infection. Although it declined over time, even a month later it was still 9% higher than normal.Post-COVID Sequelae - often lasting months - can range from dysnomia to extreme fatigue and muscle weakness to memory and cognitive difficulties (see Preprint: Results of the Danish AFTER-COVID Survey).
We've seen many other neurological manifestations associated with COVID illness (see JAMA: Neurologic Manifestations Of Patients With Severe Coronavirus Disease), including:
Just over a month ago, in Nature: Long-term Cardiovascular Outcomes of COVID-19, we saw an early analysis of the long-term (12 month) impact of COVID illness on cardiovascular health, even among those who weren't ill enough to require hospitalization.Neurological manifestations ranged from relatively mild (headaches, dizziness, anosmia, mild confusion, etc.) to more profound (seizures, stupor, loss of consciousness, etc.) to potentially fatal (ischemic stroke, cerebral hemorrhage, muscle injury (rhabdomyolysis), etc.).
The authors wrote:
We show that, beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease.
These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care).
Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.
Adding to this growing body of evidence, today we have a study, published in Diabetologia, that finds an increased risk of post-COVID patients being diagnosed with type 2 diabetes.
While a causal link isn't firmly established, this isn't the first time we've seen diabetes linked to COVID infection (see MMWR Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years — United States, March 1, 2020–June 28, 2021)
First the link, and excerpts from the study, followed by a link and excerpts from the press release. After which I'll return with a postscript.
Incidence of newly diagnosed diabetes after Covid-19
Wolfgang Rathmann, Oliver Kuss & Karel Kostev
Diabetologia (2022)
AbstractAims/hypothesisThe aim of this work was to investigate diabetes incidence after infection with coronavirus disease-2019 (Covid-19). Individuals with acute upper respiratory tract infections (AURI), which are frequently caused by viruses, were selected as a non-exposed control group.MethodsWe performed a retrospective cohort analysis of the Disease Analyzer, which comprises a representative panel of 1171 physicians’ practices throughout Germany (March 2020 to January 2021: 8.8 million patients). Newly diagnosed diabetes was defined based on ICD-10 codes (type 2 diabetes: E11; other forms of diabetes: E12–E14) during follow-up until July 2021 (median for Covid-19, 119 days; median for AURI 161 days). Propensity score matching (1:1) for sex, age, health insurance, index month for Covid-19/AURI and comorbidity (obesity, hypertension, hyperlipidaemia, myocardial infarction, stroke) was performed. Individuals using corticosteroids within 30 days after the index dates were excluded. Poisson regression models were fitted to obtain incidence rate ratios (IRRs) for diabetes.ResultsThere were 35,865 individuals with documented Covid-19 in the study period. After propensity score matching, demographic and clinical characteristics were similar in 35,865 AURI controls (mean age 43 years; 46% female). Individuals with Covid-19 showed an increased type 2 diabetes incidence compared with AURI (15.8 vs 12.3 per 1000 person-years). Using marginal models to account for correlation of observations within matched pairs, an IRR for type 2 diabetes of 1.28 (95% CI 1.05, 1.57) was estimated. The IRR was not increased for other forms of diabetes.Conclusions/interpretationCovid-19 confers an increased risk for type 2 diabetes. If confirmed, these results support the active monitoring of glucose dysregulation after recovery from mild forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
From the Press Release:
New study finds higher rates of newly diagnosed type 2 diabetes after infection with mild COVID-19
(Excerpt)
The researchers found that new cases of type 2 diabetes were more common in patients who tested positive for COVID-19 than those with an AURI (15.8 vs 12.3 per 1000 people per year) giving an incidence rate ratio (IRR) of 1.28. In simple terms, this means that the relative risk of developing type 2 diabetes in the COVID group was 28% higher than in the AURI group. The IRR for the COVID group was not increased in other unspecified forms of diabetes.
"COVID-19 infection may lead to diabetes by upregulation of the immune system after remission, which may induce pancreatic beta cell dysfunction and insulin resistance, or patients may have been at risk for developing diabetes due to having obesity or prediabetes, and the stress COVID-19 put on their bodies speeded it up", says lead author Professor Wolfgang Rathmann. “The risk of abnormally high blood sugar in individuals with COVID-19 is most likely a continuum, depending on risk factors such as injury to beta cells, an exaggerated inflammatory response, and changes in pandemic-related weight gain and decreased physical activity”, adds co-author Professor Oliver Kuss.
Prof Rathmann adds: “Since the COVID-19 patients were only followed for about three months, further follow-up is needed to understand whether type 2 diabetes after mild COVID-19 is just temporary and can be reversed after they have fully recovered, or whether it leads to a chronic condition."
Some important caveats from this study include: Patients enrolled were infected during the first year of the pandemic (before Delta or Omicron appeared), and before vaccines were rolled out. Additional studies will be needed to see if these findings can be confirmed, and whether these trends continued into the second year of the pandemic.
Although many people dismiss COVID infection as trivial since it is mostly mild, and has a high survivability rate, there is obviously more than just the acute phase of the infection to consider.
In the decade following the 1918 H1N1 pandemic, the world saw a mysterious global epidemic of Encephalitis Lethargica (The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?). Among those who survived, Parkinsonism and other neurological sequelae was common.
We've seen repeated warnings from researchers that more insidious delayed manifestations of Post-COVID infection might emerge, perhaps even 5 or even 10 years down the road.
Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanismsSimilarly, what appears to be minor heart damage today may, over time, progress into something more problematic.Emily A. Troyer, Jordan N. Kohn, and Suzi Hong
Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?
Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
Taking the `long view', the individual and societal impact of COVID-19 may end up being far greater than is currently generally appreciated, and may not become fully apparent for years.
For some additional information on `Long COVID', you may wish to revisit:
CDC Science Update: COVID-19 and Persistent Symptoms
Two Preprints on `Long COVID' To Ponder
