Diabetes risk could be 28% higher after COVID infection

Potential impacts on the heart, brain and cognitive function of people who have been infected with COVID-19 have already been flagged.
 
And now diabetes risk has been added to the list of associations with the multi-system disease.
 
That is according to a new study from Germany, which suggests routine screening for type 2 diabetes, particularly active monitoring of glucose dysregulation, should be considered in patients recovering from mild COVID-19.
 
Researchers compared 35,865 people with COVID-19 to a control group who had been diagnosed with other types of respiratory infections, and estimated an incidence rate ratio of 1.28 for type 2 diabetes.
 
In the COVID-19 cohort, 15.8 new cases of type 2 diabetes per 1000 people per year were detected compared to 12.3 per 1000 people per year for the group who caught other infections – translating to a 28% higher risk in the COVID-19 group.
 
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes and clinical editor of the Diabetes handbook, told newsGP although there are study limitations to consider, the research is adding to the knowledge base of the potential impacts of COVID infection.
 
‘It’s a reminder clinically to keep your eyes and ears open for the potential development in patients who share the same risk factors for COVID and for diabetes,’ Dr Deed said.
 
‘We have to acknowledge it’s an observational study for hypothesis generating, but not proof, that COVID can necessarily be clearly linked to a higher risk of developing diabetes.
 
‘But looking at the whole concept, the risk factors for developing COVID and severity of COVID symptoms are overlapped with the risk factors for diabetes itself, such as obesity, the elderly, etcetera.
 
‘So for the people who do develop COVID and severe COVID, they share the same sort of risk profile for people who [typically] might further develop diabetes.’
 
The study authors note that inflammation caused by COVID-19 may damage insulin-producing beta cells, causing them to die or change the way they work, resulting in acute hyperglycaemia. The inflammation can also potentially cause tissue to become less reactive to insulin.
 
They also acknowledged the potential role of COVID-19 restrictions and lockdowns, which may have resulted in study participants leading more sedentary lifestyles, noting that new-onset hyperglycaemia and insulin resistance was reported in COVID-19 patients with no prior history of diabetes.
 
Dr Deed said these findings warrant further investigation into the associated risks of the virus, and for GPs to remain alert.
 
‘The viral illness itself is still under investigation, but whether there is an association with some damage to the insulin secreting cells in the pancreas – it’s not yet proven,’ he said.
 
‘What the study shows is that noting the overlapping risk factors for developing COVID and also with diabetes, it’s probably a good reminder for GPs in assessing people post-COVID to apply good, sound knowledge to the patients they see, and ensure that they’ve done adequate screening for diabetes in the follow-up period.’
 
In the primary care setting, the authors recommend that people recovering from COVID-19 should be monitored for symptoms such as fatigue, frequent urination and increased thirst, all of which could be early warning signs of diabetes.
 
However, for the majority of people who have mild COVID-19, type 2 diabetes is unlikely to be an issue, with the study indicating a ‘temporal relationship’ between mild disease and newly diagnosed type 2 diabetes.
 
Dr Deed supports the study’s findings that active monitoring of glucose dysregulation after recovery from mild COVID-19 infection is necessary. He cites the Diabetes handbook, which provides comprehensive information on how to assess patients who may be at risk and the appropriate intervals for assessment.
 
‘A reminder is that COVID is not going away at the present time … and for people who’ve already got diabetes, they don’t do very well when they’ve got COVID,’ Dr Deed said.
 
‘This just raises the profile that GPs have a big role to play in not only managing people with COVID but also now trying to manage people post-COVID, and assessing for aggravation of chronic illness or the onset of a chronic illness, such as diabetes.
 
‘It’s just something that GPs need to be aware of and keep on their radar.’
 
The RACGP website has a factsheet for GPs to support patients with COVID-19 in managing diabetes.
 
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