Some people infected with the new coronavirus may find more than COVID-19 on their medical card: a new diagnosis of diabetes.
It is early in the research and experts are still looking for definitive answers, but it seems that COVID-19 can cause diabetes in some patients.
“The data absolutely says that this seems to be the case, and it is at a higher rate than we first realized,” said Dr. Robert Gabbay, chief scientist and medical officer of the American Diabetes Association, said TODAY.
‘It’s very, very worrying. We live in the midst of an epidemic of diabetes, and literally the last thing we need is something that raises the rate even further. ”
Up to 14% of those admitted to hospital for COVID-19 have just developed diagnosed diabetes, according to an analysis of eight studies involving more than 3,700 patients in the US, Italy and China.
More than 370 doctors from around the world have offered to share patient stories for a global registry of COVID-19-related diabetes, said Dr. Francesco Rubino, the principal investigator and chair of metabolic and bariatric surgery at King’s College London, said.
He and his colleagues first reported on new diabetes in COVID-19 in 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’s going on, he noted.
“It’s clear that the vast majority of people with COVID-19 will not have diabetes,” Rubino said. “(But) I think there’s a problem … even a relatively rare event can become significant if COVID is so common.”
Some of the new diabetes cases appear to be in people who have no history of the disease and possibly no risk factors – people who “did not expect to develop diabetes, but now I have it,” Gabbay said.
Why it happens
The pancreas makes insulin, a hormone that helps control blood sugar levels. But in diabetes, blood sugar levels are too high – because the body does not make insulin (type 1 diabetes) or because the body does not respond well to it (type 2 diabetes).
The new coronavirus can invade cells not only in the pancreas but also in the gut, liver and adipose tissue – which is very important for maintaining the normal metabolism of sugar – and affects the organs, which can cause possible dysfunctions, Rubino said.
In some people, “the virus seems to actually attack the cells that make insulin and damage it in a way where someone cannot make enough insulin,” Gabbay added.
Because multiple organs can disrupt simultaneously and cause complex changes in sugar metabolism, the symptoms that doctors see in COVID-19 patients do not look like a typical type 1 or type 2 diabetes, but possibly as a “mixture” of the two – possibly a new type of diabetes, Rubino said.
This may not even require the severe type of COVID-19 to occur: one case study in Germany described a 19-year-old man who had an asymptomatic coronavirus infection last spring and was diagnosed with diabetes a few weeks later. The authors concluded that physicians’ 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 link between diabetes and COVID-19: people with diabetes have more serious complications due to the infection and 40% of the people who died from COVID-19 had diabetes, Gabbay said.
But it will be a challenge to scientifically prove that COVID-19 causes new diabetes, Rubino noted.
“Any inflammatory condition can cause insulin resistance,” Dr. Domenico Accili, director of the Columbia University Diabetes and Endocrinology Research Center in New York, wrote in a commentary on Nature Metabolism.
“We should not rule out the possibility that SARS-CoV-2 may cause diabetes, but we should also not think about it from the air if it is not supported by evidence.”
Rubino hoped the global registry of COVID-19-related diabetes could provide concrete answers, including whether diabetes associated with the new coronavirus disappears after a patient recovers or if it can continue beyond the infection.
The advice for new or recent COVID-19 patients is to be aware of diabetic symptoms such as excessive urination, excessive thirst, blurred vision, fatigue, unexplained weight loss and, for women, yeast infections.
“There is no reason to panic about diabetes, but there is reason to be vigilant and note the link between COVID and diabetes,” Rubino said.
