Research Article
Incidence of Diabetes and Ischemic Heart Disease in COVID-19 Post-Pandemic
Raj Kamal Choudhry1*
Submitted: October 20, 2024; Accepted: October 27, 2024; Published: October 28, 2024
Corresponding Author1*: Dr Raj Kamal Choudhry, Professor, MD Medicine, Department, Jawaharlal Medical College, Bhagalpur, Bihar, India; email: [email protected]
Abstract
Background: The long-term effects of the COVID-19 Pandemic are currently getting more attention. The majority of individuals with COVID-19 report having symptoms for a duration greater than four weeks following their initial appearance. After COVID-19 infection, there is worry that cardiovascular and metabolic conditions may be harmed. The severity of the sickness and COVID-19 vulnerability, meanwhile, are known to be linked to cardiometabolic risk.
Aim: To study the incidence of ischemic heart disease and diabetes mellitus post-COVID-19 pandemic
Methods and Materials: Information for all individuals diagnosed with COVID-19 was taken at the beginning of the investigation from the department’s release of electronic medical records in February 2021. The main outcomes analyzed were first-ever documented CVD as well as DM diagnoses. The data were then collected at different periods. They were as follows: Before the date of indexing. Acute: Follow up till four weeks from the index. Post-acute: Five to twelve weeks from the date of indexing. Long: Thirteen weeks to fifty-two weeks from the date of indexing. Poisson confidence intervals (CIs) were computed.
Results: CVD events were 1362 in the COVID-19 study group, while 131 in the control study group at a phase corresponding to four weeks after the indexed date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 2,134 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to 13 to 52 weeks since the indexing date.
Conclusion: Early on, after COVID-19 infection, the risk of CVD is elevated, and this risk is elevated for up to three months. However, there is a long-term rise in the prevalence of CVD or DM in COVID-19 patients who do not already have these illnesses.
Keywords: Prevalence, Cardiovascular disorders, diabetes mellitus, post COVID-19
Introduction
The multiple organ systems illness known as Coronavirus Disease of 2019 (COVID-19) more universally acknowledged [1]. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus infects the respiratory system and causes host immune reactions that could have systemic implications by activating inflammatory mediators [2,3]. With the downregulated response of the immune system, irregular platelet aggregation, coagulopathy, endothelial cell malfunction, and thrombosis affecting different methods with a risk of end-organ harm, COVID-19 may cause an i”flammatory “cy”okine storm” [4]. While fresh cardiovascular disorders (CVD) and fresh cases of diabetes mellitus (DM) have been linked to initial COVID-19 contamination [5], longer-term consequences after the contamination have not been extensively described.
Cardiac arrest, cardiac damage with raised troponin levels, and an increased morbidity and mortality probability among COVID-19-positive individuals who get hospitalized are some of the cardiac symptoms of COVID-19 [6,7]. In the first four weeks, COVID-19 can be additionally linked to sudden myocardial infarction and ischemic stroke [8-10]. Patients with COVID-19 have witnessed new-onset hyperglycemia, frequently referred to as “stress hy” euglycemia,” which has been linked with a poorer outcome [5,11]. Both existent and newly developed DM might have sequelae, such as hyperosmolarity condition and diabetic ketoacidosis condition [12–14]. Elevated concentrations of cytokine interleukin-6 (IL-6) and cytokine tumor necrosis factor-alpha (TNF) are indicative of direct pancreatic injury by SARS-CoV-2 and accompanying general inflammatory conditions seen in chronic post-COVID-19, which results in decreased pancreatic insulin production and insulin resistance [15,16].
The long-term effects of COVID-19 are currently getting more attention. The majority of individuals with COVID-19 report having symptoms for longer than 4 weeks following their initial appearance [17-19]. After COVID-19 infection, there is worry that cardiovascular conditions and metabolic conditions may be harmed. The severity of the sickness and COVID-19 vulnerability, meanwhile, are known to be linked to cardiometabolic risk.
The recovery period following COVID-19 is still inadequately understood, though. With longitudinal data from digital medical records, it is possible to analyze COVID-19 results over a longer period. We conducted the study to compare a group of patients with COVID-19 exposure to a matched cohort of patients without a COVID-19 diagnosis. We sought to determine the overall impact of COVID-19 contamination on cardiovascular and metabolic consequences over four weeks, three months, and twelve months to identify areas for future research that may be most important and to guide clinical care and public health initiatives.
Methods and Materials
Data source and participant selection
Information for all individuals diagnosed with COVID-19 was taken at the beginning of the investigation from the department’s release of electronic medical records in February 2021. The index deadline for COVID-19 contamination was the day of the first coding. We considered individuals with medical as”easement o” “co” firmed” or” “suspected” COVID-19 since conclusive testing was not generally accessible during the epidemic’s early stages. However, we performed a risk assessment using patients with a polymerase chain reaction (PCR) test validated COVID-19 medical coding documented. A subset of normal control patients without a history of COVID-19 contamination reported till the indexing date was contrasted to the COVID-19 group.
Control participants were randomly selected from the March 2021 version registered populace, which offered the most recent data available in the database at the time of sampling. The records of controls were evaluated eighteen months before the beginning of the research, and they had to be compared for age, gender, and family practice. Patients who had widespread CVD or DM reported more than a year or within a year of the commencement of their record were not eligible to serve as controls.
Outcome measures
The main outcomes analyzed were the first-ever documented CVD and DM diagnoses. Stroke, venous thrombosis, pulmonary embolism, cardiomyopathy and myocarditis, heart failure, condition ischemic heart disease, condition of myocardial infarction, supraventricular tachycardia, atrial arrhythmias, atrial fibrillation were the subcategories into which CVD diagnoses were divided. Type 1 diabetes and type 2 diabetes mellitus diagnoses were made, and oral hypoglycaemic medications and insulin were started. A subsequent record of HbA1c ≥ 48 mmol/mol was deemed definitive of diabetes after reviewing the HbA1c records. When insulin was administered within three months of diagnosis, and the patient had a diagnostic age of thirty-five years or below, the participants were identified as having a type 1 DM profile [22]. The date of death served as the measurement of mortality.
Covariates
Data collected during the research period before the index date was used to define variables. Body mass index (BMI) and smoking status were chosen as covariates because of documented correlations with CVD and DM.
The data were then collected at different periods. They were as follows:
Before the date of indexing
Acute: Follow up till four weeks from the index
Post-acute: Five to twelve weeks from the date of indexing
Long: Thirteen weeks to fifty-two weeks from the date of indexing
Poisson confidence intervals (CIs) were computed.
We were aware that the prevalence of CVD and diabetes may shift between 13 and 52 weeks after the confirmation of COVID-19. To compare each four-week duration after a COVID-19 detection with the baseline, we calculated adjusted rate ratios and associated 95% confidence intervals (CIs) in secondary analyses. The loess method was used to fit a smooth curve to the estimates before plotting them. We limited our sensitivity analysis to COVID-19 subjects who have tested positive for SARS-CoV-19 infection via PCR.
A logistic regression framework was developed to assess the variables connected to PCR confirmation. The SPSS program, version 2021, was used to implement all computations. After peer review, we added a risk assessment to see if accounting for the number of consultations could help explain the correlation between COVID-19 and diabetes incidence.
Results
It was observed that CVD events were 3,092 in the COVID-19 study group, while 1,761 in the control study group at the phase before the index date. CVD events were 1,362 in the COVID-19 study group, while 131 in the control study group at a phase corresponding to four weeks after the indexed date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 2,134 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to 13 to 52 weeks since the indexing date.
It was found that CVD events were greater in the CIVID-19 group than in the control group at all observation phases. It was further observed that CVD cases decreased four weeks after the indexing date. It was further reduced from five to twelve weeks after the indexing date. However, it increased after 13 to 52 weeks from the indexing date. The findings were significant statistically. (p≤0.001). (table 1,2).
It was observed that Diabetes mellitus events were 3,474 in the COVID-19 study group and 2,547 in the control study group at the phase before the index date. Diabetes mellitus events were 424 in the COVID-19 study group, while 168 in the control study group at a phase corresponding to four weeks after the indexed date. Diabetes mellitus events were 690 in the COVID-19 study group, while 386 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 690 in the COVID-19 study group, while 386 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. Diabetes mellitus events were 3,263 in the COVID-19 study group, while 2,164 in the control study group at a phase corresponding to 13 to 52 weeks since the indexing date.
It was found that Diabetes mellitus events were greater in the COVID-19 group than in the control group at all the phases of observation. It was further observed that cases of diabetes mellitus decreased at four weeks after the indexing date. It increased from five weeks to twelve weeks after the date of indexing. Again it increased after 13 to 52 weeks from date of indexing. The findings were significant statistically. (p≤0.01). (table 1,2).
Table 1: Prevalence of CVDs and DM at different periods of follow-up of COVID-19
| Phase | Post-acute: Five to twelve weeks from the date of indexing | Before the date of indexing | Long: Thirteen weeks to fifty-two weeks from the date of indexing | Long: Thirteen weeks to fifty-two weeks from date of indexing | ||||
| COVID-19 subjects | Control subjects | COVID-19 subjects | Control subjects | COVID-19 subjects | Control subjects | COVID-19 subjects | Control subjects | |
| Patient weeks | 21,894,812 | 22,462,512 | 1,765,413 | 1,750,536 | 3,485,891 | 3,461,146 | 16,635,311 | 16,351,221 |
| CVD events | 3,092 | 1,761 | 1,362 | 131 | 781 | 298 | 2,134 | 1,567 |
| CVD incidence every one lakh patient weeks (95% CI) | 14.21 (13.59 to 14.67) | 7.59 (7.31 to 8.01) | 77.06 (73.86 to 84.12) | 7.42 (6.21 to 8.73) | 23.14 (20.64 to 24.79) | 8.52 (7.58 to 9.57) | 12.76 (12.24 to 13.19) | 9.11 (8.78 to 9.69) |
| Diabetes diagnoses | 3,474 | 2,547 | 424 | 168 | 690 | 386 | 3,263 | 2,164 |
| DM incidence every one lakh patient weeks (95% CI) | 15.93 (15.31 to 16.51) | 11.45 (10.91 to 11.81) | 23.84 (21.61 to 26.21) | 9.57 (8.21 to 11.52) | 19.61 (19.21 to 22.07) | 11.21 (10.13 to 12.42) | 19.57 (18.13 to 20.37) | 13.18 (12.73 to 13.85) |
Table 2: Results of analysis in difference in incidences of DM and CVD at different periods of observations.
| DM | All CVD outcomes | |||
| Unadjusted | Adjusted | Unadjusted | Adjusted | |
| Unadjust”d | 1.82 (1.56 to 2.29) | 1.83 (1.56 to 2.23) | 5.71 (4.81 to 6.91) | 5.72 (4.84 to 7.21) |
| RR (95% CI) | ||||
| P value | < 0.031 | < 0.021 | < 0.041 | “Ac”te COVID-19” up to four weeks |
| < 0.03″ | 1.29 (1.13 to 1.51) | 1.31 (1.32 to 1.51) | 1.46 (1.33 to 1.76) | 1.51 (1.32 to 1.82) |
| RR (95% CI) | ||||
| P value | < 0.011 | < 0.041 | < 0.021 | “Post-ac”te COVID-19” five to twelve weeks |
| < 0.0″ | 1.08 (0.99 to 1.16) | 1.08 (0.99 to 1.17) | 0.79 (0.71 to 0.87) | 0.91 (0.76 to 0.91) |
| RR (95% CI) | ||||
| P value |
Discussion
There is currently increasiCOVID-19’sn COVID-19’s long-term consequences. The majority of COVID-19 patients claim that their symptoms persisted for more than 4 weeks after they first manifested. There is concern that metabolic and cardiovascular problems may be damaged by COVID-19 infection. Conversely, it is known that the austerity of the illness and COVID-19 vulnerability are related to cardiometabolic risk. [20-21]
Furthermore, during the height of the disease outbreak, restrictions on patients were associated with substantial alterations in eating habits and other health related activities that may have had an effect on CVD conditions and diabetes conditions in the common people even with no evidence of COVID-19 infection. Hence, controlled trials are necessary to determine the overall impact of COVID-19 contamination on cardiovascular health outcomes and diabetic outcomes after adjusting for premorbid changes between people with and without symptoms and variations in time in matched controls. [22-23] Concerns about the potential consequences of “l” COVID-19″ syndromes are present in COVID-19 patients who are hospitalized. Still, few studies have established prolonged follow-up for sizable population-based study populations.
It was observed that CVD events were 3,092 in the COVID-19 study group, while 1,761 in the control study group at the phase before the index date. CVD events were 1,362 in the COVID-19 study group, while 131 in the control study group at a phase corresponding to four weeks after the indexed date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 2,134 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to 13 to 52 weeks since the indexing date.
It was found that CVD events were greater in the COVID-19 group than in the control group at all observation phases. It was further observed that CVD cases decreased four weeks after the indexing date. It further decreased from five weeks to twelve weeks after the indexing date. However, it increased after 13 to 52 weeks from the indexing date. The findings were significant statistically. (p≤0.001)
.
The 2019 Coronavirus Disease (COVID-19) is a multi-organ system ailment that is becoming well-recognized. By activating inflammatory mediators, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus attacks the respiratory system and triggers host immunological reactions that may have systemic effects [24,25]. COVID-19 may result in an “inflammatory “cy”one storm” due to the system’s downregulation, abnormal platelet aggregation, coagulopathy, endothelial cell dysfunction, and thrombosis that may injure end organs. Although the initial COVID-19 contamination has been connected to recent cardiovascular diseases (CVD) and cases of diabetic mellitus (DM), the longer-term effects following the contamination have not been thoroughly discussed. [26,27]
Some of the cardiac symptoms of COVID-19 include cardiac arrest, heart damage with elevated troponin levels, and a higher likelihood of morbidity and mortality. Individuals with COVID-“9 have had “stress hy”erglycemia,” or new-onset hyperglycemia, which has been associated with a worse prognosis. [28-30] Existing DM and newly formed DM may both have complications, such as hyperosmolarity and diabetic ketoacidosis. Lowered pancreatic insulin production and insulin resistance are caused by direct pancreatic injury caused by chronic COVID-19 contamination, which is indicated by elevated lecytokine’se cytokine’s interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF) [15, 16].
This study obtained information from the department’s release of electronic medical data in February 2021 for all persons diagnosed with COVID-19 at the investigation’s outset. The first day of coding was the COVID-19 contamination index deadline. Although concluswasn’tsting wasn’t always available in the early stages of the epidemic, we took into account people having medical ass”ssments o” “co” firmed” o” “suspected” COVID-19.
The primary outcomes were the first-ever documented diagnosis of DM and CVD. The subcategories into which CVD diagnoses were separated included stroke, venous thrombosis, pulmonary embolism, cardiomyopathy and myocarditis, and heart failure. Diagnoses for type 1 diabetes mellitus and type 2 diabetes mellitus were made, and insulin and oral hypoglycaemic drugs were started. Reviewing the HbA1c records, a subsequent record of HbA1c values greater or equal to 48 mmol/mol was declared to constitute proof of diabetes. Participants were classified as having a type 1 DM profile when given insulin within three months of diagnosis and had a diagnostic age of 35 years or less [22]. The mortality rate was calculated based on the date of death.
It was observed that Diabetes mellitus events were 3,474 in the COVID-19 study group, while it was 2,547 in the control study group at the phase before the index date. Diabetes mellitus events were 424 in the COVID-19 study group, while 168 in the control study group at a phase corresponding to four weeks after the indexed date. Diabetes mellitus events were 690 in the COVID-19 study group, while 386 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 690 in the COVID-19 study group, while 386 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. Diabetes mellitus events were 3,263 in the COVID-19 study group, while 2,164 in the control study group at a phase corresponding to 13 to 52 weeks since the indexing date.
It was found that Diabetes mellitus events were greater in the COVID-19 group than in the control group at all the phases of observation. It was further observed that cases of diabetes mellitus decreased at four weeks after the indexing date. It increased from five weeks to twelve weeks after the date of indexing. Again, it increased after 13 to 52 weeks from the indexing date. The findings were significant statistically. (p≤0.01).
In early COVID-19 infection, hospitalized patients can experience a variety of cardiovascular problems, including palpitations, heart problems, and thrombotic abnormalities [21]. Yet few studies have followed these patients over the long term in the absence of preexisting CVD. Knight et al. [20] described the findings of CVDs studied in a subpopulation of England in a preprint. According to their findings, CVD outcomes may continue to be worse for up to 49 weeks after COVID-19 infection [20].
More severe COVID-19 sickness is also linked to preexisting DM [22]; however, another research points to a possible link between COVID-19 and newly developed diabetes. 14.4% of individuals who were hospitalized during the early COVID-19 epidemic, according to a systematic assessment of 8 cases, went on to acquire new-onset diabetes [23]. The observation that the virus penetrates beta cells of the pancreas [24], lowers insulin production, and accelerates beta-cell death [25] points to a potential impact of SARS-CoV-2 disease on pancreatic function. Reduced exercise and deconditioning brought on by COVID-19 may potentially increase insulin resistance [26]. Increased chances of discovering diabetes that had not yet been diagnosed may also result from interactions with medical professionals. In earlier studies, hospital-based populations with lower sample sizes or follow-up times were frequently reported. This extensive population-based investigation demonstrates that people with COVID-19 had a somewhat increased baseline risk of developing diabetes.
Al-Aly and colleagues [5] identified an increase in the burden of numerous health concerns 30 days and six months following COVID-19 by using a data mining technique on digital medical data. According to Knight and colleagues [20], venous and arterial issues remained higher for 49 weeks after COVID-19. Nonetheless, there is a lack of knowledge regarding the recovery phase following COVID-19. Longer lengths of time can be used to analyze COVID-19 results when longitudinal data from digital medical records are used. We conducted a study to contrast a cohort of individuals exposed to COVID-19 to a matched cohort of people undiagnosed with COVID-19. To pinpoint the areas for potential future research that may be most crucial and to direct clinical care and public health initiatives, we sought to ascertain the overall impact of COVID-19 contamination on cardiovascular and metabolic consequences over four weeks, three months, and twelve months. [29,30]
Conclusion
Early on, after COVID-19 infection, the risk of CVD is elevated, and this risk is elevated for up to three months. However, it was observed that there was less evidence of a long-term rise in the prevalence of CVD or DM in COVID-19 patients who do not already have these illnesses. This study shows that after a COVID-19 infection, the incidence of DM is high for at least 12 weeks before it starts to decline. Given the elevated baseline risk, COVID-19 patients should be advised to lower their risk of developing diabetes, including changes to their diet, weight management approach, and physical activity level.
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- DOI: 10.62996/daj.28102024
- Cite this Article
Raj Kamal Choudhry. Incidence of Diabetes and Ischemic Heart Disease in COVID-19 Post-Pandemic. Diabetes Asia Journal. 2024;1(2):1-11. https://doi.org/10.62996/daj.28102024
