New research shows higher risk of developing diabetes after Covid-19 infection
A large new study has found that people who have recovered from Covid-19 in the past year are 40% more likely to be newly diagnosed with diabetes than those who have not been infected.
According to the study author, the increased risk translates to 1% of people who have had diabetes developing Covid-19 who otherwise would not have it, which could lead to millions of new cases worldwide .
Most people with diabetes in the study, published online Monday in the journal Lancet Diabetes and Endocrinology, were diagnosed with type 2 diabetes, not type 1. Some researchers say Covid-19 could also trigger a whole new type of diabetes in which certain cells mistakenly begin to increase , rather than lowering, blood sugar. .
The study adds to evidence showing a post-Covid-19 increased risk of cardiometabolic diseases, such as diabetes as well as heart and kidney complications. Normally, when people think of long-term symptoms of Covid-19, they think of issues such as cognitive issues, fatigue or shortness of breath. But scientists say there are likely different types of long Covid, and one appears to be defined by cardiometabolic issues that arise after Covid-19. Until there, World Health Organization estimates there have been over 464 million cases of Covid-19, so even small percentages of those people developing long-term complications would be significant.
“We’re finding out more and more that it’s not just respiratory issues, or brain fog, or just fatigue,” says Ziyad Al-Aly,
chief of research and development at the VA St. Louis Health Care System and clinical epidemiologist at Washington University in St. Louis, who led the study. “There are cardiac manifestations, and clearly diabetes and renal manifestations.”
Dr. Al-Aly’s group recently published studies on these broader risks. One showed a higher risk of developing heart problems, including strokes and heart attacks, in people who have had Covid-19 than in people who don’t. Another showed that post-Covid-19 patients were more likely to have decreased kidney function or kidney damage up to six months after infection compared to patients who had not had Covid-19. .
The researchers only found an association between Covid-19 and cardiometabolic conditions, without proving a cause. Some doctors say new diagnoses of type 2 diabetes and heart disease could be influenced by weight gain or decreased activity during the pandemic, although lifestyle changes don’t necessarily explain an increase specifically in people who have had Covid-19.
In the new diabetes study, Dr. Al-Aly and co-researchers analyzed the records of 181,000 Covid-19 patients in the Veterans Health Administration system who were diagnosed with Covid-19 in the past year and compared them to more than eight million people who did not have Covid-19. The VA study did not examine diabetes cases by vaccination status.
“When you look at the data nationally, this is clearly happening even in people who have no risk factors or very few risk factors,” Dr Al-Aly said, adding that new diagnoses occur even in young adults at a healthy weight. and no history of hyperglycemia.
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Maren Laughlin, program director at the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health, said the study was very well done. Its main limitation, she noted, is that VA patients generally tend to be older and sicker and include more men than the general population.
It has not been determined why a Covid-19 infection could lead to new cases of diabetes. One possibility is that the virus could damage the ability of the pancreas to secrete insulin, the hormone that regulates blood sugar. Another theory is that the strong immune response to Covid-19 generates an inflammatory cascade that leads to low-grade inflammation, which interferes with insulin secretion and sensitivity.
All types of diabetes share the symptom of high blood sugar, but they are separate conditions. Type 2 is the most common and can be combined with diet and exercise. Typically in type 2, people become resistant to the hormone insulin, which regulates blood sugar. The pancreas struggles to meet the body’s increased demand for insulin, which leads to an increase in blood sugar.
Type 1, on the other hand, is an autoimmune disease in which the body destroys pancreatic cells that produce insulin. Other types of diabetes include gestational diabetes, which can develop in pregnant women.
The latest study follows other recent research that found an increased risk of being diagnosed with diabetes after Covid-19 infection, including a January report from the Centers for Disease Control and Prevention looking at the children.
In a March study in the journal Diabetologia, German researchers found that people with Covid-19 had about a 28% increased risk of a new type 2 diagnosis compared to those with an acute upper respiratory infection that was not Covid. -19. The researchers compared data from more than 35,000 patients with Covid-19 to an equal number of people with infections that were not Covid-19. They did not find an increased risk for other types of diabetes.
And one February JAMA Network Open Survey found that people who tested positive for Covid-19 had about twice the risk of a new type 2 diagnosis one to five months after their infection compared to those who had tested negative for the virus. About 7% of adults hospitalized with Covid-19 received new diagnoses of diabetes within five months, compared to 3.6% of adults without Covid-19.
Interpreting the data presents many challenges, says Jason Block, an internal medicine physician and associate professor at Harvard Medical School, lead author of the JAMA study. Many people had not seen a doctor for a while during the pandemic, so they may have had diabetes without knowing it. Additionally, steroids – a drug commonly used for severe Covid-19 patients – can temporarily raise blood sugar levels and could also trigger diabetes in patients at risk of contracting the disease.
There are several possible biological reasons why a diagnosis of diabetes could follow a Covid-19 infection. Research has indicated that the virus can infect and damage beta cells in the pancreas so that they produce less insulin.
In one study, researchers found that when they added the coronavirus to samples of beta cells, genetic changes occurred in the cells, which significantly reduced their ability to make insulin. Instead, to the researchers’ surprise, the cells did something unusual: they started making a different hormone, glucagon, whose function is to increase blood sugar.
“The beta cells lost their cellular identity and transformed into a different cell type,” says Shuibing Chen, director of the diabetes program at Weill Cornell Medicine in Manhattan, who led the study.
Dr Chen says infection with Covid-19 appears to trigger a new type of diabetes that is neither type 1 nor type 2. Dr Chen says his team is studying treatments specifically for Covid-19 patients newly diagnosed with diabetes to see if they can block the process by which cells might change.
Stanford researchers in an August study published in the journal Cell Metabolism documented another possible clue to post-Covid-19 diabetes. Laboratory studies revealed that the virus selectively targets pancreatic beta cells.
“This reduced their viability quite quickly and reduced their ability to secrete insulin within a day,” says Peter Jackson, a professor in the Department of Microbiology and Immunology at Stanford University School of Medicine and lead author of the study. “It’s a strong effect.”
Write to Sumathi Reddy at [email protected]
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