Cardiovascular Autonomic Function in Long COVID-19 Individuals With and Without Diabetes

Coronavirus disease 2019 (COVID-19) has been associated with a broad spectrum of long-term complications. These include the development and progression of severe autonomic dysfunction, particularly among people with diabetes. We evaluated cardiovascular autonomic (CAN) function in a cross-sectional study in 47 adults with long COVID-19 with (N=21, mean age 61 years, 43% women, mean A1c 6.2%) and without type 2 diabetes mellitus (T2DM) (N=26, mean age 58 years, 65% women) and compared them with T2DM without COVID-19 (N=45, mean age 57 years, 42% women, mean A1c 7.8%). CAN was assessed with cardiovascular autonomic reflex tests (30:15 ratio, E.I ratio, Valsalva ratio) and indices of heart rate variability (SDNN, RMSSD). We used pairwise comparison and Analysis of Covariance (ANCOVA) both adjusted for age, gender, race, and BMI to compare the groups. In a pairwise comparison higher heart rate (HR) and lower CAN measures (SDNN, RMSSD, Valsalva) were found in T2DM with COVID-19 compared to T2DM without COVID-19. Lower HR and lower Valsalva were found in COVID-19 individuals without T2DM compared to T2DM without COVID-19. When comparing the three groups, lower Valsalva were found in COVID-19 individuals with and without T2DM compared to T2DM without COVID-19 (Figure). These data suggest that COVID-19 exacerbates CAN in patients with T2DM and impacts CAN in people without T2DM at a magnitude similar to that of T2DM patients. Disclosure J.Fleischer: None. A.Vasbinder: None. S.Hayek: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. S.V.G.Gunaratnam: None. Y.Huang: None. L.Ang: None. M.Charles: Research Support; Novo Nordisk Foundation, Speaker's Bureau; Novo Nordisk A/S, Boehringer-Ingelheim. A.Katona: None. N.Baker: None. K.R.Mizokami-stout: None. Y.Lin: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (U01DK119083, P30DK020572); Steno North American Fellowships 2021; Novo Nordisk Foundation (21OC0072180)