Journal article
Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C)
BMJ open diabetes research & care, Vol.13(1), e004536
02/04/2025
DOI: 10.1136/bmjdrc-2024-004536
PMCID: PMC11795369
PMID: 39904520
Abstract
IntroductionElevated 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.ObjectiveEvaluate the association of glycemic control with the development of Long COVID in patients with type 2 diabetes (T2D).Research design and methodsWe 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.ResultsAmong 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.ConclusionPoor 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.
Details
- Title: Subtitle
- Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C)
- Creators
- Samuel Soff - Stony Brook UniversityYun Jae Yoo - Emory UniversityCarolyn Bramante - University of Minnesota Medical CenterJane E B Reusch - University of Colorado Anschutz Medical CampusJared Davis Huling - University of MinnesotaMargaret A Hall - Emory UniversityDaniel Brannock - RTI InternationalTil Sturmer - University of North Carolina at Chapel HillZachary Butzin-Dozier - University of California, BerkeleyRachel Wong - Stony Brook UniversityRichard Moffitt - Emory UniversityAdam B WilcoxAdam M LeeAlexis GravesAlfred Jerrod AnzaloneAmin MannaAmit SahaAmy OlexAndrea ZhouAndrew E WilliamsAndrew SoutherlandAndrew T GirvinAnita WaldenAnjali A SharathkumarBenjamin AmorBenjamin BatesBrian HendricksBrijesh PatelCaleb AlexanderCavin Ward-CavinessCharisse Madlock-BrownChristine SuverChristopher ChuteChristopher DillonChunlei WuClare SchmittCliff TakemotoDan HousmanDavera GabrielDavid A EichmannDiego MazzottiDon BrownEilis BoudreauElaine HillElizabeth ZampinoEmily Carlson MartiEmily R PfaffEvan FrenchFarrukh M KoraishyFederico MarionaFred PriorGeorge SokosGreg MartinHarold LehmannHeidi SprattHemalkumar MehtaHongfang LiuHythem SidkyJ.W. Awori HayangaJami PincavitchJaylyn ClarkJeremy Richard HarperJessica IslamJin GeJoel GagnierJoel H SaltzJohanna LoombaJohn BuseJomol MathewJoni L RutterJulie A McMurryJustin GuinneyJustin StarrenKaren CrowleyKatie Rebecca BradwellKellie M WaltersKen WilkinsKenneth R GersingKenrick Dwain CatoKimberly MurrayKristin KostkaLavance NorthingtonLee Allan PylesLeonie MisquittaLesley CottrellLili PortillaMariam DeacyMark M BissellMarshall ClarkMary EmmettMary Morrison SaltzMatvey B PalchukMelissa A HaendelMeredith AdamsMeredith Temple-O'ConnorMichael G KurillaMichele MorrisNabeel QureshiNasia SafdarNicole GarbariniNoha SharafeldinOfer SadanPatricia A FrancisPenny Wung BurgoonPeter RobinsonPhilip RO PayneRafael FuentesRandeep JawaRebecca Erwin-CohenRena PatelRichard L ZhuRishi KamaleswaranRobert HurleyRobert T MillerSaiju PyarajanSam G MichaelSamuel BozzetteSandeep MallipattuSatyanarayana VedulaT ShawnScott ChapmanSoko Setoguchi O'NeilStephanie S HongSteve JohnsonTellen D BennettTiffany CallahanUmit TopalogluUsman SheikhValery GordonVignesh SubbianWarren A KibbeWenndy HernandezWill BeasleyWill CooperWilliam HillegassXiaohan Tanner ZhangNational COVID Cohort Collaborative (N3C) consortium
- Resource Type
- Journal article
- Publication Details
- BMJ open diabetes research & care, Vol.13(1), e004536
- DOI
- 10.1136/bmjdrc-2024-004536
- PMID
- 39904520
- PMCID
- PMC11795369
- NLM abbreviation
- BMJ Open Diabetes Res Care
- ISSN
- 2052-4897
- eISSN
- 2052-4897
- Publisher
- American Diabetes Association
- Language
- English
- Date published
- 02/04/2025
- Academic Unit
- School of Library and Information Science; Stead Family Department of Pediatrics; Hematology/Oncology; Nursing
- Record Identifier
- 9984786453802771
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