Post-Covid syndrome or Long Covid has emerged as a major roadblock in the recovery of patients infected with SARS-CoV-2, a new study showed.
Fatigue is most prevalent and makes a coronavirus disease (Covid-19) patient severely debilitated, among other symptoms such as myalgia (muscle pain), headache, cough and breathlessness.
A recent study conceived by Dr Anoop Misra, executive chairman and director at the department of Diabetes and Endocrinology, Fortis C-DOC and conducted jointly by Fortis C-DOC, All India Institute of Medical Sciences, C-NET, N-DOC reveals that Type 2 diabetes patients who had Covid-19 showed significantly more fatigue when compared with patients who did not have the infection.
The results show that diabetes complicates course of Covid-19 and results in excess morbidity and mortality; presence of diabetes also influences post-Covid syndrome via various pathophysiological mechanisms. Further, diabetes poses challenges in the recovery of patients. This is a first of its kind study globally.
The study assessed 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 Type 2 diabetes who came to the OPD at Fortis C-DOC Hospital for Diabetes and Allied Sciences, New Delhi. Patients studied included 52 Type 2 Diabetes patients who had suffered from coronavirus with mild to moderate severity; 56 Type 2 diabetes patients who did not suffer from the infection.
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.
Type 2 diabetes patients who had Covid-19 showed significantly more fatigue when compared with patients who did not have the infection but both groups had comparable handgrip strength.
Type 2 diabetes 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 above 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.
Dr Misra said fatigue is a predominant and very debilitating factor, present afterwards in both hospitalised and non-hospitalised Covid-19 patients.
“Fatigue and associated symptoms decrease quality of life and interfere with normal working capacity,” Dr Misra said.
He said diabetes complicates course of Covid-19, influences post-Covid syndrome 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,” he added.
Dr Misra further elaborated that the study strsses that management of diabetes should be sustained and more stringent during a pandemic. He called for management of Covid-19 fatigue through a multidisciplinary approach, including treating clinician, psychological counsellor, nutritionist, and physical therapy expert.