Pancreatic Polypeptide Cells in the Pancreatic Islet

Two New Studies Point to Diabetes from COVID

Very early in the pandemic, it was clear that diabetes and COVID had a deep relationship. Along with obesity, diabetes was a key risk factor for a rough ride with COVID. But as the pandemic unfolded, data started suggesting this was a two-way street. COVID could give patients a higher chance of developing diabetes. A spike in diabetes cases gave the first hint. Then in January, a report in MMWR pointed to an elevated risk for children.

Now, two large cohort studies in adults point to a similar elevation in risk of type 2 diabetes after COVID-19 infection. These data are leading scientists to believe diabetes may be an important feature of long COVID – also known as PASC.

A Large Prospective Cohort from the VA System

The most recent study appeared in Lancet Diabetes and Endocrinology just yesterday. Yan Xie and Ziyad Al-Aly conducted a prospective cohort study that used data from more than eight million patients. The active cohort of patients with a positive COVID-19 test was 181,280 patients. Then there were two control groups of more than four million patients each. One group was historical controls. The other was contemporary controls.

Researchers took care to control for a large set of covariates. But of course they could not rule out residual confounding. In the end, they found a 40 percent increase in the risk of a diabetes after SARS-CoV-2 infection. The authors conclude:

“Taken together, current evidence suggests that diabetes is a facet of the multifaceted long COVID syndrome and that post-acute care strategies of people with COVID-19 should include identification and management of diabetes.”

A Retrospective Cohort from Germany

Second, a study by Wolfgang Rathmann, Oliver Kuss, and Karel Kostev uses a panel of 1,171 physician practices in Germany. They analyzed a sample of 35,865 patients with documented COVID-19 and the same number of controls – matched for propensity scores, demographics, and clinical characteristics. They found a 28 percent higher risk of a diabetes diagnosis after SARS-CoV-2.

Rathmann believes this may occur because of immune responses to COVID:

“COVID-19 infection may lead to diabetes by upregulation of the immune system after remission, which may induce pancreatic beta-cell dysfunction and insulin resistance, or patients may have been at risk for developing diabetes due to having obesity or prediabetes, and the stress COVID-19 put on their bodies speeded it up.”

Clear Enough, More to Learn

At this point, it’s pretty clear that diabetes and SARS-CoV-2 interact in ways that do us no good. Each one predisposes us to higher risks of the other. It works in both directions. Certainly, we have more to learn, but the connection is clear.

Click here for the study in Lancet Diabetes and Endocrinology and here for the Rathmann study. For further reporting, click here and here. Finally, for an excellent perspective on the common threads between communicable and non-communicable diseases, click here.

Pancreatic Polypeptide Cells in the Pancreatic Islet, photograph by Xiaojun Wang et al, licensed under CC BY 4.0

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March 22, 2022