Learn what we know so far about the link between diabetes and COVID-19 and what the research means for diabetes treatment.
Early in the pandemic, scientists discovered that many people with diabetes were infected with COVID-19 and had severe outcomes. Three years later, researchers have determined the impact of COVID-19 on diabetic patients, the phenomenon of new-onset diabetes after COVID-19, and the underlying relationship between COVID-19 and diabetes. We are continuing to research a possible mechanism.Jane Reusch, MD, NIH Metabolic Disease Task Force Co-Chair Researching Coronavirus and Accelerating Recovery (RECOVER) InitiativeLearn how research may impact diabetes diagnosis, treatment, and long-term complications.
Q: How will infection with the new coronavirus affect diabetic patients?
answer: Early reports from China found that people who had diabetes before contracting COVID-19 were more likely to develop diabetes than people without diabetes. bad result. For example, diabetic patients hospitalized with COVID-19 were more likely to require oxygen or ventilator support, be admitted to the ICU, or even die prematurely from COVID-19. People with other comorbidities, such as heart disease, high blood pressure or obesity, were at even higher risk of serious complications from COVID-19.
We don’t know much about what happens to these patients after they are discharged from the hospital and their COVID-19 infection subsides. What is their clinical course? What is their natural history? Are they more likely to have lingering symptoms of COVID-19, such as blood clots and shortness of breath? We don’t know yet.
Like diabetes, COVID-19 affects the microvasculature, or small blood vessels. There is evidence that glucose and metabolic control are disrupted in people with diabetes after infection with COVID-19. We are concerned that the symptoms of patients with diabetes or severe COVID-19 infection may worsen over the long term, and we will continue to monitor the situation closely.
Q: What is long corona? Are people with diabetes more likely to develop this condition?
answer: We are in the midst of a rapid, exciting and confusing evolution of definitions. long coronavirus. It’s probably not just one thing. Essentially, long-term coronavirus infection is when new symptoms begin more than four weeks after initial infection with SARS-CoV-2, the virus that causes coronavirus disease (COVID-19). , defined as ongoing symptoms or recurrent symptoms. This syndrome is associated with various diseases. Clusters of related symptoms Fatigue, shortness of breath, heart palpitations, brain fog, anxiety, etc. It can affect almost every organ or system in the body.
Prevalence estimates vary. According to the CDC, approx. 15% of U.S. adults experience post-COVID-19 symptoms Last for more than 3 months. The exact cause is unknown.
Some studies suggest that people with diabetes may be more likely to develop post-COVID-19 symptoms than people without diabetes. It’s even more likely in women and people hospitalized with severe COVID-19 infections.
It has also been observed that in people who have had COVID-19 for a longer period of time, certain symptoms, such as fatigue and respiratory illness, seem to be more common in people with diabetes. Conversely, neurological symptoms are less common.
Interestingly, the results of clinical trials showed that: Taking metformin Adults who are overweight or obese are less likely to develop long-term COVID-19 infections.
Q: What should health care professionals know about treating patients with diabetes who have or have had COVID-19?
answer: As a clinician caring for diabetic patients with COVID-19, I’m more diligent in asking patients about symptoms they don’t usually tell me about, like exercise intolerance and brain fog. Regarding dizziness and shortness of breath, I may have previously interpreted these symptoms as indicators of developing heart disease. We may now consider these symptoms consistent with a post-COVID-19 syndrome, or at least in the differential diagnosis.
COVID-19 can have a significant impact on the cardiovascular and microvascular systems, so the number one thing I want my patients to do is try to stay physically active. I want you to manage your sleep and nutrition as much as possible. These basics of diabetes care will be even more important post-COVID-19. They may also prove important in preventing post-COVID-19 situations.
If a patient has exercise intolerance (a common symptom of long-term COVID-19 infection), we need to help them increase their exercise capacity. As with any patient who has just come off a ventilator, we want to help them gradually increase their physical activity. Ask the patient, “How much can you move?” Let’s have them move that much and add a little more. ” Set the bar low and gradually increase it to build strength and endurance. There’s no need to rush. It doesn’t have to happen all at once.
As treatments for acute coronavirus disease (COVID-19) evolve rapidly, medical professionals must consider drug interactions. For patients with active coronavirus infection (COVID-19), Paxlobid has not shown any clinically relevant drug interactions with antidiabetic agents. Metformin, insulin, empagliflozin, pioglitazone. The dosage of saxagliptin may need to be adjusted. Medical professionals recommend monitoring for side effects from glyburide.
NIH is Treatment guidelines for novel coronavirus infection (COVID-19). The CDC has the following guidance: Clinical care for novel coronavirus infection (COVID-19) Assessment and treatment of post-COVID-19 conditions. Additionally, the American Academy of Physical Medicine and Rehabilitation Long Coronavirus Guidance Statement Additional resources for medical professionals.
Q: What is the underlying mechanism explaining the relationship between diabetes and COVID-19?
answer: There are several possible reasons why acute SARS-CoV-2 infection may lead to decreased insulin secretion and increased insulin resistance.
First, studies have shown that the SARS-CoV-2 virus can infect beta cells in the pancreas and alter their function. Beta cells in the pancreas produce insulin. When beta cells become infected, their insulin secretion may decrease or they may die. It’s a bit theoretical at this point, but it’s possible to find SARS-CoV-2 in beta cells.
Another possible mechanism is inflammation, which causes both decreased insulin secretion and increased resistance to circulating insulin. During severe COVID-19 infection, the immune system produces high levels of cytokines. Cytokines are small proteins secreted by immune cells in response to infection and associated inflammation. Pro-inflammatory cytokines can cause beta cell dysfunction and death. Much of the hyperglycemia observed in hospitalized patients with COVID-19 may be due to malfunctioning beta cells due to elevated cytokine levels. In addition to their effect on insulin secretion, cytokines reduce the body’s responsiveness to circulating insulin, causing glucose to be unable to move from the bloodstream to the cells where it is needed. Thus, cytokines influence both insulin secretion and insulin action.
SARS-CoV-2 infects endothelial cells, which are part of blood vessels and capillaries in every organ in the body. ACE2 receptors, the main route by which SARS-CoV-2 enters cells, are often found in the endothelium. Diabetes and any level of hyperglycemia also have a negative effect on the endothelium.
For example, classic diabetic complications such as eye and kidney disease are known as microvascular complications (endothelial cells line the microvasculature). Impingement of endothelial cells infected with SARS-CoV-2 and widespread endothelial cell dysfunction caused by diabetes may contribute to the poor outcomes observed in early studies of hospitalized patients. It remains to be seen whether this has an impact on long-term diabetic complications, both microvascular and macrovascular (cardiovascular disease).
At least in theory, the intersection of COVID-19 and diabetes could have both acute and chronic long-term effects. Long-term effects may be vascular complications of diabetes.
Q: What do we know about new-onset diabetes after contracting COVID-19?
answer: It has been confirmed that people who have been infected with COVID-19 (usually type 2) have an approximately 60% increased risk of developing new diabetes compared to people who have not been infected with COVID-19. It has been.a Study of over 181,000 U.S. Veterans People with COVID-19 were shown to have a 40% higher risk of developing new diabetes a year later than controls.and one meta-analysis People who were infected with COVID-19 were shown to have a 66% higher risk of developing new diabetes than those who did not.
However, other cohort studies suggest that diabetes has not increased significantly after COVID-19 and is only observed in hospitalized patients. Clearly, this topic requires further research. It’s possible that people were not receiving regular medical care early in the pandemic and had diabetes, but were only diagnosed later. This raises the question of whether the new coronavirus really causes diabetes. Still, given the consistent increase in diabetes incidence in many cohorts around the world, we expect global diabetes incidence to be even higher post-pandemic.
There are unanswered questions about how long the onset of diabetes lasts after COVID-19 infection. I have had patients who developed diabetes, but subsequently recovered.a Study abroad in UK Researchers found that during the first four weeks after infection, there were far more new cases of diabetes among people infected with COVID-19 than among people who were not infected with COVID-19. discovered. However, from weeks 13 to 52, there was no difference in the incidence of diabetes between the two groups.
At this time, it is not known whether new-onset diabetes after COVID-19 persists or whether it behaves differently from diabetes unrelated to COVID-19. If this condition persists, the impact on the global diabetes epidemic could be dire. NIDDK is Longitudinal observational study To characterize the onset, clinical course, and pathophysiology of new-onset diabetes following COVID-19 infection in adults and children.
Q: What are the risk factors for developing diabetes after COVID-19?
answer: inside veterans study, The more severe the new coronavirus infection becomes, the greater the risk and burden of diabetes will be. However, people who had even a mild case of coronavirus were more likely to develop diabetes than those who had never had the virus.
In addition, classic diabetes risk factors such as obesity or overweight, family history, and physical inactivity are important.
In general, COVID-19 vaccination is considered a protective factor that reduces the risk of developing diabetes after COVID-19 infection for all people.
Q: Is the diagnosis and treatment of patients who develop diabetes after COVID-19 different from other patients with diabetes?
answer: At this time, no. Theoretically, people who develop diabetes after COVID-19 may have decreased beta cell function, but clinically we think they have less function than others. I do not have a reason.
More importantly, make sure you’re properly testing people for diabetes. It is a good idea to screen patients for COVID-19, especially those with severe infections. However, health care professionals should consider other possible causes of new-onset diabetes, such as exposure to pre-existing diabetes or reinfection with SARS-CoV-2.
In terms of treatment, we do not yet fully understand whether post-COVID-19 incident diabetes behaves differently from other forms of diabetes.
Q: What else should health care professionals know about COVID-19 and diabetes?
answer: Severe coronavirus infection may trigger the progression of more aggressive diabetic complications. Cohorts need to be developed within health systems so that we can see if patients with diabetes have an accelerated risk of complications.
Additionally, people whose blood sugar levels are within the target range at the onset of severe COVID-19 infection fare much better than those whose blood sugar levels are outside the target range. As always, health care professionals must provide comprehensive care to patients with diabetes. We need to help people with diabetes manage their blood pressure, weight, cholesterol, and blood sugar levels. Please note that the following variants can hit people hard:
Editor’s note: The NIH is recruiting children, adolescents, and adults, including pregnant women, to study people with long-term COVID-19 infections. Researching coronavirus to accelerate recoveryor recover.
What signs and symptoms have you seen in patients infected with COVID-19? Let us know in the comments below.