Post-acute sequelae of COVID-19: A metabolic perspective

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COVID-19 (complications, epidemiology, etiology, metabolism, therapy); Diabetes Mellitus, Type 2; Disease Management; Disease Susceptibility; Energy Metabolism; Glucose (metabolism); Glucose Intolerance; Humans; Insulin Resistance; Islets of Langerhans (metabolism); Liver (metabolism); Metabolic Syndrome (epidemiology, etiology, metabolism, therapy); Risk Assessment; Risk Factors; T-Lymphocytes (immunology, metabolism)


The SARS-CoV-2 pandemic continues to rage around the world. At the same time, despite strong public health measures and high vaccination rates in some countries, a post-COVID-19 syndrome has emerged which lacks a clear definition, prevalence, or etiology. However, fatigue, dyspnea, brain fog, and lack of smell and/or taste are often characteristic of patients with this syndrome. These are evident more than a month after infection, and are labeled as (PASC) or commonly referred to as long-COVID. Metabolic dysfunction (i.e., obesity, insulin resistance, and diabetes mellitus) is a predisposing risk factor for severe acute COVID-19, and there is emerging evidence that this factor plus a chronic inflammatory state may predispose to PASC. In this article, we explore the potential pathogenic metabolic mechanisms that could underly both severe acute COVID-19 and PASC, and then consider how these might be targeted for future therapeutic approaches.