It is known that having diabetes tends to make COVID-19 worse. In fact, between 20% and 30% of people who die from COVID are diabetics. There are also reports of people who never had diabetes developing that condition during a COVID infection, and reports of diabetes becoming more severe and harder to manage during an infection.

Both COVID and diabetes are epidemics that are occurring around the world. An international group of 17 diabetes experts are warning about the clash of these two epidemics. The warning appears in a recent letter published in The New England Journal of Medicine. The letter announces the establishment of a new global registry for COVID-related diabetes.

It is not surprising that having COVID makes diabetes worse, because any stressful illness makes diabetes worse. The big questions are does COVID cause diabetes in a person without diabetes and does COVID change the natural long-term course of the disease. In other words, does diabetes continue to get worse after COVID goes away? The diabetes experts are warning that emerging evidence suggests diabetes and COVID may be bidirectional. That means diabetes makes COVID worse and COVID makes diabetes worse.

The experts have a theory of how this may happen. COVID enters the body’s cells by binding to proteins on cells called ACE-2 receptors. These receptors are found in the lungs, which is why people with COVID often get pneumonia. ACE-2 receptors are also found in tissues such as the pancreas, small intestine, fats cells and liver that are important for glucose metabolism. Disruption of glucose metabolism can cause diabetes.

Goals of the Global Registry

The international experts hope that pooling information on patients with diabetes and COVID around the world will allow researchers to answer these questions:

  • Does COVID cause new-onset diabetes?
  • Does COVID cause type 1, type 2 or a new type of diabetes?
  • How common is new-onset diabetes with COVID?
  • Does new onset-diabetes continue or resolve after COVID?
  • In people who already have diabetes, does diabetes continue to get worse after COVID?
  • Does COVID increase future risk of diabetes?
  • What is the best way to treat a combination of diabetes and COVID?

The diabetes experts hope that answering these questions will add to our knowledge of both of these important epidemics. Leaning how COVID causes or worsens diabetes may also lead to new ways of understanding and treating diabetes in all people.

Source: “Kings College London, Study of New-Onset Diabetes in Covid-19,” letter written by 17 leading experts involved in CovidDiab Registry project, published in The New England Journal of Medicine.

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