New Delhi: 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 & 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 course of COVID-19 and results in excess morbidity and mortality; 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 108 type 2 diabetes patients.
The methodology followed was to assess patients with T2D who came to the OPD at 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. 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.
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 post prandial 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 increased prevalence of severe diabetes during times of COVID-19.