P226 DYNAMO Covid-19. Dynamic assessment of multi organ level dysfunction in patients recovering from Covid-19: insulin resistance and metabolic flexibility

• Published in: Thorax Vol. 77; no. Suppl 1; pp. A204 - A205
• Main Authors: Gutpa, A, Nicholas, R, McGing, JJ, Mougin, O, Bradley, CR, Nixon, AV, Mallinson, JE, Bonnington, J, McKeever, TM, Hall, IP, Lord, JM, Evans, RA, Greenhaff, PL, Francis, ST, Bolton, CE
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.11.2022; BMJ Publishing Group LTD
• Subjects: Body fat; Coronaviruses; COVID-19; Fatty liver; Flexibility; Glucose; Insulin resistance; Liver; Metabolism; Recovery (Medical); Severe acute respiratory syndrome coronavirus 2; ‘Endgame’ – Long term impacts of COVID-19
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2022-BTSabstracts.358

IntroductionInitial acute hyperglycaemia is reported in patients during hospitalisation with SARS-CoV-2 infection. However, it is unclear what maladaptations occur long-term. Whole-body insulin sensitivity and metabolic flexibility were assessed alongside whole-body and regional fat content to provide insight of metabolic health status in recovering patients.MethodsAdults were recruited at 5–7 months following hospital discharge for severe SARS-Cov2 infection (n=21), along with control volunteers (n=10) of a similar age, gender, ethnicity and BMI.Indirect calorimetry was conducted before and during an oral glucose tolerance test (OGTT) to assess metabolic flexibility [Δ respiratory exchange ratio (RER) from fasting to peak]. In conjunction, regular arterialised venous bloods were taken from a retrograde cannula over a 3-hour period to determine blood glucose and serum insulin. At separate visits (within 2 weeks), dual energy X-ray absorptiometry measured whole-body fat fraction, whilst 1H Magnetic Resonance Spectroscopy (MRS) quantified intra and extra-myocellular lipid fractions (IMCL and EMCL) in the thigh muscle and MR Imaging using a mDIXON scan identified subjects with fatty liver (fat fraction>5.6%). Average daily activity over a 7-day period was measured using an accelerometer. Data are Non-parametric: median(IQR), parametric: mean(SD) and categorical: n(%).ResultsThe OGTT serum insulin response was greater in patients (P) than controls (C) (figure 1b), but the blood glucose (figure 1a) and RER responses [P: 0.08(0.07) vs C: 0.13(0.07), p=0.1] were not. Patients had a lower average daily step count [P: 3,626(2,385–6,337) steps vs C: 7,670(5,111–10,074), p=0.07] and more had a fatty liver [P: 13(68%) vs C: 3(30%), p=0.048]. Whole-body fat fraction [P: 38.3(6.8)% vs C: 37.4(9.6)%, p=0.8] and IMCL:EMCL [P: 0.45(0.28) vs C: 0.67(0.42), p=0.1] were not different. Physical activity and liver fat were independent factors for insulin resistance in a multivariate regression model.Abstract P226 Figure 1ConclusionPatients recovering from severe Covid-19 have worse insulin sensitivity compared to controls, but similar metabolic flexibility. Physical inactivity and liver adiposity may play a role in these observations.FundingNIHR Nottingham BRC (NoRCoRP), PHOSP UKRI, Nottingham Hospitals Charity, University of Nottingham alumni donation.