When Ziyad Al-Aly’s research team told him how often diabetes seemed to hit Covid-19 survivors, he thought the data must be wrong and asked his five colleagues to recreate the numbers.
Weeks later, they returned the same results after going through millions of patient records. By then, Al-Aly had also looked at the scientific literature and began to grapple with an alarming reality: Covid-19 is not only more deadly for people with diabetes, it also triggers metabolic disease in many who did not. I don’t have it before.
“It took me a while to convince,” said Al-Aly, who directs the health system’s clinical epidemiology center for veterans affairs in St. Louis, Missouri. “It was hard to believe covid could do this.”
Among the many ripple effects of covid-19, the worsening global diabetes burden could place a heavy burden on public health. The underlying mechanisms that trigger emerging diabetes are not clear, although some doctors suggest that the SARS-CoV-2 virus can damage the pancreas, the gland that produces insulin, which is needed to convert blood sugar into energy .
Sedentary lifestyles induced by lockdown could also play a role, as could late diagnoses after people avoided doctor’s offices during the pandemic. Even with some mild coronavirus cases in children, diabetes can develop quickly, according to scientists.
Considered solely a lung disease in the early days of the pandemic, Covid-19 is increasingly known for its ability to devastate multiple organs and body systems, causing persistent and sometimes debilitating symptoms for one in ten people months after their apparent recovery.
Persistent metabolic complications, sometimes requiring high doses of insulin, suggest a subset of survivors will develop diabetes – adding to the number of the more than 463 million people with chronic disease.
The disease, in which the body does not make enough or use insulin properly, was estimated to cost an estimated $ 760 billion in the year prior to the onset of Covid, due to life-shortening complications ranging from stroke and kidney failure to foot ulcers and blindness.
Al-Aly and colleagues were the first to measure the effects in the United States using evidence from the Department of Veterans Affairs national health databases. They found that Covid survivors were 39% more likely to have new diabetes diagnoses than uninfected VA health system users in the six months after infection.
The risk is about 6.5 additional cases of diabetes per 1,000 covid patients who do not end up in the hospital. For those who do, the odds go up to 37 per 1,000 – and even higher for those in need of intensive care.
The numbers should be seen in the context of the range of covid, Al-Aly said. During the winter summit, more than 130,000 patients with the coronavirus were hospitalized in the United States alone. Globally, the virus is believed to have infected more than 153 million people, including more than 20 million in India, the country with the largest number of people suffering from diabetes after China.
Al-Aly’s data was published in Nature last month, three weeks after a study of nearly 50,000 hospitalized Covid patients in England found that they were 50% more likely to develop diabetes than comparable controls around 20 weeks after discharge .
“We are at risk of two pandemics colliding,” said Francesco Rubino, chairman of metabolic and bariatric surgery at King’s College London, who worked with Paul Zimmet, professor of diabetes at Melbourne’s Monash University to set up a global registry of covid-related diabetes.
HUNT FOR EXPLANATIONS
Researchers have hypothesized that Covid could increase the likelihood of a diagnosis of diabetes, including the possibility that the pancreatic beta cells that secrete insulin are destroyed either by the virus or by the body’s response to the infection.
Other explanations could include an acute stress response to the infection, the use of steroid treatments that aid survival but increase blood sugar, or just revealing cases of diabetes that had previously escaped diagnosis, said John Nicholls, a clinical professor of pathology from the University of Hong Kong.
Nearly 500 doctors from around the world have agreed to share data on Rubino’s diabetes registry. They upload the known risk factors, laboratory results, clinical characteristics, treatment and disease progression information of the patients to determine the most common form of the disease, possible causes and likely prognoses.
So far, almost 350 cases have been documented via the registry, and descriptive anecdotes flow through emails from affected patients and parents almost daily.
“People write to us and say, ‘My son has just been diagnosed with diabetes. He’s 8 years old. He only got eager last month or two months ago. Could it be related?'” Said Rubino.
The question of whether the virus can cause diabetes is controversial. Monitoring diabetes using population-based data could be a clearer way to gauge the impact of the pandemic, said Jonathan Shaw, associate director of the Baker Heart and Diabetes Institute in Melbourne, Australia.
Seeking to release initial results from the diabetes registry data mid-year, Rubino offers a word of early caution: there is ample evidence of the long-term consequences of covid-19 that should be avoided at any age.