Investigating the Intersection of COVID-19 and Diabetic Polyneuropathy––An Urgent Need for Intervention

Patients with diabetic polyneuropathy are at substantially greater risk for severe COVID-19 complications than patients without this condition, urging special attention to this vulnerable population.

Diabetes mellitus is a well-documented risk factor for worse COVID-19-related complications. However, the impact on COVID-19 outcomes of diabetes when it co-occurs with diabetic polyneuropathy (DN) has not been well-studied in the literature, despite over 50% of diabetic patients suffering from the condition. Patients with DN who often have impaired lung function, particularly abnormalities in bronchial noradrenergic innervation, could be likely to experience severe COVID-19 due to a vulnerable respiratory system. Our research aimed to address the knowledge gap in DN and SARS-CoV-2-related morbidity by assessing the risk of severe COVID-19 outcomes among US adults with DN, compared to those with diabetes but without DN and those without diabetes.

This line of research was additionally guided by our team’s personal and professional experiences of Ajay Macherla, whose late grandfather had suffered from DN during the peak of the COVID-19 pandemic. Ajay, now an undergraduate student at the University of Rochester, worked with the Pennsylvania State University College of Medicine Department of Family and Community Medicine physicians and researchers experienced in caring for DN patients to explore the impact of the disease on COVID-19 outcomes. Our goal was to optimally support high-risk populations afflicted by DN.

Our Findings

Our research provided new evidence suggesting that adults with DN were 1.19-2.47 times more likely to have 30-day mortality and use critical care resources (admission to emergency department, hospitalization, intensive care unit) due to COVID-19 compared to those without this condition. These findings identify DN as a condition carrying increased risk for severe COVID-19 complications, above the risk of diabetes itself. Presence of DN could be considered as a prognosticator for COVID-19 harms, and clinical practice algorithms could be adjusted when providing care for DN patients.

Implications for Clinical Practice and Policy Intervention:

Our findings, which indicate a significant negative impact of DN on COVID-19 prognosis, call for increased clinical monitoring and management efforts in patients with concurrent DN and COVID-19, and the need for more intensive public health campaigning to prevent the SARS-CoV-2 virus infection in high-risk DN populations. Our results also underscore the importance of increasing accessibility of targeted diagnostic approaches and treatments among patients with DN to help reduce death and illness toll in this population, especially among elderly and in socioeconomically-disadvantaged communities. Current public health efforts promoting COVID-19 prevention strategies, such as face masking, social distancing, and vaccination, should continue to be encouraged, particularly in high-risk DN populations.

Interested in learning more about our findings and the impact of diabetic polyneuropathy on COVID-19 outcomes? Read our paper here:

Ajay Macherla is a freshman at the University of Rochester majoring in Neuroscience. A Rochester Early Medical Scholar, Ajay plans to matriculate to the University of Rochester School of Medicine in 2026 to pursue an MD degree. His research interests lie in investigating health interventions to tackle the burden of polyneuropathy.
Wen-Jan Tuan, DHA, MS, MPH, is an assistant professor at the Penn State Department of Family and Community Medicine. He has held various leadership roles in the state health agency and academic health centers. His research has focused on enhancing the efficiency of health system management using big data and machine learning analytics.
Robert P. Lennon, MD, JD, an associate professor at the Penn State Department of Family and Community Medicine and director of family medicine resident scholarship. He provides primary care and clinical teaching to residents and medical students. His research interests include scalable interventions for improving public health locally and globally.

Alice Zhang, MD, is a family medicine physician and a primary care research fellow at the Penn State College of Medicine Department of Family and Community Medicine. Her research interests include community-based interventions and health promotion, and closing health disparities.

Aleksandra E. Zgierska, MD, PhD, is a professor at the Penn State College of Medicine and Vice Chair of Research at the Department of Family and Community Medicine. She provides primary and specialty care, including for people with diabetes and neuropathic chronic pain. Her studies have focused on improving health outcomes in addiction, pain and other impactful conditions, spanning diverse methodologies.