New Symptoms and Conditions Rise Sharply After COVID-19 Hospitalization

Randy Dotinga

February 08, 2022

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

A new study provides more evidence of a possible link between severe COVID-19 and subsequent diagnosis of type 2 diabetes. More than 7% of COVID-positive hospitalized adult patients were diagnosed with the condition within a few months compared with just 1.7% of nonhospitalized COVID-positive patients. Among hospitalized and ventilated COVID-positive patients, the rate was nearly 17%.

"Prior reports have found an increase in diabetes among adults following COVID-19 illness, and we have reported previously an increase in risk of both type 1 and type 2 diabetes among kids," said lead author Alfonso C. Hernandez-Romieu, MD, MPH, lieutenant commander of the United States Public Health Service, in an interview. "This report adds to these findings by reporting an increase linked to severity of COVID-19."

The study was published online February 4 in JAMA Network Open.

The research launched the study to expand on previous research into post-COVID conditions by including nonhospitalized patients and exploring possible links to disease severity, Hernandez-Romieu said.

For the cohort study, the researchers analyzed the health records of 388,024 people younger than 20 years and 1.79 million people aged 20 and older from 40 healthcare systems. All the patients were tested for COVID-19 from March-December 2020 (the early months of the pandemic) and all saw medical professionals between 31 and 150 days later.

Of the older patients, 9.4% turned up positive; 7.9% of the younger patients were positive.

"New conditions were rare among children and young adults 1 to 5 months after infection," Hernandez-Romieu said. "However, adults with COVID-19 who were hospitalized and who were hospitalized/ventilated were much more likely to experience new and debilitating symptoms and conditions 1 to 5 months after infection compared to those who were not hospitalized. These symptoms included shortness of breath, fatigue, sleep disorders, and cognitive dysfunction, and conditions included diabetes, myoneural disorders, and peripheral nerve disorders."

Among patients of all ages who were hospitalized, the researchers found that shortness of breath was more commonly diagnosed among the COVID-positive group vs the COVID-negative group (≥ 20 years: prevalence ratio [PR], 1.89; 99% CI, 1.79 - 2.01 and < 20 years: PR, 1.72; 99% CI, 1.17 - 2.51).

About 1 in 10 (10.5%) hospitalized patients in the older group were diagnosed with shortness of breath compared with just 4.1% of patients who were COVID-negative and not hospitalized and 4.5% of those who were COVID-positive but not hospitalized.

"Shortness of breath is likely due to the cytotoxic effect of SARS-CoV-2 on respiratory cells, which takes time to recover," Hernandez-Romieu said. "In some cases, this can lead to long-term damage of the lung leading to fibrosis and poor oxygenation."

Cases of type 2 diabetes were also more common in the hospitalized patients who were COVID-positive vs those who were hospitalized and COVID-negative (>20 years: PR, 2.03; 99% CI, 1.87 - 2.19 and <20 years: PR, 2.14; 99% CI, 1.13 – 4.06).

The researchers noted that the percentage of younger COVID-positive subjects who were hospitalized and later developed type 2 diabetes was very small at just 1.3%. But among the older patients who were hospitalized and COVID-positive, the percentage was 7.2%. It shot up to 16.7% among hospitalized patients who were both COVID-positive and ventilated.

"SARS-CoV-2 infection may lead directly to diabetes by injuring cells responsible for regulation of blood sugar, or treatments associated with severe COVID-19 may lead to dysregulation of blood sugar, or patients may have been predisposed to developing diabetes due to having obesity or prediabetes," said Hernandez-Romieu. "Further follow-up is needed to understand whether this diabetes is transient or leads to a chronic condition."

Cases of new fatigue were also higher in the older group of COVID-positive hospitalized patients vs COVID-negative hospitalized patients (PR, 1.35; 99% CI, 1.27 - 1.44). Among COVID-positive patients age 20 and older, the percentage diagnosed with new fatigue was 4.2% (nonhospitalized) 8% (hospitalized), and 19.8% (hospitalized and ventilated).

Overall, Hernandez-Romieu said the study findings suggest that "the sicker COVID-19 makes you, the more likely you will have sequelae from the infection, sometimes with chronic and debilitating conditions. Currently available COVID-19 vaccines remain highly effective at preventing severe COVID-19 and are the best tool we have to prevent post-COVID conditions."

The study has limitations. It doesn't track people who didn't seek medical care within a few months after their COVID-19 tests or hospitalizations, and it's not clear whether the new symptoms and conditions have anything to do with COVID-19.

Epidemiologist Jodie L. Guest, PhD, MPH, from Emory University in Atlanta, Georgia, told Medscape Medical News she is struck by the findings from this study and others about higher rates of type 2 diabetes after infection with COVID-19. "The observed association has been hypothesized as being attributable to one of several things. There may be direct attack of pancreatic cells expressing angiotensin-converting enzyme 2 [ACE2] receptors and alterations in glucose metabolism caused by infection. Or this may be more common in people who were prediabetic."

Guest added that the study suggests that "longer-term issues may be more common in those who needed hospitalization or even ventilation and are more common in those over 20. That said, those under 20 are still at risk for prolonged shortness of breath, heart rate abnormalities, and new onset of type 2 diabetes. All of this adds to the evidence that we want to do all we can to not get COVID-19 — like being vaccinated, boosted, and wearing masks when population prevalence is high."

The study was funded by the CDC. One author reported receiving grants from the CDC during the study. Hernandez-Romieu, the other authors, and Guest have disclosed no relevant financial relationships.

JAMA Network Open. Published online February 4, 2022. Full text

Randy Dotinga is a freelance journalist who covers medicine and health.

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