Some people infected with the new coronavirus may find more than COVID-19 in their medical records: a new diagnosis of diabetes.
The research is in its infancy and experts are still looking for definitive answers, but it appears that COVID-19 may be triggering diabetes in a portion of patients.
“The data says absolutely that it seems to be the case, and it is at a higher rate than we initially realized,” said Dr. Robert Gabbay, scientific director and physician at the American Diabetes Association, to TODAY.
“It is very, very worrying. We are living in the middle of a diabetes epidemic, and literally the last thing we need is something that is raising rates even more. ”
Up to 14% of people hospitalized for COVID-19 developed newly diagnosed diabetes, an analysis of eight studies involving more than 3,700 patients in the United States, Italy and China found.
More than 370 doctors from around the world have volunteered to share patient stories for a global diabetes registry related to COVID-19, said Dr. Francesco Rubino, principal investigator for the registry and president of metabolic and bariatric surgery at King’s College London, in the United Kingdom
He and his colleagues first reported on recent onset diabetes in COVID-19 last August in The New England Journal of Medicine.
At least 160 cases have been fully documented, with researchers preparing to analyze them to understand what is happening, he noted.
“Clearly, the vast majority of people who have COVID-19 will not have diabetes,” said Rubino. “(But) I think there is a problem … even a relatively infrequent event can become significant when COVID is so prevalent.”
Some of the new cases of diabetes appear to be in people who have no history of the disease and possibly no risk factors – people who “didn’t expect to develop diabetes, but now I do,” noted Gabbay.
Why it might be happening
The pancreas produces insulin, a hormone that helps control blood sugar levels. But in diabetes, blood sugar levels are very high – either because the body does not produce insulin (type 1 diabetes) or because the body does not respond well to it (type 2 diabetes).
The new coronavirus can enter cells not only in the pancreas, but also in the intestine, liver and adipose tissue – all very important in maintaining normal sugar metabolism – and affect these organs, causing potential dysfunctions, said Rubino.
In some people, “it appears that the virus is actually attacking the cells that produce insulin and damaging them in a way that it is not possible to produce enough insulin,” added Gabbay.
Since several organs can be affected at the same time, causing complex changes in sugar metabolism, the symptoms that doctors observe in patients with COVID-19 do not look like typical type 1 or 2 diabetes, but potentially a “mixture” of the two – possibly a new type of diabetes, Rubino said.
It may not even require the severe type of COVID-19 to happen: a case study in Germany described a 19-year-old man who had an asymptomatic coronavirus infection last spring and was diagnosed with diabetes several weeks later. The authors concluded that doctors “should be aware of the possibility of insulin-dependent diabetes as an acute complication” of COVID-19.
Looking for answers
There is already a strong relationship between diabetes and COVID-19: people with diabetes are more likely to have serious complications due to infection and 40% of people who died from COVID-19 had diabetes, noted Gabbay.
But it will be a challenge to prove scientifically that COVID-19 causes a new onset of diabetes, Rubino noted.
“Any inflammatory state can cause insulin resistance,” wrote Dr. Domenico Accili, director of the Center for Diabetes and Endocrinology Research at Columbia University in New York, in a commentary on Nature Metabolism.
“We must not rule out the possibility that SARS-CoV-2 can cause diabetes, but we must also not invent it out of the blue if it is not supported by evidence.”
Rubino hopes that the global registry of diabetes related to COVID-19 can provide concrete answers, including whether diabetes associated with the new coronavirus disappears after the patient’s recovery or if it can persist beyond infection.
The advice for new or recent patients with COVID-19 is to be aware of the symptoms of diabetes, such as excessive urination, excessive thirst, blurred vision, fatigue, unexplained weight loss and, for women, yeast infections.
“There is no reason to panic with diabetes, but there is reason to be alert and pay attention to the connection between COVID and diabetes,” said Rubino.
