A letter published on June 12 in the New England Journal of Medicine notes that there is a bidirectional relationship between diabetes and COVID-19. According to the letter, diabetes is linked to an “increased risk of severe COVID-19,” while doctors have noted “new-onset diabetes and severe metabolic complications of preexisting diabetes” in COVID-19 patients.
Diabetes is a disease in which the body’s blood glucose levels are too high, whether because the pancreas produces little or no insulin, known as type 1, or because the body has developed a resistance to insulin, known as type 2.
“These manifestations of diabetes pose challenges in clinical management and suggest a complex pathophysiology of COVID-19–related diabetes,” reads the letter, which was signed by an international group of leading diabetes experts who are part of the CoviDiab Registry project.
The CoviDiab Registry project is a research initiative spearheaded by an international group of expert diabetes researchers. According to data collected in the registry so far, between 20% and 30% of all people who die from COVID-19 also have diabetes.
Researchers are still uncertain about how SARS-CoV-2, the virus that causes COVID-19, is related to diabetes. Research so far suggests that ACE-2, the protein to which the virus binds so that it can enter human cells, is found in lung tissue cells, but also in the cells of organs involved in glucose metabolism, including the pancreas, the small intestine, the liver and the kidneys. Scientists believe that when the virus enters such tissues, it can cause dysfunction in glucose metabolism.
“Diabetes is one of the most prevalent chronic diseases, and we are now realizing the consequences of the inevitable clash between two pandemics. Given the short period of human contact with this new coronavirus, the exact mechanism by which the virus influences glucose metabolism is still unclear, and we don't know whether the acute manifestation of diabetes in these patients represent classic type 1, type 2 or possibly a new form of diabetes,” Francesco Rubino, co-lead investigator of the CoviDiab Registry project, said in a statement released by King’s College London.
Paul Zimmet, another co-lead investigator in the CoviDiab Registry project, also explained in the statement that researchers are still unsure of the “magnitude of the new onset diabetes in COVID-19.”
“By establishing this Global Registry, we are calling on the international medical community to rapidly share relevant clinical observations that can help answer these questions,” he noted.
A study published late May in the journal Diabetologia found that 1 in 10 patients who have diabetes and also contract COVID-19 die within seven days of being admitted into the hospital. The study also found that 1 in 5 patients with both diabetes and COVID-19 end up being intubated and mechanically ventilated within a week of being hospitalized. The study was based on 1,317 patients who were admitted to 53 public and private French hospitals between March 10 and March 31. Two-thirds of the subjects were men.