The COVID-19 virus might actually cause the development of diabetes in certain patients, according to a letter just published in The New England Journal of Medicine. The letter was signed by 17 diabetes authorities from around the world who are participating in what’s known as the CoviDiab Registry. This initiative, which is being led by Francesco Rubino, MD, of King’s College London and Paul Zimmet, MD, of Monash University in Australia, was specially created to study how COVID-19-related diabetes develops and to find out how widespread is the connection between diabetes and COVID-19.
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The investigators noted that the relationship between COVID-19 and diabetes appears to be “bi-directional.” On one hand, people with diabetes tend to have an increased risk of severe COVID symptoms and of death. It’s been reported, for example, that between 20% and 30% of patients who have died from the virus also had diabetes. On the other hand, it’s been learned that some patients who contract the COVID-19 virus then subsequently develop diabetes.
What might the connection be between the two diseases? According to Dr. Rubino, “Diabetes is one of the most prevalent chronic diseases and we are now realizing 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.” One clue comes from what we already know about a protein called ACE-2. Some 20 years ago researchers studying a different coronavirus determined that the virus was getting into human body cells by targeting ACE-2, which is a receptor found on certain cells. It seems that ACE-2 (which stands for angiotensin converting enzyme-2) binds to coronaviruses (COVID-19 among them), like a “key being inserted into a lock,” as once researcher put it. This binding allows the virus to get inside body cells. And ACE-2 is located not only in the lungs but also in the pancreas, the small intestine, the liver, the kidney and fat tissue — all of which are involved in metabolizing blood sugar. Although ACE-2 routinely performs several essential roles in proper body functioning, when it binds to the COVID-19 virus it’s unable to carry out these normal functions. As a result, scientists theorize that in COVID-19 patients, diabetes (of whatever type) is the result.
The next questions then become: is this COVID-triggered diabetes permanent or temporary (like gestational diabetes)? And how extensive is the phenomenon of COVID-triggered diabetes? Because this coronavirus has been with us less than a year, it’s too early to tell. As Dr. Zimmet explained, “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.” That’s where the CoviDiab Registry becomes so valuable. According to Dr. Zimmet, “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.” Registry member and diabetes specialist Stephanie Amiel, MD, of King’s College London, explained, “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.”
Want to learn more about coronavirus and diabetes? Read “Coronavirus and Diabetes: What You Need to Know,” “Healthy Eating During Hard Times” and “Avoiding Coronavirus With Diabetes: Stock Up and Stay Home, CDC Says.”