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Can Covid-19 Lead To Diabetes?

  • Dr. Abhishtita Mudunuri Dr. Abhishtita Mudunuri
  • 4 Min Read
  • Fact Checked

There have been many causes attributed to an increased incidence of new-onset diabetes and uncontrolled diabetes cases in these covid times. From lifestyle changes to post covid-19 sequelae, numerous other hypotheses have been put forth. So, let’s look at the various causes for this increase in diabetes incidence or even worsening of pre-existing diabetes.   

Lifestyle

In a retrospective cohort study done in England on 47780 discharged covid 19 patients (average age >65years) the rate of new-onset diabetes was 29 per 1000 person, years on a median follow up of 4.6 months. What could be the possible reason for this?

Well, during these covid times there has been a significant change in our habits from leaning more towards a sedentary lifestyle, to snacking more on processed foods which are high in carbohydrates fats coupled with disturbed sleep patterns and increased stress levels. All these factors contribute more towards insulin resistance. Insulin as we all know is a sugar-lowering hormone, it opens a gateway on the cell surface which lets glucose enter the cell and be processed into energy. Now in Insulin resistance, the cells are resistant to the action of insulin causing a consequent rise in blood glucose levels. Why does this happen? A diet rich in carbohydrate intake results in increased storage of carbohydrates as fat;  when you have a sedentary lifestyle this worsens the situation. This fat layer will resist the action of insulin, which will then go on to cause prediabetes and then diabetes. Lockdowns, work from home, have caused an increase in these kinds of lifestyle choices also consequently showing a rise in BMI in the general population. In fact, from an Indian perspective a cohort analysis was done that showed a 6.66% increase in T2DM risk over a 49 day lockdown period.

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Covid-19 Infection

Diabetes is usually associated with other chronic comorbidities like hypertension, obesity, chronic kidney disease, heart disease and this has been known to cause a more severe form of covid 19 infection. Covid 19 infection occurs commonly in elderly diabetics due to long-standing uncontrolled diabetes causing a suppression of the immune system, and hence also more adverse outcomes. Any infection causes a stress response which can cause a further rise in blood sugar levels and exacerbate the infection. In diabetics, obese individuals the early antiviral interferon response is blunted contributing to a more severe infection. This causes a vicious cycle wherein uncontrolled diabetics are more prone to severe covid 19 infection and the infection further worsens blood sugar levels. These changes in blood glucose levels are transient and should normalize once there is complete recovery from the infection.  

Medication

Covid 19 infection has been seen to cause a hyperinflammatory response which in moderate to severe cases has to be controlled with steroids. Steroids as we all know cause a transient rise in blood glucose levels which of course reduces after stopping the medication. So a temporary rise in glucose levels will be seen in diabetics while on steroids but this will normalize once off steroids. 

Post-Covid

While there are a number of studies out there suggesting a possible rise in new-onset diabetes after a covid 19 infection the reasons are not clear. Some clinicians and scientists suggest most patients could have had undiagnosed diabetes which was unmasked during the covid 19 infection and persisted since, or there has been a rise in BMI (body mass index) during the lockdown period causing a subtle progression towards pre-diabetes or even pre-diabetes converting into diabetes now. In a retrospective cohort study of  3 data sources from a large United States health plan, among 193113 COVID‐19 patients aged ≤65 years, New-onset diabetes was the sixth most common post‐acute clinical sequelae over a median follow‐up of 2.9 months. There have been a few studies on the effect of coronavirus particles on beta cells of the pancreas but these studies are small so there’s no definite evidence on long-term effects of the virus infection causing diabetes. So it’s important to test your glucose levels once you recover from a Covid 19 infection. 

At best we can say that changing habits are primarily responsible for the risk in diabetes and prediabetes cases. Any other cause contributes to a transient rise in blood sugars. Of course, we still don’t know the long-term effects of a covid 19 infection scientists, clinicians are working towards getting a better understanding of this. So, as a take-home point, test your blood glucose levels (Hba1c, Fasting blood sugar levels), eat healthy, move, sleep well, and learn to destress; that’s the best way to keep diabetes at bay.

Want to know more about Covid-19? Read this complete guide on Covid-19 curated by our experts.

References:

  • Insulin resistance in COVID-19 and diabetes (1)
  • New‐onset diabetes in “long COVID” (2)
  • Diabetology & Metabolic Syndrome (3)
  • Increase in the risk of type 2 diabetes during lockdown for the COVID19 pandemic in India (4)

Dr. Abhishtita Mudunuri is an Internal Medicine Physician Diabetologist with over 10 years of experience in treating lifestyle disorders like Diabetes, Hypertension, Dyslipidemia, etc. She has worked previously at Columbia Asia, Sunshine Hospitals, and Apollo Group of Hospitals. Currently, she is working as a Senior Manager and Diabetologist at MFine.

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