{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:09:25Z","timestamp":1785431365583,"version":"3.56.0"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["1OT2OD032581-01"],"award-info":[{"award-number":["1OT2OD032581-01"]}]},{"name":"NIH","award":["U54 MD007600"],"award-info":[{"award-number":["U54 MD007600"]}]},{"award":["1OT2OD032581-01"],"award-info":[{"award-number":["1OT2OD032581-01"]}],"id":[{"id":"https:\/\/ror.org\/044zkrt47","id-type":"ROR","asserted-by":"publisher"}]},{"award":["U54 MD007600"],"award-info":[{"award-number":["U54 MD007600"]}],"id":[{"id":"https:\/\/ror.org\/044zkrt47","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Hemoglobin A1c is a central biomarker for long-term glycemic control and a key predictor of diabetes-related complications. The COVID-19 pandemic disrupted routine healthcare delivery and introduced potential metabolic effects of SARS-CoV-2 infection, yet the long-term impact of COVID-19 on glycemic trajectories in individuals with diabetes remains unclear. In this retrospective study, we leveraged harmonized electronic health record data from the National Clinical Cohort Collaborative to evaluate changes in HbA1c before and after documented SARS-CoV-2 infection in adults with diabetes (n = 93,320). Patients were required to have repeated HbA1c measurements pre- and post-infection and stable exposure to key antihyperglycemic medications. A paired statistical analysis was used to identify individuals with statistically significant post-infection changes in HbA1c. We then developed and evaluated multiple supervised machine learning classifiers using an 80\/20 train\u2013test split and cross-validation to assess demographic, clinical, and structural factors associated with significant glycemic change. Most patients (71%) did not experience a statistically significant change in average HbA1c following COVID-19 infection, and among those who did, decreases were more common than increases. A random forest classifier achieved the best overall performance, and feature importance and SHAP analyses highlighted body mass index, insulin use, age, and socioeconomic proxies as key contributors. These findings suggest that while COVID-19 infection does not substantially alter long-term glycemic control for most patients with diabetes, individual-level clinical and structural factors influence post-infection glycemic variability.<\/jats:p>","DOI":"10.3390\/ijerph23050644","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:02:27Z","timestamp":1779375747000},"page":"644","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Leveraging Machine Learning to Assess Post-COVID-19 Glycemic Control in Diabetic Patients"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4466-0786","authenticated-orcid":false,"given":"Marie","family":"Lluberes-Contreras","sequence":"first","affiliation":[{"name":"Bioinformatics and Data Science Laboratory, Department of Computer Science, University of Puerto Rico, San Juan, PR 00925, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7011-0918","authenticated-orcid":false,"given":"Eduardo","family":"Figueroa-Santiago","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Puerto Rico, San Juan, PR 00925, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid-Reza","family":"Kohan-Ghadr","sequence":"additional","affiliation":[{"name":"SysBioSolutions LLC, Portage, MI 49024, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Ortiz-Ortega","sequence":"additional","affiliation":[{"name":"Medresearch LLC, Caguas, PR 00725, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2246-6744","authenticated-orcid":false,"given":"Abiel","family":"Roche-Lima","sequence":"additional","affiliation":[{"name":"Center for Collaborative Research in Health Disparities, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.2337\/dc15-1188","article-title":"Long-term glycemic variability and risk of adverse outcomes: Systematic review and meta-analysis","volume":"38","author":"Gorst","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1007\/s12325-022-02106-4","article-title":"The Association Between Sustained HbA1c Control and Long-Term Complications Among Individuals with Type 2 Diabetes: A Retrospective Study","volume":"39","author":"Boye","year":"2022","journal-title":"Adv. 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