The pandemic of the new coronavirus continues to be the major and critical health problem worldwide. When, to date, more than 491 million people worldwide have been infected and sickened by COVID-19, when 6,176,000 people have lost the battle for life due to this highly toxic SARS-CoV-2 virus, it becomes clear that this disease was and is a global threat to our society, no matter how much the latest Omicron 1 and Omicron 2 strains present a lower risk of morbidity and mortality.
It is now known that people of advanced age or with underlying diseases are at greater risk of disease and complications from COVID-19. The most important of these diseases are hypertension, cardiovascular diseases and diabetes mellitus.
It appears that people with diabetes mellitus have a higher risk of becoming seriously ill with COVID-19 or even dying (3 to 4 times higher risk as all studies show). At the same time, the disease may severely deregulate an already existing diabetes mellitus and may also show symptoms of acute insulin-dependent diabetes mellitus in non-diabetic individuals, due to the toxic effect of SARS-CoV-2 virus on pancreatic beta cells.
What else does the encounter between diabetes and COVID-19
According to recent literature, the encounter of COVID-19 with diabetes seems to take on a new dimension. These data show an increased risk of developing diabetes mellitus (DM) after coronavirus infection in non-diabetic individuals in the context of Long-COVID syndrome.
Lancet
In particular, an important evidence-based study analysing a large database in the USA comparing the risk of developing diabetes mellitus in 180 people was published in the prestigious scientific journal Lancet at the end of March.000 people who became ill with COVID-19, for one year after becoming ill, with the corresponding risk of developing diabetes in 8,000,000 healthy people who did not become ill in the same year.
It appeared that the risk of developing diabetes mellitus (99% type 2) in people who became ill was highly elevated (by 40%) and showed an increase ranging from 31% to more than 100%, depending on the presence or absence of risk factors such as age, body mass index (BMI), prediabetes, etc.etc.
In hospitalized subjects who required hospitalization, the risk of diabetes mellitus, at one year of follow-up, was increased by 173% and in hospitalized and intubated subjects due to COVID-19, it was increased by 273%!
Extremely interesting, however, is the fact that even mildly ill subjects (not requiring hospitalization) had a 25% increased risk of diabetes mellitus one year later in the context of the Long-COVID syndrome.
Diabetologia
At the same time, a similar study from a German database was published in the prestigious medical journal Diabetologia, comparing the incidence of type 2 diabetes mellitus in a population of 35,856 COVID-19 patients one year after their illness with the similar incidence in the same number of patients with upper respiratory tract infection (who were not COVID-19). Again, there was a 30% increased incidence of type 2 diabetes mellitus in the diseased population.
There are many putative reasons for the increased risk of type 2 diabetes mellitus in the context of Long-COVID syndrome. The development of insulin resistance and impaired insulin secretion has also been described in non-diabetic patients who became ill and recovered. Inflammatory cytokines and TNF-a remain at elevated expression even after hospitalisation and can cause pancreatic beta-cell dysfunction (responsible for insulin secretion) and insulin resistance.
In conditions characterised by the presence of chronic inflammation (such as obesity, visceral fat accumulation, etc.), infection can exacerbate this chronic inflammation even after hospitalisation and promote insulin resistance, which is a pathogenetic pillar for the development of type 2 diabetes mellitus. Increased expression of ACE2 protein (a protein crucial for the entry of SARS-CoV-2 virus into cells) in pancreatic beta cells is also suspected, resulting in an increased risk of a toxic effect of the virus on pancreatic beta cells and hence a reduced insulin response.
Unanswered questions and how to proceed
The aforementioned studies added several new insights into the relationship between COVID-19 and diabetes particularly in the long-COVID phase. There are, of course, many unanswered questions still:
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- It is unknown whether this post-hospitalization type 2 diabetes mellitus is pre-existing prediabetes or unknown diabetes that becomes evident after hospitalization for COVID-19 as a consequence of immunological overactivation and all those factors described as possible for the development of type 2 diabetes mellitus.
- Is this type 2 diabetes mellitus reversible in the context of long-COVID?
- What is the optimal treatment and management of this type of diabetes?
- For how long after hospitalization does the risk of developing type 2 diabetes mellitus remain elevated?
- Should people who have had type 2 diabetes mellitus without known risk factors for developing it be given more comprehensive serological, autoantibody and c-peptide testing for the possibility of another type of diabetes?
Regardless of these questions, however, following the important data from the studies reported, the need to screen patients with COVID-19 for the possible development of type 2 diabetes mellitus becomes clear.
This screening should be done at regular intervals up to one year after hospitalization (we have no data on increased development of type 2 diabetes mellitus after one year from hospitalization). Diabetes screening should include, in addition to fasting glucose, the two-hour glucose curve, which gives reliable data on the potential status of diabetes in the person being screened.
As it turns out, Long-COVID status, after all, holds many new surprises even for people who are mildly ill. And the increased risk of type 2 diabetes mellitus is, certainly now, one of these surprises.
Source: ygeianews.gr
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