COVID-19 May Increase the Risk of Insulin Resistance in Adult Patients Without Diabetes: A 6-Month Prospective Study

  • Mochuan Chen
    Affiliations
    Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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  • Bing Zhu
    Affiliations
    Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
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  • Dong Chen
    Affiliations
    Department of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang, China
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  • Xingzhong Hu
    Affiliations
    Department of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang, China
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  • Xueqin Xu
    Affiliations
    Department of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang, China
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  • Wen-Jun Shen
    Affiliations
    Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, California

    Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
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  • Chenchan Hu
    Correspondence
    Address correspondence and reprint requests to Dr Chenchan Hu, Departments of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People’s Hospital of Wenzhou, 1 Qinzhong Road, Ouhai District, Wenzhou, 325000, Zhejiang Province, China.
    Affiliations
    Department of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang, China
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  • Jue Li
    Correspondence
    Dr Jue Li, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, 1239 Siping Road, Yangpu District, Shanghai, 200092, China.
    Affiliations
    Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
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  • Shen Qu
    Correspondence
    Dr Shen Qu, Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, 301 Yanchang Road, Jin’an District, Shanghai, 200072, China.
    Affiliations
    Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
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      Abstract

      Objective

      During the coronavirus disease 2019 (COVID-19) pandemic, exploring insulin resistance and beta-cell activity is important for understanding COVID-19‒associated new-onset diabetes. We assessed insulin sensitivity and fasting insulin secretion in patients with COVID-19 without diabetes on admission and at 3 and 6 months after discharge.

      Methods

      This 6-month prospective study assessed data from the records of 64 patients without diabetes diagnosed with COVID-19 at Wenzhou Central Hospital, China. Each patient was followed up at 3 and 6 months after discharge. Repeated measures analysis of variance was used to investigate differences in multiple measurements of the same variable at different times. Linear regression analysis was performed to analyze the contributor for changes in the triglyceride-glucose (TyG) index.

      Results

      Fasting C-peptide levels in patients at baseline were lower than the normal range. Compared with the baseline results, patients had significantly elevated fasting C-peptide levels (0.35 ± 0.24 vs 2.36 ± 0.98 vs 2.52 ± 1.11 μg/L; P < .001), homeostasis model assessment for beta-cell function (0.42, interquartile range [IQR] 0.36-0.62 vs 2.54, IQR 1.95-3.42 vs 2.90, IQR 2.02-4.23; P < .001), and TyG indices (8.57 ± 0.47 vs 8.73 ± 0.60 vs 8.82 ± 0.62; P = .006) and decreased fasting glucose levels (5.84 ± 1.21 vs 4.95 ± 0.76 vs 5.40 ± 0.68 mmol/L; P = .003) at the 3- and 6-month follow-up. Male gender, age, interferon-alfa treatment during hospitalization, and changes in total cholesterol and high-density lipoprotein levels were significantly associated with changes in the TyG index.

      Conclusion

      Our study provided the first evidence that COVID-19 may increase the risk of insulin resistance in patients without diabetes.

      Key words

      Abbreviations:

      ACE2 (angiotensin-converting enzyme 2), BMI (body mass index), COVID-19 (coronavirus disease 2019), FBG (fasting blood glucose), HDL (high-density lipoprotein), HOMA (homeostatic model assessment), HOMA-CP (homeostasis model assessment for beta-cell function), HOMA-IR (homeostasis model assessment for insulin resistance), IFN (interferon), IL (interleukin), IQR (interquartile range), LDL (low-density lipoprotein), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), TC (total cholesterol), TyG (triglyceride-glucose)
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