Abstract 5
Authors: Vulpala Alekya , Deb Prasun , Nalla Smitha 
Published: February 2023

Background: The world continues to face the ongoing COVID 19 pandemic, which has affected multiple organ systems. Diabetes is a slow growing pandemic, affecting an individual in multiple ways. Both these disease conditions have impacted each other in terms of clinical progression and outcome. To date, acute hyperglycaemic effects of Covid and new onset diabetes post covid have been established. How long this glycaemic effect persists, is yet to be established. In our study, we aimed to look at the glycaemic changes over 6 months post covid-19 infection, among previously diagnosed type 2 diabetic subjects having good to modestly good control of diabetes.

Methods: Type 2 diabetic individuals who met the eligibility criteria and visited the Endocrinology outpatient department with a history of covid infection, were included. The severity of covid infection and steroid usage data was collected retrospectively from discharge summary, and patient history. HbA1c, fasting and postprandial glucose values prior to covid-19 infection were collected from previous outpatient records. Diet, physical activity and drug compliance history were collected by oral questionnaires. These individuals were called back for follow-up at 3 months. Those with poor glycaemic control were followed-up at monthly intervals, for drug titration. Data collected over six months period was analysed for significance of change in glycatedhaemoglobin, fasting and prandial glucose values. The confounding effects of poor dietary compliance, lack of physical activity, steroid use during covid was also studied after adjusting the data.

Results: Among 1856 patients screened, 256 subjects were included in the study after meeting eligibility criteria. Among them 36.5% (96) were females and 62.5% (160) were males. More than half of the subjects (135) were aged greater than 60 years. The mean duration of diabetes was 8.2 years. In majority (183), duration of diabetes was less than 10 years. The severity of Covid infection was found to be parallel with prior diabetic control. The mean glycatedhaemoglobin level before covid was 7.2%. On follow up at three months it had raised to 8.6% (p < 0.001). At six months, the mean glycatedhaemoglobin was at higher level of 7.9% (p < 0.001) in spite of dose titration in 72% of subjects. The change is equally driven by both fasting and prandial glucose levels (all p < 0.001). When data was adjusted to the use of steroids, still significant changes in all three variables-glycatedhaemoglobin, fasting and prandial glucose levels persisted. When confounding effects of both steroid use and lack of physical activity were excluded, the glycatedhaemoglobin changes at three and six months was significant at p < 0.0001 and p < 0.02 respectively. Though the change in fasting and prandial glucose values at three months was significant (p < 0.001), it was not significant at six months (p = 0.08). The changes in glycaemic control were affected by severity of Covid infection, with poor glycaemic control in those having severe infection.

Conclusions: Covid 19 infection impairs glycaemic control in long term. Thus, frequent monitoring and timely drug titration is necessary for appropriate management of diabetes post Covid.