Post COVID-19 Complications: Fatigue Prevalent In Corornavirus Patients With Type 2 Diabetes

People suffering from an underlying disease like type-2 diabetes are more likely to suffer from complications like fatigue. Here is everything you need to know about this new prevalent symptom of COVID among diabetics.

It has been almost two years since the deadly virus interrupted life as we knew it and caused unimaginable suffering to millions of people throughout the world. The elderly and persons with underlying health disorders like diabetes and hypertension have been warned since the beginning of the epidemic that they are at a higher risk of serious disease and fatal complications. Experts have repeatedly cautioned this population group that extra care and safety measures are required to keep safe. Even now as new COVID-19 variants continue to remain rampant in many countries including India, the post-COVID-19 complications, also known as Long COVID, is emerging as a major roadblock in the recovery of patients infected with SARS-CoV-2.

Long Covid is a disorder in which persons who have healed from COVID-19 continue to experience symptoms for far longer than they should. Long-term Covid cases are those who continue to have signs of the disease four weeks after their initial recovery. So far, several symptoms, including myalgia (muscle pain), headache, cough and breathlessness are believed to be the prominent symptoms of the disease, but studies have shown that fatigue is also one of the debilitating symptoms that affect COVID patients.

Fatigue Is Common In COVID-19 Patients Suffering From Diabetes

A recent study led by Dr Anoop Misra, Padma Shri, Executive Chairman and Director, Diabetes and Endocrinology, Fortis C-DOC, and conducted in collaboration with Fortis C-DOC, AIIMS, C-NET, N-DOC, and the Diabetes Foundation and published in the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews, found that Type 2 diabetes (T2D) patients who had COVID-19 experienced significantly more fatigue than those who did not. The findings reveal that diabetes worsens the course of COVID-19 and leads to increased morbidity and death. Diabetes also affects PCS via a variety of pathophysiological mechanisms. Diabetes also makes it difficult for people to recover.

Dr Anoop Misra 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. 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."

The Study

The goal of the study was to compare the prevalence of fatigue (as a surrogate marker for sarcopenia or muscle mass and power) and handgrip strength (as a surrogate marker for sarcopenia or muscle mass and power) in patients with Type 2 diabetes after COVID-19 infection to patients with diabetes without a history of COVID-19 infection. A total of 108 types 2 diabetic individuals were included in the study.

Patients with T2D who presented to the OPD at Fortis CDOC Hospital for Diabetes and Allied Sciences in New Delhi were assessed. Patients included 52 type 2 diabetes patients with mild to moderate COVID and 56 Type 2 diabetic patients who did not have COVID. Age, diabetes duration, BMI, TSH, serum albumin, and vitamin D levels were all comparable in both groups. 25(OH)D, serum albumin, and TSH levels were matched for common factors that can cause fatigue. The average duration for patients to appear after COVID was 92 days (range 32-262). The Chalder Fatigue Scale (reported as fatigue score, FS) was used to rate symptoms, and the Jamar Hydraulic Hand Dynamometer was used to measure handgrip strength (in kg).

Key Findings Of The Study

Here are the key findings of the study:

• 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.

Importance Of Controlling Diabetes

Whether as a post COVID complication or otherwise, there is an urgent need to control diabetes in people as it is already an epidemic that might blow out of proportion without timely intervention. Further explaining the need to take appropriate measures to control diabetes, Dr Misra, elaborates, "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."