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Does COVID-19 Trigger New Cases of Diabetes?

MONDAY, June 22, 2020 -- Early in the coronavirus pandemic, doctors learned that people with diabetes face a greater risk of developing serious complications from COVID-19 infections.

What they didn't immediately realize is that the new coronavirus might trigger diabetes in people who didn't have the blood sugar disease before.

To get a better idea of exactly how COVID-19 and diabetes interact, an international group of 17 leading diabetes experts just announced they'll be collecting data through a new global registry called the CoviDiab Registry.

"The evidence so far is clear that there is an interplay between diabetes and COVID-19. The link is bi-directional as diabetes is associated with severe COVID-19 manifestations and, conversely, COVID-19 is associated with severe manifestations of preexisting diabetes," said the lead author of the letter, Dr. Francesco Rubino. He is a professor of metabolic and bariatric surgery at King's College London in the United Kingdom.

"Because of the preliminary nature of these observations, we have launched the international registry to quickly gather more evidence and confirm or dispel the concerns that the virus may indeed induce diabetes," he explained.

Rubino said it's not yet clear how COVID-19 might trigger diabetes. He said there are known stress responses that can make preexisting diabetes worse or unmask already existing diabetes. Some of the treatments used for COVID-19 are known to increase blood sugar levels, so that could play a role, too.

Past research also showed that the coronavirus responsible for SARS (severe acute respiratory syndrome) seemed to trigger an acute type of diabetes. That virus also directly damaged the pancreas (the major organ involved in diabetes).

Sanjoy Dutta, vice president of research for JDRF (formerly the Juvenile Diabetes Research Foundation), agreed that there are a number of potential ways that COVID-19 might lead to diabetes.

"The idea of a viral trigger has been associated with type 1 diabetes, but is definitely not proven. There are so many viruses and so many viral infections and, fortunately, the number of people with type 1 diabetes is much, much lower," he said.

Dutta explained that there are other pathways in the body that can create an imbalance of blood sugar that could trigger acute diabetes. He said this type of diabetes might go away if blood sugar levels were controlled, but it's still unknown.

While the registry is collecting data and getting a better understanding of how the two conditions affect each other, there are some helpful things people can do.

If you already have diabetes:

"Having diabetes clearly increases the risk of experiencing more severe COVID-19 [infections], as well as complications from diabetes itself," Rubino said. That means avoiding infection is even more important for people with diabetes. Rubino said people with diabetes need to be extra cautious and follow public health advice -- such as hand-washing, social distancing and wearing a mask -- to mitigate risk of catching an infection.

People with diabetes should keep a closer eye on their blood sugar levels. If blood sugar levels are higher than they should be, contact your doctor. Your diabetes care might need to be adjusted. Additionally, regularly checking your blood sugar can help you avoid serious diabetes complications if you develop a COVID-19 infection and don't realize it.

If you have pre-diabetes or a high risk of diabetes:

If you've been diagnosed with pre-diabetes or you're at high risk of developing diabetes due to conditions such as obesity, taking steps to maintain a healthy lifestyle may be more important than ever to help prevent diabetes. Following public health guidelines to try to avoid infection is important for people with pre-diabetes and a high risk of diabetes, too.

If you have COVID-19, but don't have diabetes:

If you've been diagnosed with COVID-19, but don't have diabetes, be wary of the sudden onset of symptoms that could indicate diabetes. These include being very thirsty, needing to urinate more than usual, feeling very tired, having blurry vision or feeling confused. These symptoms could signal complications of diabetes that require urgent medical attention, Rubino said.

Dutta said if you know you have a family history of diabetes, especially type 1 diabetes, it's a good idea to let your doctor know because you have a higher risk of developing diabetes.

A potentially lasting risk?

For those who develop diabetes during a COVID-19 infection and then get better, Rubino said doctors don't yet know if the risk of diabetes will return to normal, or if it will remain higher for an extended period.

"Until we know more, it is prudent to assume that patients who have had diabetes during the course of COVID-19 could be at increased risk of diabetes later on even if diabetes resolves after the infection," he explained.

Rubino said doctors should monitor anyone who got diabetes during a COVID-19 infection over time to see what happens to their blood sugar levels. He added that the global registry is accessible by any physician around the world, and he encourages doctors to share their findings to increase understanding of the COVID-19/diabetes relationship.

The new registry information was recently published online as a letter in the New England Journal of Medicine.

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Posted: June 2020