World analysis consortium examines if COVID-19 might trigger diabetes

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Ever since Metro Vancouver resident Craig Spanza was infected with COVID-19 while working last March, he has battled countless long-term after-effects, including debilitating brain fog, exhaustion and shortness of breath.

But Spanza, 49, is also dealing with a new diagnosis that has come unexpectedly since his illness: rapid-onset type 2 diabetes.

“It feels safe, like it was triggered by COVID,” said Spanza. “The doctor said I wasn’t on the charts on the random glucose tests.”

Spanza is not alone. Globally, doctors treating people recovering from COVID-19 have found that some of their patients were diagnosed with diabetes shortly after contracting the virus.

It is well known that diabetes is likely to produce worse outcomes in people who contract COVID-19.

An international research consortium is now trying to find out whether the novel coronavirus can also trigger diabetes in some people. The project is a joint initiative of King’s College London and Monash University, Australia.

The researchers are trying to find out how diabetes could develop in people who have contracted COVID-19.

Diabetes epidemic

Sathish Thirunavukkarasu, a researcher at McMaster University’s Population Health Research Institute, is the only Canadian researcher tied to the consortium.

People with diabetes need to measure their blood sugar levels throughout the day to make sure they are neither too high nor too low. (Africa Studio / Shutterstock)

“The burden of diabetes has certainly increased in the last decade,” he said of a video call from India visiting his family.

“So you really want to understand whether COVID-19 could be an important factor in fueling this diabetes epidemic.”

People with diabetes either cannot make insulin (usually known as type 1 diabetes) or cannot properly use the insulin the pancreas makes (also known as type 2 diabetes).

Insulin regulates the amount of sugar in the blood to make sure the body is working properly. If left untreated, diabetes can lead to kidney disease, heart disease, blindness, and strokes and even death.

Long-term studies required

Thirunavukkarasu says medical experts first discussed the possible link last year in a comment in the New England Journal of Medicine.

They’re still trying to determine if COVID-19 is causing type 1 or type 2 diabetes or a completely different type, although he says it looks mostly like type 2 diabetes at this point.

SARS-CoV-2, the virus that causes COVID-19, has been shown to attack cells in the pancreas, Thirunavukkarasu says, which may explain the link between the two diseases.

Metformin is a typical drug used to treat type 2 diabetes. More than 90 percent of diabetes cases are type 2. (Francis Dean / Corbis / Getty)

He points out that during the SARS outbreak in 2003, some patients were also noted elevated blood sugar levels, although in most cases the problem resolved on its own after a few months.

“Long-term studies are needed to really understand whether diabetes is … transient or if it turns into diabetes over a long period of time,” he said.

Undiagnosed diabetes

Amanda Sterczyk, manager of health research and policy analysis at Diabetes Canada, says her organization is keeping an eye on research.

“It will be several years before we fully understand what is happening here,” she said.

Sterczyk says it’s important to note that many cases of diabetes go undiagnosed because some people don’t have adequate access to health care and others don’t know what symptoms and warning signs to look out for.

Dr. Beth Cummings shared this International Diabetes Federation poster to help families remember the tell-tale symptoms of type 1 diabetes. (Submitted by Dr. Beth Cummings)

Diabetes Canada estimates that there could be up to 1.5 million people across the country with undiagnosed diabetes.

According to Sterczyk, it is possible that the sudden onset of diabetes in COVID-19 patients was due to these people interacting with the healthcare system and eventually being diagnosed.

Measure A1Cs

Thirunavukkarasu recognizes that this is possible.

He says a systematic review of studies found that of about 3,000 COVID-19 patients, about 14.4 percent who were hospitalized with the virus were first diagnosed with diabetes – but that number includes people who did Had diabetes before contracting COVID-19 and was undiagnosed.

One way to tell if diabetes was undiagnosed prior to COVID-19 is to look at a patient’s A1C test results, which measure their average blood sugar levels over the past three months.

Type 1 diabetes, also called insulin-dependent diabetes, is treated by injecting insulin because the body no longer produces it naturally. (Reed Saxon / The Associated Press)

Thirunavukkarasu says that some people who develop diabetes after severe COVID-19 infection have normal A1C levels but high short-term blood sugar levels, suggesting that they did not have diabetes prior to their illness.

Researchers are currently studying data that specifically includes the A1C levels. Like Sterczyk, he says more research is needed.