When, to date, more than 491 million people worldwide are infected and infected with COVID-19, when 6,176,000 people have lost the battle for life because of this highly toxic SARS-CoV-2 virus, it becomes clear that This disease has been and is a global threat to our society, even though the latest Omicron 1 and Omicron 2 strains pose a lower risk of morbidity and mortality.
It is now known that older people or those with underlying diseases are at greater risk for COVID-19 disease and complications. The most important of these diseases are hypertension, cardiovascular diseases and diabetes.
“It seems that people with diabetes have a higher risk of getting serious COVID-19 or even ending up (3 to 4 times higher risk as all studies show). At the same time, the disease may severely deregulate an existing diabetes mellitus but also show symptoms of an acute insulin-dependent diabetes mellitus in non-diabetic individuals, due to the toxic effect of the SARS-CoV-2 virus on pancreatic β-cells. Andreas Melidonis, Coordinating Director of the Diabetological-Cardiometabolic Center of Metropolitan Hospital, President of EKOMEN.
What else does the diabetes & COVID-19 meeting bring?
According to recent bibliographic data, the encounter of COVID-19 with diabetes seems to take on a new dimension. These data show an increased risk of developing diabetes mellitus (SD) after coronavirus disease in non-diabetics in the context of Long-COVID syndrome.
-Lancet
At the end of March, the major scientific journal Lancet published a major, well-documented study analyzing a large database in the United States that compared the risk of developing diabetes in 180,000 people with COVID-19 with one year after onset. risk of occurrence in 8,000,000 healthy population that had not become ill at the corresponding time. The risk of developing diabetes mellitus (99% of type 2) in patients with the disease was found to be particularly high (40%) and ranged from 31% to more than 100%, depending on the presence or absence of risk factors such as age, body mass index (BMI), prediabetes, etc.
In patients who needed hospitalization the risk of developing diabetes, in one year of follow-up, was increased by 173% and in patients hospitalized and intubated due to COVID-19 was increased by 273%!
Extremely interesting is the fact that people who became mildly ill (did not need hospitalization) had a 25% increased risk of developing diabetes a year later in Long-COVID syndrome.
-Diabetology
At the same time, a similar study was published in the authoritative medical journal Diabetologia from a German database comparing the incidence of type 2 diabetes in a population of 35,856 COVID-19 patients, one year after the onset of the disease, with a similar incidence in the same number of patients. who contracted an upper respiratory tract infection (not COVID-19). Here, too, there was a 30% increased incidence of type 2 diabetes in the affected population.
“There are many possible causes for the increased risk of developing type 2 diabetes in the context of Long-COVID syndrome. The development of insulin resistance and affected insulin secretion has also been described in non-diabetic patients who have become ill and recovered. “Inflammatory cytokines and TNF-a remain elevated even after hospitalization and can cause pancreatic β-cell dysfunction (responsible for insulin secretion) and insulin resistance,” explains the doctor.
In conditions characterized by the presence of chronic inflammation (such as obesity, visceral fat accumulation, etc.) the infection can worsen this chronic inflammation even after hospitalization and favor insulin resistance, which is a pathogenetic pillar for increased expression of type 2 diabetes mellitus. Increased expression of ACE2 protein (key protein for SARS-CoV-2 virus entry into cells) is also possible in pancreatic β-cells, resulting in an increased risk of β-cell toxicity in β-cells. and, consequently, reduced insulin secretion.
Unanswered questions & how we proceed
The aforementioned studies have added considerable evidence of a link between COVID-19 and diabetes, especially in the Long-COVID phase. There are, of course, many unanswered questions:
It is unknown whether this type 2 diabetes mellitus after treatment is a pre-existing or unknown diabetes mellitus that becomes apparent after treatment for COVID-19 as a result of immune hyperactivity and all of these factors described as potential for developing diabetes mellitus. 2.
• Is this type 2 diabetes reversible under Long-COVID?
• What is the best treatment and treatment for this type of diabetes?
• For how long after hospitalization does the risk of developing type 2 diabetes remain?
• Should people who have type 2 diabetes without known risk factors for it have a more complete serological test, autoantibodies and c-peptide test for the possibility of another type of diabetes?
“However, regardless of these questions, after the important data of the studies mentioned, the need to control patients with COVID-19 for the possible development of type 2 diabetes is obvious.
This test should be done at regular intervals up to one year after hospitalization (we do not have data on an increased incidence of type 2 diabetes after the time of hospitalization). Diabetes control should include, in addition to fasting sugar, the two-hour sugar curve, which gives reliable data on the possible status of diabetes in the person being tested.
As it turns out, the Long-COVID situation, in the end, holds many new surprises even for people who are slightly ill. And the increased risk of developing type 2 diabetes is, certainly now, one of these surprises “, concludes Dr. Melidonis.
Writes:
Dr. Andreas Melidonis, Coordinating Director of the Diabetological-Cardiometabolic Center of Metropolitan Hospital, President of EKOMEN.
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