1302-P: Long-COVID in Type 1 and Type 2 Diabetes—Prevalence, Clinical Outcomes, and Inflammatory Marker Responses

Introduction: Diabetes significantly impacts COVID-19 morbidity and mortality, with the long-term sequelae ('long-COVID') in diabetes poorly understood. This study examines the prevalence and clinical outcomes of long-COVID, and the influence of pharmacotherapy, such as metformin use, on COVID-19 symptom persistence. Another objective is to determine inflammatory cytokine concentrations in patients with long-COVID.

Methods: Adult T1D and T2D patients at Joslin Diabetes Center, USA, were surveyed for COVID-19 history with EMRs providing demographic and clinical data. Blood samples were analyzed using Elecsys Anti-SARS-CoV-2 (Roche, Indianapolis) and V-Plex assays (MSD, Rockville) for COVID-19 antibodies and cytokines, respectively.

Results: Among 358 patients (162 T1D, 196 T2D), T2D patients were older (62.8 years, SD 11.9) compared to T1D patients 47.4 years, SD 15.6; p<0.001). The majority were White, with a higher proportion of Asian Americans among T2D (4% vs. 27%, p<0.001). Long-COVID was reported by 30% of T2D and 13% of T1D patients (p=0.002). Comparing T1D and T2D patients with long COVID, T2D patients exhibited higher HbA1c values by 1.1% (SD: 0.48) (p=0.03). No difference in HBA1c was seen in patients with T1D. In T1D, significant increases in IL-1b, IL-6 (p<0.001 each), and TNF-a (p=0.003) were observed, with no change in IL-10 (p=0.62). T2D patients with long-COVID had increased TNF-α (p=0.01) and decreased IL-10 (p=0.04). Additionally, Metformin initiation was linked to a 48% reduced likelihood of long-COVID (p=0.04).

Conclusion: Long-COVID manifests differently in T1D and T2D, with distinct cytokine changes suggesting unique inflammatory responses. In T2D, patients with long-COVID exhibit worse glycemic control and metformin may play a potentially protective role. Ongoing research is needed to determine the relationship between metformin use and inflammatory markers in long-COVID.