The jury is still out on whether diabetes is a risk factor for post-acute sequelae of COVID-19 (PASC), a researcher reported.
In a scoping review of seven studies, three (43%) concluded that diabetes was indeed a “potent” risk factor for the prolonged development of COVID after infection, according to Jessica L. Harding, PhD, of Emory University School of Medicine in Atlanta.
Among these studies, diabetes was tied with a four times greater chance of developing prolonged COVID-19 symptoms, with all odds ratios settling above 4. These studies were primarily comprised of patients hospitalized for COVID-19 infection, she said. in a presentation at the annual meeting of the American Diabetes Association (ADA).
However, in the four (57%) other studies included, the findings were inconclusive as to any significant links between diabetes and long-term COVID. For these studies, all ORs and relative ratios ranged from 0.5 to 2.2 and did not reach statistical significance.
“This review suggests that there is some evidence that diabetes may be a potent risk factor for long-term COVID,” Harding said, adding that the results were limited by the small number of studies focusing on possible links between diabetes and long-term COVID, along with with the heterogeneity of the studies. In particular, a consistent definition of long-term COVID was lacking (although it was generally thought of as ongoing COVID symptoms such as fatigue, cough, dyspnoea, and others); variation in relation to duration of follow-up and risk adjustment; and differences in the at-risk populations included.
Harding explained that a 2022 Cell study inspired his research. That study found that type 2 diabetes was one of four significant risk factors for developing long-term COVID, and also reported that SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific autoantibodies were strong risk factors for post-operative sequelae. – acute cases of COVID-19.
“Further high-quality studies across multiple populations and settings are needed to determine whether diabetes is indeed a risk factor for long-term COVID,” Harding’s group said. “While we wait for these data, careful monitoring of people with diabetes for the development of long-term COVID is advised.”
For the review, they analyzed 39 studies published from January 2020 to January 2022 that included a minimum of 4 weeks of follow-up after a diagnosis of COVID-19. All studies also compared the incidence of long-term COVID in people with diabetes versus patients without.
The seven studies included in the analysis had a longitudinal cohort design and had adults from high-income countries such as Italy, Norway, USA, UK and Sweden. The largest study followed 4,182 patients.
There was a mix of hospitalized and non-hospitalized COVID patients, as well as patients with other comorbidities, such as kidney transplant recipients. This study of kidney transplant recipients with COVID-19 found a 4.42-fold increased chance of long-term COVID with diabetes (OR 4.42, 95% CI 1.16-16.8).
Harding has not revealed any relationship with the industry. Co-authors disclosed relationships with Bayer and Merck.