Long COVID Could Be a Major Issue Looming Over Diabetes Community

Jessica Harding, PhD

New research suggests the diabetes community may not be out of the woods yet in regard to the impact of COVID-19.

A scoping review of observational research studies published in English after January 2020 presented at the American Diabetes Association (ADA) 82nd Scientific Sessions, results of the study suggest patients with diabetes could be at a more than 4-fold increase in risk for developing post-acute sequelae of COVID-19 (PASC), often referred to as long COVID.

“As time goes on, we are seeing the negative impacts that long COVID has on the daily lives of patients. Though more research is needed, we now know that patients with diabetes are at a disproportionate risk of long COVID and that these patients should be closely monitored,” said Jessica L Harding, PhD, assistant professor at Emory University’s School of Medicine in Atlanta, GA and lead author on the study. “Careful monitoring of glucose levels in at-risk individuals may help to mitigate excess risk and reduce the burden of lingering symptoms that inhibit their overall wellbeing.”

Throughout the COVID-19 pandemic, the increase risk of severe disease and mortality with COVID-19 among patients with diabetes was widely publicized. In the study presented at ADA 2022, Harding and a team of colleagues from Emory University sought to assess how this increased risk of disease severity might impact risk of long COVID, which recent research suggests is prevalent among 10-30% of individuals who contracted COVID-19. With this in mind, Harding and team performed a scoping literature review on January 27, 2022, using the following terms: long hauler, long COVID-19, post-acute sequelae, and persistent COVID-19 combined with the operator OR, with AND diabetes, and COVID-19.

Through a search of the PubMed database from January 01, 2020-Janaury 27, 2022, investigators identified 39 studies. Of these, 7 were included in the investigators’ analyses. All 7 studies had a longitudinal cohort design, enrolled patients from high-income nations, had sample sizes ranging from 104 to 4182 participants, and had follow-up times ranging from 4 weeks to more than 7 months. For inclusion in the review, studies needed to be published in English, report on incidence of long COVID in people with diabetes versus those without diabetes, and have a minimum follow-up period of 4 weeks after a diagnosis of COVID-19. In her presentation, Harding pointed out long COVID was variably defined and included symptoms such as fatigue, cough, and dyspnea.

Upon analysis, 43% (n=3) reported a diagnosis of diabetes was considered a risk factor for LONG COVID. Among these 3 studies, all reported odds ratios greater 4. For the 4 studies that did not suggest diabetes was a risk factor for long COVID, the odds or risk ratio in these studies ranged from 0.5 to 2.2.

During her presentation, Harding pointed out there were multiple limitations within their study for clinicians to consider when interpreting the results of their review. These included the relatively small number of studies included and the heterogeneity of studies included with specific regard to the definition of long COVID, follow-up times, and risk adjustment. Before concluding the presentation, Harding noted the need for further studies examining the topic to optimize future care of these patients.

“More high-quality studies across multiple populations and settings are needed to determine if diabetes is indeed a risk factor for long COVID. In the meantime, while we wait for that data, careful monitoring of people with diabetes for the development of long COVID may be advised,” Harding added.

This study, “Diabetes as a Risk Factor for Long-COVID-19—A Scoping Review,” was presented at ADA 2022.