Metabolic–Renal Divergence in Diabetic Patients Three Months After COVID-19: Evidence from a Real-World Cohort

Abstract

Background: The short-term impacts of COVID-19 in diabetes are still unknown as well. When glycemic improvement is followed by renal stabilization in a patient after treatment of COVID-19 infection. Objective: To evaluate three-month glycemic and renal trajectories following COVID-19 infection and to identify predictors of persistent poor glycemic control. Methods: This retrospective real-world cohort study included 301 adults with diabetes and confirmed COVID-19 infection. Baseline measurements were obtained at the first post-COVID clinical assessment, and follow-up measurements were recorded approximately three months later. Paired t-tests assessed within-subject changes in HbA1c, fasting plasma glucose (FPG), and serum creatinine. McNemar’s test evaluated shifts in glycemic control category (HbA1c<8%). Multivariable linear and logistic regression analyses identified predictors of glycemic change and persistent poor control. Effect sizes were calculated using Cohen’s d. Results: HbA1c was significantly decreased (9.08±2.22% to 8.43±2.04%. FPG was reduced (51 mg/dL; p < 0.001). The creatinine level remained similarly in line but slightly rose in diabetic patients at 3 months of chronic comorbidity (+ 0.094mg/dL; p=0.001), an indication of metabolic-renal divergence. Significant improvement of the glycemic control category was observed as well (p<0.001). Conclusion: Three months after COVID-19 treatment, there was a positive correlation between glycemic control and glucose decline, along with a reasonable renal outcome. This clearly illustrates an acute need for early cardiometabolic care after infection.