Could COVID-19 trigger new-onset diabetes?

Global clinical observations have revealed a bidirectional relationship between COVID-19 and diabetes: diabetes is associated with an increased risk of COVID-19 severity and mortality (20–30% of patients with COVID-19 who died have been reported to have diabetes). Conversely, new-onset diabetes and atypical metabolic complications of pre-existing diabetes, including life-threatening ones, have been observed in people with COVID-19.

Emerging evidence suggests that COVID-19 may actually trigger the onset of diabetes in healthy people and also cause severe complications of pre-existing diabetes.

A letter published in the New England Journal of Medicine — signed by an international group of 17 leading diabetes experts involved in the CoviDiab Registry project, a collaborative international research initiative — announced the establishment of a Global Registry of new cases of diabetes in patients with COVID-19.

The Registry aims to understand the extent and characteristics of diabetes in patients with COVID-19, and identify strategies for treating and monitoring affected patients.

It is still unclear how SARS-Cov-2 impacts diabetes. Previous research has shown that ACE-2, the protein that binds to SARS-Cov-2 allowing the virus to enter human cells, is not only located in the lungs but also in organs and tissues involved in glucose metabolism such as the pancreas, the small intestine, the fat tissue, the liver and the kidney. Researchers hypothesise that by entering these tissues, the virus may cause multiple and complex dysfunctions of glucose metabolism. It has also been known for many years that virus infections can precipitate type 1 diabetes.

Professor of Metabolic Surgery at King’s College London Francesco Rubino (co-lead investigator of the CoviDiab Registry project said, “Diabetes is one of the most prevalent chronic diseases and we are now realising the consequences of the inevitable clash between two pandemics.

“Given the short period of human contact with this new coronavirus, the exact mechanism by which the virus influences glucose metabolism is still unclear and we don’t know whether the acute manifestation of diabetes in these patients represent classic type 1, type 2 or possibly a new form of diabetes.”

Paul Zimmet, Professor of Diabetes at Monash University, Melbourne, Honorary President of the International Diabetes Federation and co-lead investigator in the CoviDiab Registry project, said, “We don’t yet know the magnitude of the new-onset diabetes in COVID-19 and if it will persist or resolve after the infection; and if so, whether or not COVID-19 increases risk of future diabetes.

“By establishing this Global Registry, we are calling on the international medical community to rapidly share relevant clinical observations that can help answer these questions.”

Professor of Diabetes Research at King’s College London and co-investigator of the CoviDiab Registry project Stephanie Amiel said, “The registry focuses on routinely collected clinical data that will help us examine insulin secretory capacity, insulin resistance and autoimmune antibody status to understand how COVID-19-related diabetes develops, its natural history and best management.

“Studying COVID-19-related diabetes may uncover novel mechanisms of disease.”

Image credit: ©stock.adobe.com/au/Daniel CHETRONI