{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T03:09:21Z","timestamp":1761102561332,"version":"3.41.0"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"VA Puget Sound Office of Research and Development","award":["No number"],"award-info":[{"award-number":["No number"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To examine public health impacts of Long COVID on long-term hyperglycemia and metabolic health.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Materials &amp; Methods<\/jats:title>\n<jats:p>We conducted a retrospective cohort study using US Veterans Health Administration electronic health records data to examine associations of Long COVID documentation (International Statistical Classification of Diseases, Tenth Revision code U09.9) with clinical outcomes (number of primary care visits, receipt of new classes of glucose-lowering medications, weight change, hemoglobin A1c, initiation of insulin, initiation of dialysis, hospitalization, and mortality) among U.S. Veterans with diabetes (1 October 2021\u20131 October 2023; n\u2009=\u20091,896,080).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Veterans were 69.7 years old on average at cohort entry, 6% female, and 1% had U09.9 documentation. Compared to Veterans without U09.9, those with U09.9 had 39% more primary care visits per year after the index date (incidence rate ratio [IRR] 1.36, 95%CI 1.36; 1.37), 21% more glucose-lowering medication classes added per year (IRR 1.21, 95%CI 1.18; 1.24), a 0.62\u2009kg greater weight gain (95%CI 0.52; 0.72), a 0.10-point lower mean HbA1c (95%CI -0.12; -0.08), a 43% greater odds of starting insulin (odds ratio [OR] 1.43, 95%CI 1.32; 1.54), a 34% greater odds of starting dialysis (OR 1.34, 95%CI 1.11; 1.62), a 102% greater odds of VA hospitalization (OR 2.02, 95%CI 1.95; 2.09), and a 13% lower odds of mortality (OR 0.87, 95%CI 0.83; 0.91).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In Veterans with diabetes, Long COVID documentation was associated with greater medication use, odds of starting dialysis, and odds of hospitalization, but with lower odds of mortality. Individuals with Long COVID documentation did not have more weight gain or higher HbA1c, suggesting that adverse effects of Long COVID on medication changes and kidney function in persons with diabetes may be due to other factors. Future studies should examine mechanisms by which Long COVID might contribute to progression of kidney disease and more intensive diabetes treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324709","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T17:49:57Z","timestamp":1747936197000},"page":"e0324709","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of long COVID documentation with clinical outcomes among Veterans with diabetes"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3671-1464","authenticated-orcid":true,"given":"Pandora L.","family":"Wander","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elliott","family":"Lowy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8771-5468","authenticated-orcid":true,"given":"Anna","family":"Korpak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren A.","family":"Beste","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-192X","authenticated-orcid":true,"given":"Edward J.","family":"Boyko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"issue":"12","key":"pone.0324709.ref001","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.46783","article-title":"Rates of ICD-10 Code U09.9 documentation and clinical characteristics of VA patients with post-COVID-19 condition","volume":"6","author":"PL Wander","year":"2023","journal-title":"JAMA Netw Open"},{"key":"pone.0324709.ref002","unstructured":"Anderson JK, Young SK, Mackey KM, Williams BE, Parr NJ, Helfand M. Brief evidence assessment guidance for long COVID clinics: nervous system. VA ESP Project #09-\u20131992023."},{"issue":"9","key":"pone.0324709.ref003","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1056\/NEJMoa2311330","article-title":"Cognition and memory after covid-19 in a large community sample","volume":"390","author":"A Hampshire","year":"2024","journal-title":"N Engl J Med"},{"key":"pone.0324709.ref004","doi-asserted-by":"crossref","first-page":"1429848","DOI":"10.3389\/fendo.2024.1429848","article-title":"Association of COVID-19 infection and the risk of new incident diabetes: a systematic review and meta-analysis","volume":"15","author":"J Zhou","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"4","key":"pone.0324709.ref005","doi-asserted-by":"crossref","first-page":"782","DOI":"10.2337\/dc21-1686","article-title":"The incidence of diabetes among 2,777,768 Veterans with and without recent SARS-CoV-2 infection","volume":"45","author":"PL Wander","year":"2022","journal-title":"Diabetes Care"},{"issue":"6","key":"pone.0324709.ref006","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3013","article-title":"The impact of cognitive impairment in dementia on self-care domains in diabetes: a systematic search and narrative review","volume":"34","author":"T Santos","year":"2018","journal-title":"Diabetes Metab Res Rev"},{"key":"pone.0324709.ref007"},{"key":"pone.0324709.ref008","article-title":"2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020","volume":"43","author":"American Diabetes Association.","year":"2020","journal-title":"Diabetes Care"},{"issue":"48","key":"pone.0324709.ref009","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.15585\/mmwr.mm7148a4","article-title":"SARS-CoV-2 serology and self-reported infection among adults - National Health and Nutrition Examination Survey, United States, August 2021-May 2022","volume":"71","author":"LJ Akinbami","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"5","key":"pone.0324709.ref010","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"ME Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"8","key":"pone.0324709.ref011","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1007\/s11255-023-03528-x","article-title":"Long-term interplay between COVID-19 and chronic kidney disease","volume":"55","author":"H Schiffl","year":"2023","journal-title":"Int Urol Nephrol"},{"issue":"11","key":"pone.0324709.ref012","doi-asserted-by":"crossref","first-page":"2851","DOI":"10.1681\/ASN.2021060734","article-title":"Kidney outcomes in long COVID","volume":"32","author":"B Bowe","year":"2021","journal-title":"J Am Soc Nephrol"},{"issue":"12","key":"pone.0324709.ref013","doi-asserted-by":"crossref","first-page":"2816","DOI":"10.1093\/ndt\/gfad121","article-title":"Long-term effect of COVID-19 infection on kidney function among COVID-19 patients followed in post-COVID-19 recovery clinics in British Columbia, Canada","volume":"38","author":"M Atiquzzaman","year":"2023","journal-title":"Nephrol Dial Transplant"},{"issue":"2","key":"pone.0324709.ref014","doi-asserted-by":"crossref","DOI":"10.1016\/j.stem.2021.12.010","article-title":"SARS-CoV-2 infects the human kidney and drives fibrosis in kidney organoids","volume":"29","author":"J Jansen","year":"2022","journal-title":"Cell Stem Cell"},{"issue":"8","key":"pone.0324709.ref015","doi-asserted-by":"crossref","first-page":"965","DOI":"10.3390\/biom14080965","article-title":"The significance of endothelial dysfunction in long COVID-19 for the possible future pandemic of chronic kidney disease and cardiovascular disease","volume":"14","author":"H Yanai","year":"2024","journal-title":"Biomolecules"},{"issue":"10","key":"pone.0324709.ref016","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1001\/jamainternmed.2023.3587","article-title":"Late mortality after COVID-19 infection among US Veterans vs risk-matched comparators: a 2-year cohort analysis","volume":"183","author":"TJ Iwashyna","year":"2023","journal-title":"JAMA Intern Med"},{"key":"pone.0324709.ref017","doi-asserted-by":"crossref","DOI":"10.2196\/53445","article-title":"Characterization of post-COVID-19 definitions and clinical coding practices: longitudinal study","volume":"16","author":"M Maripuri","year":"2024","journal-title":"Online J Public Health Inform"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324709","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T17:50:07Z","timestamp":1747936207000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324709"}},"subtitle":[],"editor":[{"given":"Gaetano","family":"Santulli","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":17,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0324709","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}