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Coronavirus may trigger onset of diabetes, study finds

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While a known risk factor, an international review published in The Lancet Diabetes and Endocrinology has revealed just how serious the dangers can be for diabetics.
 
Between 20–50% of patients diagnosed with COVID-19 during the pandemic have had diabetes, while in Australia 20% of those hospitalised with the virus had diabetes, as did one third of coronavirus-related deaths up until 12 April.
 
The data highlight increased risk of complications, such as developing severe pneumonia, Adult Respiratory Distress Syndrome and multiple organ failure. The risk of death is also up to 50% higher, particularly for elderly people with type 2 diabetes.
 
The findings are based on evidence from epidemiological observations in regions heavily affected by COVID-19, reports from Centers for Disease Control and Prevention (CDC), and other national health centres and hospitals.
 
‘The data so far suggest that the elderly patient, particularly those with diabetes, but even more so if they’ve got other comorbidities such as heart disease, heart failure or hypertension, are more likely certainly to die,’ Paul Zimmet AO, a professor of diabetes at Monash University and co-author of the report, told newsGP.
 
Particularly concerning is the review’s suggestion that COVID-19 may actually trigger the onset of diabetes in normally healthy people as a result of damage to the pancreatic β cells.
 
‘We’ve known for a long time, many years, that virus infections can precipitate type 1 diabetes – coxsackie infections were the classical example,’ Professor Zimmet said.
 
‘What’s believed here is that the virus attacks the β cells in the pancreas – the cells that make insulin – and that the form of type 1 diabetes could be developing in people, which [can] become permanent.
 
‘I’ve heard of one case from the US that it was transient diabetes, but otherwise there is a real risk that it’s a direct damaging attack on the cells that make the insulin.’
 
Potential pancreas β cell damage caused by COVID-19 leading to insulin deficiency is supported by the co-authors of the study, who have reported frequent cases of severe diabetic ketoacidosis (DKA) at the time of hospital admission.
 
To identify if previously healthy individuals have developed diabetes as a result of contracting the virus and to ensure patients receive the best care, the report proposes all people who test positive to COVID-19 should also be tested for diabetes.
 
‘They should be tested at the time they become ill as it clearly will influence their medical management and health outcome,’ Professor Zimmet said.
 
‘GPs can do the standard tests for diabetes; they can test either fasting or random blood sugars or the haemoglobin A1C test.’
 
As some state governments look towards easing social distancing restrictions, Professor Zimmet recommends those with diabetes continue to be mindful.
 
‘There are clear guidelines being set by the Government in terms of social distancing and the hand cleaning, etc,’ he said.
 
‘The most important thing for elderly people with type 2 diabetes is to be observing all of those things and try and avoid going to supermarkets and other markets where they may be exposed to other people who have already got the infection.’
 
Meanwhile when it comes to young people with type 1 diabetes, Professor Zimmet said the risks appear to be much less. Though parents should be reassured, following Government recommendations and having access to satisfactory healthcare is vital.
 
‘People with diabetes should make sure that they’re in contact with their general practitioner or specialist and that their diabetes is under good control,’ he said.
 
‘The other thing is that after this is over, which hopefully is not going to be too far off, they need to be checked [to make sure] that their diabetes hasn’t been made unstable or whether they’ve got lung problems, etc.’
 
The report recommends the following sub-groups of people with diabetes may require specific attention:

• people with poor metabolic control of their diabetes
• diabetes with complications
• people with type 2 diabetes and obesity
• management of those with diabetes who have had bariatric surgery for obesity
• people who have had transplantations of the pancreas and kidneys, or are on regular dialysis
• those on immunosuppressive therapy for other disorders, and/or on cortisone
• those on certain diabetes medications
• continuation of an appropriate antihypertensive and lipid-lowering regimen in type 2 diabetes patients with other components of the metabolic syndrome

It is also recommended that diabetic GPs and other health professionals who are engaged in care of COVID-19 patients ensure they have the personal protective equipment (PPE) they need to prevent contracting the virus.
 
‘One of the problems is that the information about COVID-19 is still pretty scanty. There were a lot of statements saying that there’s no evidence that people with diabetes are at more risk of contracting COVID-19 – that wasn’t a fair comment,’ Professor Zimmet said.
 
‘We’ve been very lucky with our Government’s actions, that we really are one of the countries best-placed in the world to come out of this. But we should not yet relax until we know that the virus is out of the community and the people who have actually been infected don’t have long-term effects.’
 
The RACGP has launched a new fact sheet designed to help GPs care for their patients with diabetes during the coronavirus pandemic.
 
The RACGP has more information on coronavirus available on its website.
 
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coronavirus COVID-19 diabetes

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