Public health

COVID’s metabolic legacy looms large: Endocrine Society


Associate Professor Mihail Zilbermint

The COVID-19 pandemic will likely leave a metabolic legacy in terms of increased new onset diabetes after COVID infection and in obesogenic lifestyle and behavioural changes that won’t snap back easily.

Speaking at an Endocrine Society meeting on COVID-19, diabetes and obesity, Associate Professor Mihail Zilbermint said there was growing evidence of a bidirectional relationship between COVID-19 and diabetes.

While the increased risk of severe COVID-19 in people with diabetes was well known, the metabolic effects of COVID – evident from early in the pandemic – was only starting to be fully explored.

He said the reports of increased diabetes after COVID came from patients with even mild COVID through to those experiencing long COVID.

As reported recently in the limbic, a German study of more than 70,000 people found an increased incidence of type 2 diabetes in individuals recovered from COVID-19 compared to those recovered from acute upper respiratory infections (IRR 1.28).

Associate Professor Zilbermint, Director of Endocrinology, Diabetes and Metabolism at the Johns Hopkins Community Physicians Suburban Hospital, said another study in US veterans had shown similar results.

Beyond the first 30 days of infection, COVID-19 survivors exhibited increased risks of incident diabetes (HR 1.40) and anti-hyperglycaemic medication use (HR 1.85) compared to contemporary controls.

A similar worrying effect in children and adolescents has been reported by the CDC.

“COVID-19 is not that benign in children. The increased risk of diabetes among children with COVID-19 highlights the importance of COVID-19 prevention strategies in this age group including vaccination for eligible persons, ” Associate Professor Zilbermint said.

He said while the disease mechanism was still unclear, the findings were an argument for clinicians – GPs and specialists – to screen for diabetes in patients who had recovered from COVID-19.

Pandemic weight gain

Associate Professor Amy Rothberg, Director of the Michigan Weight Management Program and Diabetes Cure Clinic, told the meeting she was concerned that the COVID-19 pandemic had accelerated the already high and increasing prevalence of obesity.

“COVID-19 has exposed a lot of vulnerabilities in our current food system, our surrounding environment and the absence of processes to protect the health of our vulnerable populations,” she said.

She said a Stress in America poll by the American Psychological Society in 2021 found 42% of Americans reported unintended average weight gain of 29 lb (13 kg) during the first year of the pandemic.

“10% reported a weight gain of 50lb (22kg) or greater. Two-thirds reported an undesirable change in sleep and we know that poor sleep hygiene is associated with weight gain or at least weight resistance.”

“We also consumed a lot more alcohol during the pandemic and more alcohol means more empty calories, disinhibited eating, and fragmented and poor sleep,” she said.

“We were all working from home – a scenario in which we were less active and spent far more time in front of our screens again contributing to more sedentariness.”

She said adolescents doubled their non-school-related screen time from about 4 hrs per day to about 8 hours per day.

“And of course we had 24 hour access to our kitchen which also led to greater consumption but also a shift from fresh food to shelf stable foods. We consumed greater amounts of what we label comfort food and certainly we ordered more food to be delivered.”

Associate Rothberg said most of the COVID-19 deaths occurred in people with poor metabolic health.

“But obesity is a modifiable risk factor and metabolic health must be a priority. We need to recognise obesity as a disease – it is fundamentally about biology – and we need to prioritise as a health issue.”

“We can reduce the stigma and myths and misconceptions and improve our response which should be multifaceted.”

“We should provide enough support to individuals achieve a healthier weight by expanding weight management services and access to effective modalities including intensive lifestyle behavioural programs, anti-obesity medications, and surgery.”

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