June 13, 2020

expert reaction to letter warning of new-onset diabetes in COVID-19 patients

A letter, published in The New England Journal of Medicine (NEJM), warns of new-onset diabetes in COVID-19 patients.

Dr Abd Tahrani, Senior Lecturer in Metabolic Endocrinology and Obesity Medicine and NIHR Clinician Scientist; University of Birmingham, said:

“The current evidence suggest that diabetes and poor glycaemic control are risk factors for severe COVID-19 and that COVID-19 might precipitate diabetes-related ketoacidosis. However, whether COVID-19 can increase the risk of developing diabetes mellitus remains unknown and the correspondence published at NEJM provides plausible mechanisms for a bi-directional relationship between diabetes and COVID-19. Hence, it is important to examine these complex interactions between diabetes and COVID-19 further and the setting up of the global registry CoviDIAB is an important step in that regards. However, for now and till further evidence is available, it is important that we improve glycaemic control in people with diabetes to reduce the risk of severe COVID-19 as well as working on strategies that prevent the development of Type 2 diabetes.  An essential step in that direction is treating people with obesity and making obesity treatments (from life style interventions to bariatric surgery) available to patients with obesity that require treatment nationally as current treatment option availability is post code lottery.” 

Dr Gabriela da Silva Xavier, Senior Lecturer in Cellular Metabolism, University of Birmingham, said:

“The three papers that were cited to support the need for further research represents one case study describing the case of one patient with new onset diabetes and two papers describing larger cohorts with diabetes where the disease may have been aggravated by COVID-19.  None of the studies cited explicitly describe diabetes brought on by COVID-19.

“One of the cited papers provides circumstantial evidence for potential damage of the cells that produce insulin, the pancreatic beta cells, by SARS, not COVID-19.

“Taken together, it is currently unclear whether COVID-19 is causal for diabetes, but there is some correlation with worsening of disease with COVID-19.  It is, therefore, logical to want to investigate whether COVID-19 is causal for or exacerbates diabetes by establishing a registry where patient history of diabetes is systematically logged, as proposed in the letter. 

“In short it would be unfair to take the cited data to indicate that COVID-19 is causal of diabetes and diabetes complications but, given the observations, it is reasonable to propose to look at this carefully, as proposed in the letter.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“This is definitely an important question that many doctors are watching but we need to see what happens to diabetes rates over the next 1-2 years to confirm or refute such risks.  We will certainly get these data as all national datasets are keeping close watch.  In meantime, people should be encouraged to keep active and eat healthily or as best they can to keep their weights stable or to lose a few pounds to lessen their risks of diabetes now (and in the future) and potentially to reduce their risks of developing more severe COVID-19 should then succumb to the infection. That is the best we can do and we need more governmental help to promote and make healthier lifestyles easier as we come out of lockdown.”  

Dr Riyaz Patel, Associate Professor of Cardiology & Consultant Cardiologist, UCLH, said:

“There is no robust data yet to indicate that COVID-19 causes new diabetes or worsens existing diabetes. Some data however suggests there could be a possible link so researchers are seeking to explore this further.

“Observational data linking the two may be confounded for a few reasons. For example we know that any stress inducing illness can cause blood sugar levels to temporarily rise and we see this for example with heart attacks. Also people who are more likely to get very sick with covid may be at risk of developing diabetes anyway perhaps because they are overweight. We know that obesity is linked to worse outcomes with COVID.

“However there are many uncertainties about COVID, how it affects our cells and especially the longer term effects after surviving the illness. The researchers are experts in diabetes and propose to study this in more detail by collecting data at scale internationally. If there is a direct link then that will have important implications on how we treat COVID patients during and after the acute illness.

Prof Lora Heisler, Chair in Human Nutrition, University of Aberdeen, said:

“Information collected about people who have unfortunately caught highly contagious COVID-19 has shown that some people are at more risk of developing more serious symptoms and particularly upsetting, at greater risk of not surviving if they get COVID-19.  This higher risk group includes older folks and those who already have diseases, including type 2 diabetes.  What isn’t clear is why people who already have type 2 diabetes are at greater risk for more serious symptoms and possible fatality from COVID-19.  Since COVID-19 is so new, scientists and doctors just don’t know.  Some positive news was reported by Hongliang Li earlier this month in the journal Cell Metabolism.  They found that people with type 2 diabetes with better management of their blood sugar had a better outcome with COVID-19 as compared to patients with poorer control of their blood sugar. 

“What is really important about this new initiative is that it is asking a different question – does COVID-19 trigger diabetes, either type 1 or type 2, in people who did not have diabetes before getting COVID-19?  To begin to answer this, these experts are establishing a Global Registry –  or a list – of new cases of diabetes in patients with COVID-19.  This registry is a great first step in trying to answer this question.  A challenge, however, will be trying to figure out whether the diabetes is actually new before COVID-19 because some people may have undiagnosed diabetes.  Even still, this registry will provide very valuable information about the emerging association between these two diseases.”

’Correspondence: New-Onset Diabetes in Covid-19’ by Rubino et al was published in NEJM on Friday 12^th June 2020

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

Conflicts of interest:

Prof Naveed Sattar: No COIs

Dr Riyaz Patel: No conflicts

None others received