Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management

Abstract

Presence of various health issues even after recovering from acute COVID19 is collectively called post COVID syndrome (PCS, or “long COVID”). The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate postural hypotension with tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction in patients with diabetes. Strict control of diabetes and other co-morbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS. Patients may suffer from several debilitating symptoms/signs that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks after infection, and are not explained by an alternative diagnosis [ 1 ]. Common symptoms include fatigue, breathlessness, myalgia, weakness, headache, cognitive blunting etc. This conglomeration of symptoms is called “Long COVID” or more appropriately as “Post COVID-19 Syndrome (PCS)” [ 2 ]. The aim of the brief review is to summarise current knowledge of health events occurring after COVID-19 in brief and relate them for patients with diabetes.

High prevalence of post COVID-19 fatigue in patients with type 2 diabetes: A case-control study

“…While fatigue has been seen in considerable number of patients after COVID-19, its pathogenesis is largely unknown ( 1 ). One of the key factors is inflammation induced by COVID-19, which can cause ‘accelerated ageing’ of the muscles ( 13 ) leading to sarcopenia.…”

“…Hypoxia induced by major COVID-19 pneumonia and subsequent fibrosis could also lead to muscle fatigue. Besides these psychological stress and depression, often seen post COVID-19 could also lead to fatigue ( 1 ). Prolonged corticosteroid use ( 16 )and electrolyte disorders (e.g., hypokalaemia) could exacerbate muscle weakness.…”

“…In a review, data from nine clinical studies showed significant decrease in fatigue scores in the group receiving vitamin C group vs. control group ( 24 ). Exercise and physiotherapy should be started early as it may benefit not only fatigue but cardiovascular, pulmonary and mental fitness ( 1 ). In cases of marked weight loss, it may be advisable to withhold SGLT2i and GLP-1 receptor analogs.…”

“…Diabetes complicates course of COVID-19 and results in excess morbidity and mortality ( 11 ). Presence of diabetes also influences PCS via various pathophysiological mechanisms ( 1 ). Further, diabetes poses challenges in recovery of PCS.…”

Post-COVID-19 syndrome and type 2 diabetes: Primacy of exercise in prevention and management

“…and delays in recovery from COVID-19 [ 16 ]. Further, Post COVID-19 syndrome could affect patients with diabetes differentially [ 17 ]. Fatigue is the most common symptomology of post COVID-19 syndrome, and according to a recent study, it is seen more in patients with T2D [ 16 ].…”