It’s known that the COVID-19 coronavirus is particularly dangerous for people with diabetes, with between 20 to 30 per cent of deaths linked to the condition. But now researchers are suggesting that coronavirus can cause diabetes in people who were previously healthy.
The world’s top diabetes experts have come together to set up the CoviDiab register to establish whether coronavirus can cause diabetes.
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The register will track and measure cases of diabetes among people infected with the disease to establish whether coronavirus can cause diabetes.
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Chronic disease
Francesco Rubino, Professor of Metabolic Surgery at King’s College London and co-lead investigator of the CoviDiab Registry project, said: “Diabetes is one of the most prevalent chronic diseases and we are now realizing the consequences of the inevitable clash between two pandemics.
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“Given the short period of human contact with this new coronavirus, the exact mechanism by which the virus influences glucose metabolism is still unclear and we don’t know whether the acute manifestation of diabetes in these patients represents classic type 1, type 2 or possibly a new form of diabetes.”
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Researchers have previously shown an association between the two conditions but have not established the mechanism by which coronavirus can cause diabetes.
The answer may lie with the protein ACE-2, which binds to the SARS-Cov-2 virus, allowing it to enter human cells and to cause damage to organs and tissues which are part of the glucose metabolism.
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Increased risk
Paul Zimmet, Professor of Diabetes at Monash University in Melbourne, Honorary President of the International Diabetes Federation and co-lead investigator in the CoviDiab Registry project said: “We don’t yet know the magnitude of the new onset diabetes in COVID-19 and if it will persist or resolve after the infection; and if so, whether or not or COVID-19 increases risk of future diabetes.
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“By establishing this Global Registry, we are calling on the international medical community to rapidly share relevant clinical observations that can help answer these questions.”
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The registry uses routinely collected clinical data that will help examine aspects such as insulin secretory capacity, insulin resistance and autoimmune antibody status to understand whether coronavirus can cause diabetes.
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Recent studies from the UK and elsewhere suggest that adults with both Type 1 and 2 diabetes are at increased risk of death if they contract the coronavirus, particularly if they don’t take care to control their glucose levels.
The question of whether coronavirus can cause diabetes arose in early June when a letter in the New England Journal of Medicine (NEJM) suggesting that COVID-19 is not just a risk for people with diabetes, but that coronavirus can cause diabetes.
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Diabetes causes
Type 1 diabetes is caused by the immune system attacking the insulin-producing cells in the pancreas, which control blood sugar levels. It has been suggested that viral infection can be a cause of this immune system reaction.
Type 2 diabetes involves the response of organs such as the liver and muscles to insulin, causing the islets to overwork. This too has been linked to viral infection, such as mumps, enterovirus and respiratory viruses, and suggests a mechanism by which coronavirus can cause diabetes.
During the SARS epidemic there were reports from China of patients developing new-onset, acute diabetes. In most cases, the diabetes resolved after three years, but it persisted in 10 percent of patients.
The COVID-19 virus is, like SARS, a coronavirus, suggesting that either disruption of normal cell function or acute inflammation of the lungs, kidney and islet cells is the mechanism by which coronavirus can cause diabetes.
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The letter to the NEJM doesn’t conclude whether coronavirus can cause diabetes, either Type 1, type 2, or perhaps some new form. A lack of data, compared with statistics on such factors as obesity, ethnicity and high blood pressure makes it hard to conclude whether coronavirus can cause diabetes until further studies are done.
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Severe symptoms
The CoviDiab Register is a step towards compiling sufficient information, and maybe vital in establishing what treatment is suitable if it is established that coronavirus can cause diabetes.
The NHS Know Diabetes website says: “Having diabetes does NOT mean you are more likely to catch coronavirus. However, if you do catch coronavirus, it can cause more severe symptoms and complications in people with diabetes. It’s important therefore to remain protected as much as possible.
“The risk of developing more severe symptoms of coronavirus is thought to be increased in those whose HbA1c (average blood sugar) is higher, people in older age groups, people who are overweight, people from black, Asian and minority ethnic backgrounds, and those with other long-term conditions such as cancer or chronic lung disease.”
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Though it’s known that the COVID-19 coronavirus is particularly dangerous for people with diabetes, with between 20 to 30 per cent of deaths linked to the condition, researchers are now suggesting that coronavirus can cause diabetes in people who were previously healthy.
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