This document discusses long COVID and diabetes. It defines long COVID as signs and symptoms that continue or develop after acute COVID-19 infection. It notes the risk of developing new or worsening diabetes with COVID-19 and discusses the bidirectional relationship between the two conditions. The pathophysiology of long COVID is not fully understood but may involve persistent inflammation and immune system dysfunction. Management of diabetes in long COVID focuses on adequate glycemic control through lifestyle modifications and medications.

1. DIABETES AND
LONG COVID

2. LEARNING OBJECTIVES:
➤ What is LONG COVID?
➤ What are the risk factors of long covid?
➤ What is the pathophysiology of long covid?
➤ What are types of long covid?
➤ What are symptoms of long covid?
➤ Management of long covid ?

3. CASE DEFINITIONS: (AS PER NICE 2021)
Acute COVID-19: Signs and symptoms of COVID 19 for up to 4 weeks.
Ongoing symptomatic COVID-19: Signs and symptoms of COVID 19 from 4 weeks up to 12 weeks.
Post-COVID-19 syndrome: Signs and symptoms that develop during or after an infection consistent with COVID 19, continue for
more than 12 weeks and are not explained by an alternative diagnosis.
Long COVID : signs and symptoms that continue or develop after acute COVID 19. It includes both ongoing symptomatic COVID 19
(from 4 to 12 weeks) and post COVID 19 syndrome (12 weeks or more).
Long covid should be suspected in patients with suspected or confirmed acute COVID-19 and
present to any healthcare setting, irrespective of whether they were hospitalised or had a
positive or negative SARS-CoV-2 test (PCR, antigen or antibody).

4. The Conundrum of ‘Long-COVID-19ʹ: A Narrative Review International Journal of General Medicine 2021:14 2491–2506
The likelihood of developing
ongoing symptomatic COVID-19 or
post-COVID-19 syndrome is not
considered to be linked to the
severity of their acute COVID 19
(including whether they were in
hospital)

5. PATHOPHYSIOLOGY OF LONG COVID
Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes Metab Syndr. 2021 May-Jun;15(3):869-875. doi: 10.1016/j.dsx.2021.04.007. Epub 2021 Apr 20. PMID: 33892403; PMCID: PMC8056514.

9. The Conundrum of ‘Long-COVID-19ʹ: A Narrative Review International Journal of General Medicine 2021:14 2491–2506

10. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management BMJ 2021; 374 :n1648 doi:10.1136/bmj.n1648

11. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management BMJ 2021; 374 :n1648 doi:10.1136/bmj.n1648

12. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management BMJ 2021; 374 :n1648 doi:10.1136/bmj.n1648

13. Mackay A. A Paradigm for Post-Covid-19 Fatigue Syndrome Analogous to ME/CFS. Front Neurol. 2021 Aug 2;12:701419. doi: 10.3389/fneur.2021.701419. PMID: 34408721; PMCID: PMC8365156.

14. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management BMJ 2021; 374 :n1648 doi:10.1136/bmj.n1648

15. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management BMJ 2021; 374 :n1648 doi:10.1136/bmj.n1648

16. DOI: https://doi.org/10.1016/j.chest.2020.10.067

17. https://enderley.nhs.uk/wp-content/uploads/2020/04/Covid-booklet-post-discharge-hospital-FINAL.pdf

18. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management BMJ 2021; 374 :n1648 doi:10.1136/bmj.n1648

19. LONG COVID IN A
NUTSHELL

20. ➤ Inter relationship between covid and Diabetes?
➤ Incidence of Dysglycaemia/New onset Diabetes in covid?
➤ Risk of developing long covid among patients with acute covid 19 having Diabetes?
➤ Management of Diabetes in covid and long covid?
➤ Prognosis of covid and long covid in patients having Diabetes?

21. DIABETES AND COVID19: A
BIDIRECTIONAL RELATIONSHIP
Unnikrishnan, R., Misra, A. Diabetes and COVID19: a bidirectional relationship. Eur J Clin Nutr 75, 1332–1336 (2021). https://doi.org/10.1038/s41430-021-00961-y

22. Lim, S., Bae, J.H., Kwon, HS. et al. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol 17, 11–30 (2021). https://doi.org/10.1038/s41574-020-00435-4
Potential pathogenic mechanisms in patients with T2DM and COVID-19

23. www.thelancet.com/diabetes-endocrinology Vol 8 September 2020
COVID-19 and diabetes: understanding the reasons for
worse outcomes

24. High prevalence of diabetes in a
hospitalized COVID-19 population.
Patients with diabetes or hypertension had
more severe disease and greater mortality.
Ambrish Mithal,et al,Diabetes Metab Syndr. 2021
doi: 10.1016/j.dsx.2020.12.029

25. Diabetes Care 2021 Feb; 44(2): 526-532.
https://doi.org/10.2337/dc20-2260

26. LONG COVID AND
DIABETES
Raveendran AV, Misra A. Post COVID-19 Syndrome ("Long COVID") and Diabetes: Challenges in Diagnosis and Management. Diabetes Metab Syndr. 2021;15(5):102235. doi:10.1016/j.dsx.2021.102235
Published on Jul 2021

27. CURRENT
EVIDENCE ABOUT
THE RISK OF
GETTING LONG
COVID AMONG
PATIENTS WITH
DIABETES

28. In conclusion, current and previous evidence
suggest that diabetes seems to play a more
relevant role during the acute phase of COVID-19
rather than for the development of post-COVID
symptoms in previously hospitalized COVID-19
survivors.
César Fernández-de-las-Peñas,et al vol. 70 no. 12 2917-2921 DOI
https://doi.org/10.2337/db21-0329
Published on December 2021

29. Management of Diabetes in Long Covid

30. https://www.mohfw.gov.in/pdf/ClinicalGuidanceonDiagnosisandManagementofDiabetesatCOVID19PatientManagementfacility.pdf

31. Front. Endocrinol., 28 October 2020 | https://doi.org/10.3389/fendo.2020.584642

32. WHO GUIDELINES FOR REDUCING SEDENTARY
LIFESTYLE

33. Lim, S., Bae, J.H., Kwon, HS. et al. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol 17, 11–30 (2021). https://doi.org/10.1038/s41574-020-00435-4

34. https://www.mohfw.gov.in/pdf/ClinicalGuidanceonDiagnosisandManagementofDiabetesatCOVID19PatientManagementfacility.pdf

35. https://www.mohfw.gov.in/pdf/ClinicalGuidanceonDiagnosisandManagementofDiabetesatCOVID19PatientManagementfacility.pdf

36. https://www.mohfw.gov.in/pdf/ClinicalGuidanceonDiagnosisandManagementofDiabetesatCOVID19PatientManagementfacility.pdf

37. Take Home Message:
Long covid is a syndrome which affects multiple organs in the body and manifests with different range of signs
and symptoms.
Identify the patients with Long covid early and use a Holistic and patient centered approach,offer appropriate tests
and rule out life threatening complications and refer to Multidisciplinary services as needed and perform a holistic
assessment and provide appropriate treament,support and rehabilitation.Advice regular self monitoring and follow
up.
Our understanding about the epidemology,prevalence,risk factors,pathophysiology,various
presentations,prognosis and management of Long covid is still evolving and further research is needed to
understand our new enemy in a better manner.
Diabetes seems to play a more relevant role during the acute phase of COVID-19 rather than for the development
of post-COVID symptoms in previously hospitalized COVID-19 survivors.Adequate glycemic control reduces
mortality risk in covid.

38. THANK
YOU