From acute infection to chronic disease: the metabolic sequelae post-COVID-19

Abstract

The COVID-19 pandemic, caused by SARS-CoV-2, has evolved from an acute respiratory illness to a systemic disease with long-term metabolic and endocrine consequences. Recent evidence highlights the significant prevalence of post-COVID-19 syndrome, characterized by persistent pathologies such as insulin resistance, dyslipidemia, and mitochondrial dysfunction, which contribute to the development of metabolic disorders such as type 2 diabetes and metabolic syndrome. The interaction of the virus with the ACE2 receptor, expressed in multiple endocrine tissues, along with chronic inflammation, cytokine storms, and direct damage to pancreatic β cells, underlies these complications. In Mexico, where pre-existing metabolic conditions are highly prevalent, COVID-19 has exacerbated the burden of cardiometabolic diseases, with indicators reporting a higher incidence of diabetes and post-infection hepatic steatosis. This literature review synthesizes current knowledge on the pathophysiological mechanisms and the generation of metabolic sequelae post-COVID-19. The need for long-term, multidisciplinary follow-up to mitigate long-term consequences and improve patients’ lives is emphasized. Gaps in understanding long-term causality and optimal interventions necessitate further research through longitudinal studies and controlled clinical trials.