How COVID-19 is impacting type 1 diabetes management
Since the start of the COVID-19 pandemic, the number of people newly diagnosed with diabetes, especially type 1 diabetes (T1D), has increased. Several studies are underway to investigate this increase in diagnoses. Type 1 diabetes can be induced by environmental factors such as viruses, and COVID-19 may negatively affect pancreatic function and insulin secretion. COVID-19 may lead to type 1 diabetes by directly damaging insulin-producing cells in the pancreas or as a side effect of inflammation caused by the immune system fighting the virus. The SARS-CoV-2 virus can thrive in an environment with elevated blood glucose levels, which may induce relative insulin deficiency, i.e. type 2 diabetes (T2D).
A recent study published in the scientific journal Nature used the U.S. Department of Veterans Affairs (VA) national medical database to find that COVID-19 survivors were approximately 39% more likely to be newly diagnosed with diabetes within six months of infection compared to non-infected individuals in the VA health care system. Before the pandemic, GlobalData projected that the diagnostic prevalence of T1D in the United States would increase by 0.93% annually, and the diagnostic prevalence of T2D by 1.80%. Because COVID-19 can cause diabetes, these rates of increase are likely to increase. Drug developers must anticipate this increased need and the additional complications that COVID-19 and diabetes (and COVID-19-induced diabetes) may cause.
As diabetes diagnoses increase, it is critical to note that people with diabetes are at higher risk for severe COVID-19 illness. However, as COVID-19 vaccinations began earlier this year, diabetes advocacy groups pointed out that people with type 1 and type 2 diabetes were being given unequal priority for vaccination in the United States, despite research showing that people with type 1 diabetes, like those with type 2 diabetes, are at higher risk for dying from COVID-19.
The US Centers for Disease Control and Prevention (CDC) interpretation of risk differed from the determination of health authorities in the UK, where both type 1 and type 2 diabetes are included in the list of conditions that pose a high risk after COVID-19 infection. A study in the Lancet Diabetes and Endocrinology analyzed 61 million medical records from the National Health Service in England and concluded that people with type 1 diabetes are almost three times more likely to die from COVID-19 than people without diabetes, and people with type 2 diabetes are almost two times more likely to die from COVID-19.
COVID-19 patients with diabetes may be more difficult to treat due to fluctuating blood glucose levels and diabetic complications. The incidence of diabetic ketoacidosis (DKA) has increased during the pandemic. Infections in patients with type 1 diabetes often lead to DKA, so COVID-19 may lead to worse outcomes in children and adolescents with type 1 diabetes than in their peers without diabetes.
Key opinion leaders (KOLs) interviewed by GlobalData noted that the increase in DKA during the pandemic has made physicians hesitant to prescribe sodium-glucose cotransporter-2 (SGLT-2) inhibitors to patients with type 1 diabetes because, despite the significant cardiovascular benefits of SGLT-2 inhibitors, physicians are unwilling to take the risk of DKA given the additional risk factor of COVID-19. Despite these increased risks, the CDC updated its vaccine prioritization guidance on March 29, 2021 to include type 1 diabetes as a high-risk disease that should be prioritized for vaccine distribution.
Another unique lesson learned from the pandemic is the rise of telehealth and how it relates to patient engagement. Healthcare professionals play a key role in developing patient-centered care, especially by educating and supporting them on the skills needed to successfully manage both type 1 and type 2 diabetes. Greater access for doctors to patients and for patients to doctors leads to better monitoring and management, which in turn leads to improved glycemic control. The pandemic has also influenced diabetes developers' strategies, with accessibility and affordability now being prioritized.
In the US market, several pharmaceutical companies have widely promoted programs to help patients access insulin during the pandemic. Eli Lilly is offering a copay program to allow patients to purchase insulin at a discount, widening access for diabetes patients at a time when the socio-economic impacts of the pandemic have left many without medical care. Novo Nordisk has expanded access to its free 90-day insulin supply program for workers in the US economy who have lost access to medical care due to the pandemic. Due to possible supply chain disruptions due to the pandemic, both Eli Lilly and Novo Nordisk have assured patients and physicians who rely on their diabetes products that there will be no disruptions to their supply chains.
Diabetes is prevalent, making it a lucrative market for drug developers. The number of diabetes patients is expected to further increase due to COVID-19, and as the pathophysiology of diabetes caused by COVID-19 is further studied, more patients will need targeted therapeutics. And as the pandemic has highlighted, so will the need to ensure affordability of diabetes medications. The growing demand for antidiabetic drugs and insulin represents a huge opportunity for drug developers to develop novel and more accessible treatments for diabetes patients.
“Type 1 diabetes is being left out of the COVID-19 conversation, but the ripple effects continue” was originally published on Pharmaceutical Technologya brand owned by GlobalData.
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