High prevalence of post-COVID-19 fatigue in patients with Type 2 diabetes: Study

Post-COVID-19 syndrome (PCS) or Long COVID has emerged as a major roadblock in the recovery of patients infected with SARS-CoV-2. Amidst many symptoms such as myalgia (muscle pain), headache, cough and breathlessness, fatigue is most prevalent and makes a COVID patient severely debilitated.

A recent study conceived by Dr Anoop Misra, Padma Shri, Executive Chairman and Director, Diabetes and Endocrinology, Fortis C-DOC, conducted jointly by Fortis C-DOC, AIIMS, C-NET, N-DOC and Diabetes Foundation and published in the journal, Diabetes & Metabolic Syndrome: Clinical Research and Reviews, reveals that Type 2 diabetes (T2D) patients who had COVID-19 showed significantly more fatigue when compared with patients who did not have COVID-19.

The results show that diabetes complicates the course of COVID-19 and results in excess morbidity and mortality; the presence of diabetes also influences PCS via various pathophysiological mechanisms. Further, diabetes poses challenges in the recovery of patients. This is a first-of-its-kind study globally.

The study objective was to assess the prevalence of fatigue using the CFQ-11 and handgrip strength (as a surrogate marker for sarcopenia or muscle mass and power) in patients with Type 2 diabetes after COVID-19 infection and to compare them against patients with diabetes without a history of COVID-19. The sample size assessed was from 108 type 2 diabetes patients.

The methodology followed was to assess patients with T2D who came to the OPDat Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi. Patients studied included 52 Type 2 Diabetes patients who had suffered from COVID with mild to moderate severity; 56 Type 2 diabetes patients who did not suffer from COVID. Both groups were matched for age, duration of diabetes, BMI, TSH, serum albumin and vitamin D levels.

Matching was done for common factors which may cause fatigue; 25(OH)D, serum albumin and TSH levels. The average time of presentation of patients post-COVID was 92 (range 32-262) days. Symptoms were scored using Chalder Fatigue Scale (reported as fatigue score, FS) and handgrip strength (in kg) was recorded by Jamar Hydraulic Hand Dynamometer.

Key Findings:

- T2D patients who had COVID-19 showed significantly more fatigue when compared with patients who did not have COVID-19 but both groups had comparable handgrip strength.

- T2D with previous COVID-19 infection and who had Fatigue score > 4 have (high fatigue level) had significant higher inflammation markers during acute illness, and post COVID-19, had increased postprandial blood glucose levels, lost more weight, had reduced physical activity and showed significantly lower handgrip strength as compared to those with Fatigue score < 4. Overall, high fatigue seems to result from severe COVID-19 and high blood sugar levels.

- Rehabilitation of those with fatigue score>4 after acute infection would require careful attention to nutrition, glycemic control and graduated physical activity protocol.

- These findings are particularly relevant in view of the increased prevalence of severe diabetes during times of COVID-19.

Dr Anoop Misra, Padma Shri, Executive Chairman and Director, Diabetes and Endocrinology, Fortis C-DOC, shared, "Fatigue is a predominant and very debilitating factor, present afterwards in both hospitalized and non-hospitalized COVID patients. Fatigue and associated symptoms decrease quality of life and interfere with normal working capacity."

Talking about the study he continued, "For the first time, such a collaborative case-control study has been done by Fortis C-DOC, AIIMS, C-NET, N-DOC and Diabetes Foundation and it shows diabetes complicates the course of COVID-19, influences PCS or long COVID via various pathophysiological mechanisms. In addition, diabetes poses challenges in the recovery of patients. It is imperative, therefore, for chronic diabetic patients to follow a healthy lifestyle, adhere to treatment guidelines and go for regular health checks."

Dr Misra, elaborated further, "This new important study re-emphasizes that management of diabetes should be sustained and more stringent during a pandemic. COVID-19 fatigue should be addressed through a multidisciplinary approach which includes the treating clinician, psychological counsellor, nutritionist, and physical therapy expert. Blood glucose and blood pressure should be optimal and more aggressive glycemic management is required. Special care must be taken regarding nutrition and protein and vitamin supplements should be used as required. Exercise and physiotherapy should be started early after COVID-19 as it may benefit not only fatigue but cardiovascular and pulmonary health and mental well-being of the patient."