COVID-Diabetes Link Confirmed

As I penned in these virtual pages almost a year ago, COVID survivors have a high risk for developing diabetes. Early on, diabetes was identified as a risk factor for severe COVID illness, but two years later, scientists were surprised by the unforseen reverse correlation between COVID and the metabolic condition. The increased risk for diabetes in COVID survivors was recently confirmed by US and German scientists.

A study of more than 180,000 American veterans done at the St. Louis VA Health Care System found that COVID survivors were 40% more likely to get a new diagnosis of diabetes within a year of their COVID diagnosis than a control group of veterans who avoided the virus. That works out to about 13.5 extra cases of diabetes per 1,000 COVID patients.

The increased risk for diabetes was evident even in people who had a low risk of diabetes before COVID, and the likelihood of newly diagnosed diabetes increased with the level of care patients received for COVID. In other words, the sicker the patients were with COVID, the more likely they were to develop diabetes.

The other study from Germany found that people who had mild COVID cases were 28% more likely to be diagnosed with type 2 diabetes compared to a control group consisting of patients who had an upper respiratory tract infection caused by a different bug. That study was based on an analysis of electronic records from a nationwide primary care database that followed patients, including almost 36,000 COVID cases, for 3-5 months. This means that these newly diagnosed cases of diabetes arose quickly after COVID infection, and were not a result of general respiratory infection, but were a specific consequence of CoV-2 infection.

Questions remain about whether diabetes that follows COVID is just temporary and reversible after patients fully recover, or whether it leads to chronic disease. In other words, if you had even mild COVID, you should ask your doctor to screen you for diabetes, which simply entails a fasting blood draw to test for glucose and hemoglobin A1c levels, which are elevated in diabetic patients.

A lingering question is how COVID leads to diabetes. Does the virus directly affect the insulin-secreting beta cells in the islets of the pancreas, or is new-onset diabetes caused by metabolic changes in fat cells which we know are readily infected by the virus. It is also possible that insulin production is perturbed by viral damage to the cells that line vessels supplying blood to the pancreas, indirectly causing death of insulin producing cells. A more trivial cause for post-COVID diabetes could simply be an unveiling of incipient diabetes that might have gone undiagnosed because people have been away from the health-care system during the pandemic. It is also possible that steroid medications prescribed to tame the COVID inflammatory response could elevate glucose levels in the blood, leading to a diabetes diagnosis.

Research into the cause of the COVID-diabetes link continues apace—stay tuned.

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