Is there a link between COVID-19 and diabetes?
Metro Creative
Diabetics who contract COVID-19 should check blood sugar before meals and at bedtime, and stay in contact with their physician to keep on top of changes in glucose levels.
Dr. Amit Bhargava
A new study of patients in the United States found an increased risk of diabetes in those who had recovered from COVID-19. What’s more worrisome is that number jumped to a 40% increase one year after recovery.
As researchers and the medical community shift focus to long-term effects of COVID-19, one area of study is showing that not only are diabetics at higher risk of contracting severe COVID-19, but that there may be a reverse link: Does being infected with COVID-19 create a high risk of contracting diabetes? A study in Germany examined mild COVID-19 infections and found those patients were 28% more likely to be diagnosed with type 2 diabetes compared to people who were never infected.
Diabetes occurs when blood sugar levels are high due to the body not producing insulin or not producing or regulating it enough. More than 500 million people around the world are diabetic and are divided into type 1 and type 2 categories. Type 1 diabetes occurs when your pancreas stops making insulin. Type 2 diabetes is a metabolic disorder in which you may be able to produce insulin but can’t regulate it. Diabetes can lead to other long-term complications with the heart, kidneys, eyes, and nerve endings.
The U.S.-based COVID and diabetes study found the risk of diabetes increases along with the severity of a COVID-19 illness. In the study, patients treated in intensive care units saw the risk of diabetes skyrocket 276%. That study followed more than 180,000 patients in a database for the U.S. Department of Veterans Affairs after they contracted COVID-19. Researchers compared their outcomes to control groups of people before and during the pandemic who did not contract COVID-19.
Why the link?
“As we are thankfully seeing more people survive COVID-19, its long-term impact continues to become apparent,” says Dr. Amit Bhargava, Vice Chief and Director of Clinical Operations for Allegheny Health Network’s Division of Endocrinology. He believes most people have no idea there’s a correlation between COVID and diabetes. “With the emergence of new data regarding the bi-directional link between COVID-19 and diabetes, awareness will increase. For example, we have learned that people with pre-existing diabetes saw a worsening of their blood sugars during and after an infection with COVID-19 due to a stress response and, in some, COVID-19 triggered new onset diabetes.”
As to the reason for the connection, there are several theories.
“The SARS-CoV-2 virus binds to angiotensin-converting enzyme 2 (ACE2) receptors, which are also expressed in the insulin producing cells of the pancreas, and is thought to affect their function,” explains Bhargava. He says COVID-19 likely exacerbates the situation for patients already at some risk for diabetes. “Patients with pre-existing or borderline diabetes can experience stress hyperglycemia when fighting an acute illness, thereby worsening blood sugars,” Bhargava says. “Steroids like dexamethasone, used to treat symptoms of COVID-19, also elevate a patient’s blood sugars.”
Bhargava sees this data as extremely important in highlighting the impact of COVID-19 on the affected population. “Further studies are needed to clarify the complex pathways via which COVID-19 causes new onset diabetes and worsens pre-existing diabetes,” he adds.
It is also changing the way he evaluates patients.
“In the setting of a prior COVID-19 infection, elevated blood sugars in such patients trigger us to immediately screen for diabetes,” Bhargava says. “In patients with pre-existing diabetes and an active COVID-19 infection, we are cognizant that more aggressive therapy like insulin may be needed to keep blood sugars in range and must be instituted promptly and early.”
Moving forward, Bhargava says this data is changing the way the medical community is evaluating and treating COVID-19 patients concerning potential diabetes.
“For patients who develop COVID-19 and are hospitalized, their blood sugars are monitored in the hospital,” he says. “Of this population, those with elevated blood sugars and no history of diabetes are placed on medication to lower blood sugars and often discharged on a glucose-lowering drug regimen which may include insulin. Patients are prompted to check blood sugar levels before meals and at bedtime, and to follow up with their primary care provider.”
He says as they recover, it may be possible to cut down or eliminate the glucose-lowering medication. However, for patients with existing diabetes, the dose of glucose-lowering medication may be increased during acute illness with COVID-19 or they may be started on insulin if not already taking it.
“It is recommended that these patients check their blood sugars before meals and at bedtime and maintain contact with their physician,” Bhargava said. “As they recover from COVID-19, blood sugar levels will often stabilize, and the dosing of medication can likely be decreased.” For patients who are not hospitalized and have no diagnosis of diabetes, there is currently no guideline that suggests a closer monitoring of blood sugars following a COVID-19 infection. However, if someone experiences symptoms of diabetes such as increased thirst or urination, they should consult with their physician immediately.
For patients with diabetes who are not hospitalized, he still recommends checking blood sugar before meals and at bedtime and staying in contact with their physician to keep on top of changes in glucose levels.