Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C)
Introduction Elevated glycosylated hemoglobin (HbA1c) in individuals with type 2 diabetes is associated with increased risk of hospitalization and death after acute COVID-19, however the effect of HbA1c on Long COVID is unclear.Objective Evaluate the association of glycemic control with the developm...
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2025-02-01
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| Series: | BMJ Open Diabetes Research & Care |
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| author | Jane E B Reusch Rachel Wong Nasia Safdar Harold Lehmann Brijesh Patel Til Stürmer Hongfang Liu Peter Robinson Elaine Hill Richard Moffitt Justin Guinney Joel Gagnier Cavin Ward-Caviness Noha Sharafeldin Justin Starren Amit Saha Lesley Cottrell Melissa A Haendel Margaret A Hall Vignesh Subbian Kristin Kostka Farrukh M Koraishy Andrew E Williams Robert Hurley Steve Johnson Usman Sheikh Rishi Kamaleswaran Christopher Dillon Michele Morris Randeep Jawa Hemalkumar Mehta Benjamin Bates Tellen D Bennett Nabeel Qureshi Katie Rebecca Bradwell Federico Mariona Adam B Wilcox Adam M Lee Alexis Graves Amin Manna Amy Olex Andrea Zhou Andrew Southerland Andrew T Girvin Anita Walden Anjali A Sharathkumar Benjamin Amor Brian Hendricks Caleb Alexander Carolyn Bramante Charisse Madlock-Brown Christine Suver Christopher Chute Chunlei Wu Clare Schmitt Cliff Takemoto Dan Housman Davera Gabriel David A Eichmann Diego Mazzotti Eilis Boudreau Don Brown Elizabeth Zampino Emily Carlson Marti Emily R Pfaff Evan French Fred Prior George Sokos Greg Martin Heidi Spratt Hythem Sidky JW Awori Hayanga Jami Pincavitch Jaylyn Clark Jeremy Richard Harper Jessica Islam Jin Ge Joel H Saltz Joel Saltz Johanna Loomba John Buse Jomol Mathew Joni L Rutter Julie A McMurry Karen Crowley Kellie M Walters Ken Wilkins Kenneth R Gersing Kenrick Dwain Cato Kimberly Murray Lavance Northington Lee Allan Pyles Leonie Misquitta Lili Portilla Mariam Deacy Mark M Bissell Marshall Clark Mary Emmett Mary Morrison Saltz Matvey B Palchuk Meredith Adams Meredith Temple-O'Connor Michael G Kurilla Nicole Garbarini Ofer Sadan Patricia A Francis Penny Wung Burgoon Rafael Fuentes Rebecca Erwin-Cohen Richard A Moffitt Richard L Zhu Robert T Miller Saiju Pyarajan Sam G Michael Samuel Bozzette Sandeep Mallipattu Satyanarayana Vedula Scott Chapman T Shawn Soko Setoguchi O'Neil Stephanie S Hong Tiffany Callahan Umit Topaloglu Valery Gordon Warren A Kibbe Wenndy Hernandez Will Beasley Will Cooper William Hillegass Xiaohan Tanner Zhang Samuel Soff Yun Jae Yoo Jared Davis Huling Daniel Brannock Zachary Butzin-Dozier Alfred Jerrod Anzalone Philip RO. Payne Rena Patel |
| author_facet | Jane E B Reusch Rachel Wong Nasia Safdar Harold Lehmann Brijesh Patel Til Stürmer Hongfang Liu Peter Robinson Elaine Hill Richard Moffitt Justin Guinney Joel Gagnier Cavin Ward-Caviness Noha Sharafeldin Justin Starren Amit Saha Lesley Cottrell Melissa A Haendel Margaret A Hall Vignesh Subbian Kristin Kostka Farrukh M Koraishy Andrew E Williams Robert Hurley Steve Johnson Usman Sheikh Rishi Kamaleswaran Christopher Dillon Michele Morris Randeep Jawa Hemalkumar Mehta Benjamin Bates Tellen D Bennett Nabeel Qureshi Katie Rebecca Bradwell Federico Mariona Adam B Wilcox Adam M Lee Alexis Graves Amin Manna Amy Olex Andrea Zhou Andrew Southerland Andrew T Girvin Anita Walden Anjali A Sharathkumar Benjamin Amor Brian Hendricks Caleb Alexander Carolyn Bramante Charisse Madlock-Brown Christine Suver Christopher Chute Chunlei Wu Clare Schmitt Cliff Takemoto Dan Housman Davera Gabriel David A Eichmann Diego Mazzotti Eilis Boudreau Don Brown Elizabeth Zampino Emily Carlson Marti Emily R Pfaff Evan French Fred Prior George Sokos Greg Martin Heidi Spratt Hythem Sidky JW Awori Hayanga Jami Pincavitch Jaylyn Clark Jeremy Richard Harper Jessica Islam Jin Ge Joel H Saltz Joel Saltz Johanna Loomba John Buse Jomol Mathew Joni L Rutter Julie A McMurry Karen Crowley Kellie M Walters Ken Wilkins Kenneth R Gersing Kenrick Dwain Cato Kimberly Murray Lavance Northington Lee Allan Pyles Leonie Misquitta Lili Portilla Mariam Deacy Mark M Bissell Marshall Clark Mary Emmett Mary Morrison Saltz Matvey B Palchuk Meredith Adams Meredith Temple-O'Connor Michael G Kurilla Nicole Garbarini Ofer Sadan Patricia A Francis Penny Wung Burgoon Rafael Fuentes Rebecca Erwin-Cohen Richard A Moffitt Richard L Zhu Robert T Miller Saiju Pyarajan Sam G Michael Samuel Bozzette Sandeep Mallipattu Satyanarayana Vedula Scott Chapman T Shawn Soko Setoguchi O'Neil Stephanie S Hong Tiffany Callahan Umit Topaloglu Valery Gordon Warren A Kibbe Wenndy Hernandez Will Beasley Will Cooper William Hillegass Xiaohan Tanner Zhang Samuel Soff Yun Jae Yoo Jared Davis Huling Daniel Brannock Zachary Butzin-Dozier Alfred Jerrod Anzalone Philip RO. Payne Rena Patel |
| collection | DOAJ |
| description | Introduction Elevated glycosylated hemoglobin (HbA1c) in individuals with type 2 diabetes is associated with increased risk of hospitalization and death after acute COVID-19, however the effect of HbA1c on Long COVID is unclear.Objective Evaluate the association of glycemic control with the development of Long COVID in patients with type 2 diabetes (T2D).Research design and methods We conducted a retrospective cohort study using electronic health record data from the National COVID Cohort Collaborative. Our cohort included individuals with T2D from eight sites with longitudinal natural language processing (NLP) data. The primary outcome was death or new-onset recurrent Long COVID symptoms within 30–180 days after COVID-19. Symptoms were identified as keywords from clinical notes using NLP in respiratory, brain fog, fatigue, loss of smell/taste, cough, cardiovascular and musculoskeletal symptom categories. Logistic regression was used to evaluate the risk of Long COVID by HbA1c range, adjusting for demographics, body mass index, comorbidities, and diabetes medication. A COVID-negative group was used as a control.Results Among 7430 COVID-positive patients, 1491 (20.1%) developed symptomatic Long COVID, and 380 (5.1%) died. The primary outcome of death or Long COVID was increased in patients with HbA1c 8% to <10% (OR 1.20, 95% CI 1.02 to 1.41) and ≥10% (OR 1.40, 95% CI 1.14 to 1.72) compared with those with HbA1c 6.5% to <8%. This association was not seen in the COVID-negative group. Higher HbA1c levels were associated with increased risk of Long COVID symptoms, especially respiratory and brain fog. There was no association between HbA1c levels and risk of death within 30–180 days following COVID-19. NLP identified more patients with Long COVID symptoms compared with diagnosis codes.Conclusion Poor glycemic control (HbA1c≥8%) in people with T2D was associated with higher risk of Long COVID symptoms 30–180 days following COVID-19. Notably, this risk increased as HbA1c levels rose. However, this association was not observed in patients with T2D without a history of COVID-19. An NLP-based definition of Long COVID identified more patients than diagnosis codes and should be considered in future studies. |
| format | Article |
| id | doaj-art-3c1f9bb4182849c88d4cc56ab4cd95c7 |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-3c1f9bb4182849c88d4cc56ab4cd95c72025-02-05T02:55:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972025-02-0113110.1136/bmjdrc-2024-004536Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C) Jane E B Reusch0Rachel Wong1Nasia SafdarHarold LehmannBrijesh PatelTil Stürmer2Hongfang LiuPeter RobinsonElaine HillRichard Moffitt3Justin GuinneyJoel GagnierCavin Ward-CavinessNoha SharafeldinJustin StarrenAmit SahaLesley CottrellMelissa A HaendelMargaret A Hall4Vignesh SubbianKristin KostkaFarrukh M KoraishyAndrew E WilliamsRobert HurleySteve JohnsonUsman SheikhRishi KamaleswaranChristopher DillonMichele MorrisRandeep JawaHemalkumar MehtaBenjamin BatesTellen D BennettNabeel QureshiKatie Rebecca BradwellFederico MarionaAdam B WilcoxAdam M LeeAlexis GravesAmin MannaAmy OlexAndrea ZhouAndrew SoutherlandAndrew T GirvinAnita WaldenAnjali A SharathkumarBenjamin AmorBrian HendricksCaleb AlexanderCarolyn Bramante5Charisse Madlock-BrownChristine SuverChristopher ChuteChunlei WuClare SchmittCliff TakemotoDan HousmanDavera GabrielDavid A EichmannDiego MazzottiEilis Boudreau Don BrownElizabeth ZampinoEmily Carlson MartiEmily R PfaffEvan FrenchFred PriorGeorge SokosGreg MartinHeidi SprattHythem SidkyJW Awori HayangaJami PincavitchJaylyn ClarkJeremy Richard HarperJessica IslamJin GeJoel H SaltzJoel SaltzJohanna LoombaJohn BuseJomol MathewJoni L RutterJulie A McMurryKaren CrowleyKellie M WaltersKen WilkinsKenneth R GersingKenrick Dwain CatoKimberly MurrayLavance NorthingtonLee Allan PylesLeonie MisquittaLili PortillaMariam DeacyMark M BissellMarshall ClarkMary EmmettMary Morrison SaltzMatvey B PalchukMeredith AdamsMeredith Temple-O'ConnorMichael G KurillaNicole GarbariniOfer SadanPatricia A FrancisPenny Wung BurgoonRafael FuentesRebecca Erwin-CohenRichard A MoffittRichard L ZhuRobert T MillerSaiju PyarajanSam G MichaelSamuel BozzetteSandeep MallipattuSatyanarayana VedulaScott ChapmanT ShawnSoko Setoguchi O'NeilStephanie S HongTiffany CallahanUmit TopalogluValery GordonWarren A KibbeWenndy HernandezWill BeasleyWill CooperWilliam HillegassXiaohan Tanner ZhangSamuel Soff6Yun Jae Yoo7Jared Davis Huling8Daniel Brannock9Zachary Butzin-Dozier10Alfred Jerrod AnzalonePhilip RO. PayneRena PatelDivision of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USADepartment of Biomedical Informatics, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USADepartment of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USADepartment of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USADepartment of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USADivision of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USAStony Brook University Renaissance School of Medicine, Stony Brook, New York, USADepartment of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USABiostatistics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USARTI International, Research Triangle Park, North Carolina, USASchool of Public Health, University of California Berkeley, Berkeley, California, USAIntroduction Elevated glycosylated hemoglobin (HbA1c) in individuals with type 2 diabetes is associated with increased risk of hospitalization and death after acute COVID-19, however the effect of HbA1c on Long COVID is unclear.Objective Evaluate the association of glycemic control with the development of Long COVID in patients with type 2 diabetes (T2D).Research design and methods We conducted a retrospective cohort study using electronic health record data from the National COVID Cohort Collaborative. Our cohort included individuals with T2D from eight sites with longitudinal natural language processing (NLP) data. The primary outcome was death or new-onset recurrent Long COVID symptoms within 30–180 days after COVID-19. Symptoms were identified as keywords from clinical notes using NLP in respiratory, brain fog, fatigue, loss of smell/taste, cough, cardiovascular and musculoskeletal symptom categories. Logistic regression was used to evaluate the risk of Long COVID by HbA1c range, adjusting for demographics, body mass index, comorbidities, and diabetes medication. A COVID-negative group was used as a control.Results Among 7430 COVID-positive patients, 1491 (20.1%) developed symptomatic Long COVID, and 380 (5.1%) died. The primary outcome of death or Long COVID was increased in patients with HbA1c 8% to <10% (OR 1.20, 95% CI 1.02 to 1.41) and ≥10% (OR 1.40, 95% CI 1.14 to 1.72) compared with those with HbA1c 6.5% to <8%. This association was not seen in the COVID-negative group. Higher HbA1c levels were associated with increased risk of Long COVID symptoms, especially respiratory and brain fog. There was no association between HbA1c levels and risk of death within 30–180 days following COVID-19. NLP identified more patients with Long COVID symptoms compared with diagnosis codes.Conclusion Poor glycemic control (HbA1c≥8%) in people with T2D was associated with higher risk of Long COVID symptoms 30–180 days following COVID-19. Notably, this risk increased as HbA1c levels rose. However, this association was not observed in patients with T2D without a history of COVID-19. An NLP-based definition of Long COVID identified more patients than diagnosis codes and should be considered in future studies.https://drc.bmj.com/content/13/1/e004536.full |
| spellingShingle | Jane E B Reusch Rachel Wong Nasia Safdar Harold Lehmann Brijesh Patel Til Stürmer Hongfang Liu Peter Robinson Elaine Hill Richard Moffitt Justin Guinney Joel Gagnier Cavin Ward-Caviness Noha Sharafeldin Justin Starren Amit Saha Lesley Cottrell Melissa A Haendel Margaret A Hall Vignesh Subbian Kristin Kostka Farrukh M Koraishy Andrew E Williams Robert Hurley Steve Johnson Usman Sheikh Rishi Kamaleswaran Christopher Dillon Michele Morris Randeep Jawa Hemalkumar Mehta Benjamin Bates Tellen D Bennett Nabeel Qureshi Katie Rebecca Bradwell Federico Mariona Adam B Wilcox Adam M Lee Alexis Graves Amin Manna Amy Olex Andrea Zhou Andrew Southerland Andrew T Girvin Anita Walden Anjali A Sharathkumar Benjamin Amor Brian Hendricks Caleb Alexander Carolyn Bramante Charisse Madlock-Brown Christine Suver Christopher Chute Chunlei Wu Clare Schmitt Cliff Takemoto Dan Housman Davera Gabriel David A Eichmann Diego Mazzotti Eilis Boudreau Don Brown Elizabeth Zampino Emily Carlson Marti Emily R Pfaff Evan French Fred Prior George Sokos Greg Martin Heidi Spratt Hythem Sidky JW Awori Hayanga Jami Pincavitch Jaylyn Clark Jeremy Richard Harper Jessica Islam Jin Ge Joel H Saltz Joel Saltz Johanna Loomba John Buse Jomol Mathew Joni L Rutter Julie A McMurry Karen Crowley Kellie M Walters Ken Wilkins Kenneth R Gersing Kenrick Dwain Cato Kimberly Murray Lavance Northington Lee Allan Pyles Leonie Misquitta Lili Portilla Mariam Deacy Mark M Bissell Marshall Clark Mary Emmett Mary Morrison Saltz Matvey B Palchuk Meredith Adams Meredith Temple-O'Connor Michael G Kurilla Nicole Garbarini Ofer Sadan Patricia A Francis Penny Wung Burgoon Rafael Fuentes Rebecca Erwin-Cohen Richard A Moffitt Richard L Zhu Robert T Miller Saiju Pyarajan Sam G Michael Samuel Bozzette Sandeep Mallipattu Satyanarayana Vedula Scott Chapman T Shawn Soko Setoguchi O'Neil Stephanie S Hong Tiffany Callahan Umit Topaloglu Valery Gordon Warren A Kibbe Wenndy Hernandez Will Beasley Will Cooper William Hillegass Xiaohan Tanner Zhang Samuel Soff Yun Jae Yoo Jared Davis Huling Daniel Brannock Zachary Butzin-Dozier Alfred Jerrod Anzalone Philip RO. Payne Rena Patel Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C) BMJ Open Diabetes Research & Care |
| title | Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C) |
| title_full | Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C) |
| title_fullStr | Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C) |
| title_full_unstemmed | Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C) |
| title_short | Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C) |
| title_sort | association of glycemic control with long covid in patients with type 2 diabetes findings from the national covid cohort collaborative n3c |
| url | https://drc.bmj.com/content/13/1/e004536.full |
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associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT matveybpalchuk associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT meredithadams associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT meredithtempleoconnor associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT michaelgkurilla associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT nicolegarbarini associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT ofersadan associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT patriciaafrancis associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT pennywungburgoon associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT rafaelfuentes associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT rebeccaerwincohen associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT richardamoffitt associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT richardlzhu associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT roberttmiller associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT saijupyarajan associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT samgmichael associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT samuelbozzette associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT sandeepmallipattu associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT satyanarayanavedula associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT scottchapman associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT tshawn associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT sokosetoguchioneil associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT stephanieshong associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT tiffanycallahan associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT umittopaloglu associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT valerygordon associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT warrenakibbe associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT wenndyhernandez associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT willbeasley associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT willcooper associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT williamhillegass associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT xiaohantannerzhang associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT samuelsoff associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT yunjaeyoo associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT jareddavishuling associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT danielbrannock associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT zacharybutzindozier associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT alfredjerrodanzalone associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT philipropayne associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c AT renapatel associationofglycemiccontrolwithlongcovidinpatientswithtype2diabetesfindingsfromthenationalcovidcohortcollaborativen3c |