This spring we were among the first news sources anywhere to report on the bizarre and distressing phenomenon: Is COVID-19 Causing Diabetes? At the time, the prestigious British medical journal The Lancet had just published its first guidance for COVID-19 care. This “set of practical recommendations” wasn’t peer-reviewed or data-backed, but under the circumstances there hadn’t been time to rigorously test all potential therapies and theories, and it must have been deemed worthwhile to publish the educated guesses of experts in the field.
We noticed a curious detail in the guidance: “All patients without diabetes and particularly when at high risk for metabolic disease who have contracted the viral infection need to be monitored for new onset diabetes that might be triggered by the virus.” [emphasis added]
The Lancet letter went on to describe disproportionate insulin resistance and “tremendous insulin requirements” for some hospitalized patients. Other studies at the time had noted the high incidence (and danger) of acute hyperglycemia in COVID-19 patients. Soon, authorities were advising doctors to treat all COVID-19 patients as if they had diabetes. An international constellation of diabetes doctors established an international registry was established to track patients with COVID-triggered diabetes.
As experts shared their experiences, the evidence cascaded: yes, COVID-19 really was causing diabetes. A November study published in the journal Diabetes, Obesity & Metabolism showed that 14.4% of hospitalized COVID-19 patients were newly diagnosed with diabetes. Those with new onset diabetes were also seen to be at higher risk of severe outcomes from the virus, “a lethal intersection between a communicable and a non?communicable disease,” according to the authors. Some data even showed that children, who generally escape the worst ravages of the coronavirus, had begun developing Type 1 diabetes with greater frequency during the pandemic.
Now the Washington Post has published an update on the story, the most prominent media organization yet to confront the news.
While the phenomenon of COVID-triggered new onset diabetes seems no longer in doubt, there is still an awful lot of uncertainty and confusion. COVID-19 has seemed to cause cases defined as both Type 1 and Type 2 diabetes, but many others that don’t seem to neatly fit into either category. The article quotes Dr. Francesco Rubino, who founded the international CoviDiab registry: “There could be a hybrid form [of diabetes]. It’s concerning.” These conditions also may or may not be temporary—for most, it’s just too soon to tell.
There are also increasing reports of new onset diabetes among patients with mild or even asymptomatic infections. With so many millions affected globally by the coronavirus—at this writing, over 100,000,000 confirmed cases, that number only a mere fraction of a larger and unknowable grand total—the mind boggles at the possible scale of the damage. Diabetes itself is already regarded as a pandemic, one that had already been growing rapidly across essentially the entire planet.
The theorized mechanism for new onset diabetes remains much the same as it was when we originally reported the story in May 2020. The coronavirus is known to attack the body primarily through ACE2 receptor cells, which are found in great numbers on the Beta cells. If the coronavirus damages Beta cells on its way into the body, it could precipitate some measure of the pancreatic failure that is characteristic of both major types of diabetes. Unfortunately, researchers haven’t been able to confirm this mechanism; the WaPo article has details on their attempts. The race is still on to figure out why this is happening and how it can be treated or prevented.