More than a year after recovering from a COVID-19 infection, Jennifer Hobbs is adjusting to her new normal: brain fog, joint pain, increased liver enzymes and now type 2 diabetes. Hobbs had prediabetes before getting COVID-19, but his blood sugar level was under control, and he didn’t need any treatment. Recently, that changed.
“I take my blood sugar [level] Every morning, and even with two different types of drugs, it’s all over the place,” said Hobbs, 36. The new diabetes diagnosis has both Hobbs and his primary care provider wondering whether the coronavirus has played a role.
Two years into the pandemic, scientists and physicians are shifting their attention to the long-term consequences of a COVID-19 infection known as “Long COVID.” Recent studies add diabetes to the list of potentially long COVID consequences.
Experts have known that people with diabetes are at a higher risk of serious COVID-19 infection, but now, a new connection is opening up – that a COVID-19 infection may lead to a higher risk of diabetes.
A study published this month looked at people with mild COVID-19 infection in Germany and found that they were 28% more likely to be newly diagnosed with type 2 diabetes than those who had never been infected.
A similar study in the United States found an increased rate of diabetes among people who had recovered from COVID-19: a 40% increase in risk for at least one year after infection. Researchers estimate that 2 out of every 100 people who are infected with COVID-19 will have a new diagnosis of diabetes.
This US-based study, published last week in the medical journal The Lancet, also found that people who had little or no risk factors for diabetes also had a 38% increased risk of developing diabetes later due to COVID-19 infection. .
The more severe someone’s coronavirus infection was, the higher the risk of developing diabetes. Those who were treated in the ICU had a 276% increased risk of diabetes. This association may be related to the steroids that some patients receive while receiving acute care in hospital, which can elevate blood glucose levels.
“It’s not diabetes for a month or two after recovery. It’s for a year, and it’s definitely happening in people who aren’t hospitalized,” said lead researcher Dr. Ziad Al-Aly, chief of research and development at the St. Louis Health Care System in the VA and a clinical epidemiologist at Washington University in St. Louis.
That study used the US Department of Veterans Affairs’ national database to follow more than 180,000 people after getting COVID-19. The research team compared the results of this group with the results of a control group of more than 4 million people before the pandemic, as well as another group of more than 4 million people who did not get COVID-19 during the pandemic.
In children, the overall risk of newly diagnosed diabetes is even worse. A report by the US Centers for Disease Control and Prevention published in January found that children were two and a half times more likely to develop diabetes after a COVID-19 infection than those who had never been infected a month after infection .
For many years, theories have circulated about inflammation caused by viral infections associated with diabetes. However, according to Dr. Robert Gubbe, chief scientist and medical officer of the American Diabetes Association, this is the first time studies have shown such a strong link between diabetes and a specific virus.
It is still unclear to scientists why COVID-19 is putting people at risk for diabetes. One theory involves the receptor where the virus attaches to the lungs, which is also present in the pancreas.
“There have been several studies showing that SARS-CoV-2 can attack the beta cells of the pancreas and cause at least temporary damage, if not more permanent damage,” said Dr. Sarah Kroemer, an assistant in medicine at Mass General Hospital in the department of endocrinology, diabetes and metabolism. She was not involved in the two new studies.
Beta cells are pancreatic cells that produce insulin. As these cells are destroyed by COVID-19 infection, the body may lose its ability to make insulin. It is similar to type 1 diabetes, an autoimmune disorder in which the body destroys its own beta cells and therefore cannot make insulin.
“It is also possible that there is an acute inflammation of COVID that may be present in low levels, even in asymptomatic or minimally symptomatic cases,” Kroemer said. “This can lead to short-term insulin resistance, which may snowball or set off a chain of events that leads to more long-term insulin resistance.”
This second theory would better explain the development of type 2 diabetes, which is the most common form, in which the body is still making insulin but becomes resistant to it and thus cannot respond to it. Type 2 diabetics made up more than 99% of cases of newly diagnosed diabetes following COVID-19 infection, which Al-Aly’s study identified.
Kroemer said other factors may contribute to this increased risk for diabetes.
“When you are diagnosed with SARS-CoV-2, you may stay home for a while, you may eat differently, you may not exercise. There are many ways in which it can affect your lifestyle and behavior. can, and we don’t. Don’t really know how they might interact with metabolic disease,” she said.
In a study led by Kroemer, her research team found that people with newly diagnosed diabetes after COVID-19 were younger, black or Hispanic, and younger.
“We thought that many of these people may have pre-existing diabetes who were not diagnosed because they had poor access to health care,” Kroemer said.
Eleven months after her COVID-19 infection, 45-year-old Claudia Mendez was diagnosed with type 2 diabetes during an urgent care visit. Her blood sugar level was found to be 300, which is a marked increase from the normal level below 140. For Mendez, studies like this are finally answering questions that have been brewing for the past two years in the long run of COVID-19.
“It’s a double-edged sword just because you never want to be in this place, but to hear that it’s being accepted is kind of a relief,” she said.
These studies don’t mean that specific diabetes cases like Mendez’s and Hobbes’s were directly caused by the coronavirus, but they are changing the way doctors think about the relationship between the two conditions.
Now, COVID-19 can be considered a risk factor for diabetes. “I think the big message for physicians is that knowing that someone has had a COVID infection should raise your awareness of potentially screening for diabetes,” Gabbe said.
care for chronic conditions
As diabetes has been added to an emerging list of post-COVID complications, experts are concerned about the staggering impact on the already strained healthcare system.
“Essentially, this is going to create a large number of people with newly diagnosed diabetes,” Al-Aly said. “This is a really serious downstream effect and will require life-long care. … I think we need to be prepared to really build capacity to deal with these patients.”
The question remains whether America’s health care system is prepared to handle the spike in chronic conditions emerging from the pandemic. Al-Ali’s research team also recently found that people with COVID-19 infection had a 60% increase in cardiovascular disorders after recovery.
“We are already challenged to take care of all the people with diabetes that currently exist. The last thing we need is to increase the number,” Gabbe said.