Soff Samuel, Yoo Yun Jae, Bramante Carolyn, Reusch Jane E B, Huling Jared Davis, Hall Margaret A, Brannock Daniel, Sturmer Til, Butzin-Dozier Zachary, Wong Rachel, Moffitt Richard
Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA.
Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2025 Feb 4;13(1):e004536. doi: 10.1136/bmjdrc-2024-004536.
Elevated glycosylated hemoglobin (HbA1c) in individuals with type 2 diabetes is associated with increased risk of hospitalization and death after acute COVID-19, however the effect of HbA1c on Long COVID is unclear.
Evaluate the association of glycemic control with the development of Long COVID in patients with type 2 diabetes (T2D).
We conducted a retrospective cohort study using electronic health record data from the National COVID Cohort Collaborative. Our cohort included individuals with T2D from eight sites with longitudinal natural language processing (NLP) data. The primary outcome was death or new-onset recurrent Long COVID symptoms within 30-180 days after COVID-19. Symptoms were identified as keywords from clinical notes using NLP in respiratory, brain fog, fatigue, loss of smell/taste, cough, cardiovascular and musculoskeletal symptom categories. Logistic regression was used to evaluate the risk of Long COVID by HbA1c range, adjusting for demographics, body mass index, comorbidities, and diabetes medication. A COVID-negative group was used as a control.
Among 7430 COVID-positive patients, 1491 (20.1%) developed symptomatic Long COVID, and 380 (5.1%) died. The primary outcome of death or Long COVID was increased in patients with HbA1c 8% to <10% (OR 1.20, 95% CI 1.02 to 1.41) and ≥10% (OR 1.40, 95% CI 1.14 to 1.72) compared with those with HbA1c 6.5% to <8%. This association was not seen in the COVID-negative group. Higher HbA1c levels were associated with increased risk of Long COVID symptoms, especially respiratory and brain fog. There was no association between HbA1c levels and risk of death within 30-180 days following COVID-19. NLP identified more patients with Long COVID symptoms compared with diagnosis codes.
Poor glycemic control (HbA1c≥8%) in people with T2D was associated with higher risk of Long COVID symptoms 30-180 days following COVID-19. Notably, this risk increased as HbA1c levels rose. However, this association was not observed in patients with T2D without a history of COVID-19. An NLP-based definition of Long COVID identified more patients than diagnosis codes and should be considered in future studies.
2型糖尿病患者糖化血红蛋白（HbA1c）升高与急性COVID-19后住院和死亡风险增加相关，然而HbA1c对新冠后综合征的影响尚不清楚。
评估2型糖尿病（T2D）患者血糖控制与新冠后综合征发生之间的关联。
我们使用来自国家新冠队列协作组的电子健康记录数据进行了一项回顾性队列研究。我们的队列包括来自八个站点的具有纵向自然语言处理（NLP）数据的T2D患者。主要结局是COVID-19后30至180天内死亡或新发复发性新冠后综合征症状。使用NLP从呼吸、脑雾、疲劳、嗅觉/味觉丧失、咳嗽、心血管和肌肉骨骼症状类别中的临床记录中识别症状关键词。采用逻辑回归按HbA1c范围评估新冠后综合征的风险，并对人口统计学、体重指数、合并症和糖尿病用药进行校正。以新冠阴性组作为对照。
在7430例新冠阳性患者中，1491例（20.1%）出现有症状的新冠后综合征，380例（5.1%）死亡。与HbA1c为6.5%至<8%的患者相比，HbA1c为8%至<10%（比值比1.20，95%置信区间1.02至1.41）和≥10%（比值比1.40，95%置信区间1.14至1.72）的患者死亡或新冠后综合征的主要结局增加。在新冠阴性组中未观察到这种关联。较高的HbA1c水平与新冠后综合征症状风险增加相关，尤其是呼吸和脑雾症状。在COVID-19后30至180天内，HbA1c水平与死亡风险之间无关联。与诊断代码相比，NLP识别出更多有新冠后综合征症状的患者。
T2D患者血糖控制不佳（HbA1c≥8%）与COVID-19后30至180天出现新冠后综合征症状的较高风险相关。值得注意的是，这种风险随着HbA1c水平的升高而增加。然而，在无COVID-19病史的T2D患者中未观察到这种关联。基于NLP的新冠后综合征定义识别出的患者比诊断代码更多，未来研究应予以考虑。
