COVID-19 News: Doctors Worldwide Are Reporting Increases Of New Onset Diabetes Cases Most Probably Triggered By COVID-19!
: Globally a new phenomenon is being witnessed in which those that never had a history of diabetes before but upon being infected with the new SARS-CoV-2 coronavirus are experiencing a sudden elevation of blood sugar levels and in some cases are ending up with full blown diabetes weeks after so called ‘COVID-19 recovery.’ https://www.thailandmedical.news/news/breaking-covid-19-latest-study-shows-patients-not-previously-diagnosed-with-diabetes-exhibiting-hyperglycemia-and-increased-mortality
Thailand Medical News has already reported about the increase in the number of individuals especially young adults and even children infected with COVID-19 but without any prior history of diabetes developing the disease as early as June 2020. https://www.thailandmedical.news/news/breaking-medical-experts-warn-that-covid-19-could-trigger-diabetes-in-otherwise-healthy-individuals-who-never-had-the-condition-before-
In Bethesda-Maryland, Dr Mihail Zilbermint is used to treating diabetes as he heads a special team that cares for patients with the metabolic disorder at a Suburban Hospital. However as the hospital admitted increasing numbers of patients with COVID-19, his caseload ballooned.
He said, “Before, we used to manage maybe 18 patients per day. Now his team cares for as many as 30 daily.”
Interestingly many of those patients had no prior history of diabetes. Some who developed elevated blood sugar while they had COVID-19, the illness caused by the novel coronavirus, returned to normal by the time they left the hospital. Others went home with a diagnosis of full-blown diabetes.
Dr Zilbermint said, “We’ve definitely seen an uptick in patients who are newly diagnosed.”
But worryingly it is not just hospitalized COVID-19 patients that had started manifesting this trait, it is now being seen also in many who had only mild conditions of the COVID-19 disease or were asymptomatic and is now becoming a trending COVID-19 News
This growing trend
is being witnessed in many countries such as China, India, Brazil, United States, United Kingdom etc while in certain countries like Thailand and Singapore, individuals who were asymptomatic along with their doctors, are oblivious of the possible connections.
Though COVID-19 often attacks the lungs, it is increasingly associated with a range of problems including blood clots, neurological disorders, and kidney and heart damage.
Scientists say new-onset diabetes may soon be added to those complications-both Type 1, in which people cannot make the insulin needed to regulate their blood sugar, and Type 2, in which they make too little insulin or become resistant to their insulin, causing their blood sugar levels to rise.
However scientists do not know whether COVID-19 might hasten already developing problems or actually cause them or both.
There are already reasons to believe that the SARS-CoV-2 virus could affect the pancreas and also the endocrine system, leading to the development of diabetes as insulin production is affected. https://www.thailandmedical.news/news/breaking-covid-19-endocrine-system-new-study-shows-that-sars-cov-2-damages-the-endocrine-system
Already as early as January 2020, doctors in Wuhan, China, noticed elevated blood sugar in patients with COVID-19. Physicians in Italy, another early hot spot, wondered whether diabetes diagnoses might follow, given the long-observed association between viral infections and the onset of diabetes. That association was seen in past outbreaks of other coronavirus illnesses such as influenza and SARS.
However a year after the pandemic began, the precise nature and scope of the COVID-diabetes link remain a mystery. Many of those who develop diabetes during or after COVID-19 have risk factors, such as obesity or a family history of the disease. Elevated blood glucose levels also are common among those taking dexamethasone, a steroid that is a front-line treatment for COVID-19.
Some cases also have occurred in patients with no known risk factors or prior health concerns. And some cases develop months after the body has cleared the virus. https://www.thailandmedical.news/news/must-read-covid-19-long-term-effects-covid-19-survivors-could-suffer-chronic-medical-conditions-for-years
A 47-year-old banking executive in Evening Shade, Arkansas, John Kunkel,, was one of the surprise cases. He was hospitalized with COVID-19 in early July. During a follow-up visit with his doctor, he learned he had dangerously high blood glucose levels and was readmitted. Kunkel has since received a diagnosis of Type 2 diabetes.
He said, “I had no preexisting health issues. I was blown away. Why?” Kunkel has had five emergency room visits and three hospital stays since getting COVID-19. He recently lost his job because he was unable to return to work, given his continuing health problems. “Will you get your life back?” he asked. “Nobody knows.”
It is now being estimated that as many as 14.4% of people hospitalized with severe COVID-19 developed diabetes, according to a global analysis published Nov. 27 in the journal Diabetes, Obesity and Metabolism. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14269
In that study, an international group of researchers sifted through reports of uncontrolled hyperglycemia, or high blood sugar, in more than 3,700 COVID-19 patients across eight studies. While those diagnoses might be the result of a long-observed response to severe illness, or to treatment with steroids, the authors wrote, a direct effect from COVID-19 “should also be considered.”
Concerns that COVID-19 might be directly implicated also were supported, they said, by the exceptionally high doses of insulin that diabetes patients with severe COVID-19 often require and the dangerous complications they develop.
To date, researchers do not understand exactly how COVID-19 might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But they are racing to find answers to these and other questions, including whether the novel coronavirus may have spawned an entirely new type of diabetes that might play out differently from the traditional forms of the disease.
Dr Francesco Rubino, a diabetes surgery professor at King’s College London, is convinced there is an underlying connection between the diseases. https://www.nejm.org/doi/full/10.1056/NEJMc2018688
During the Summer of 2020, he and a group of other diabetes experts launched a global registry of patients with COVID-19-related diabetes. After they spread the word with an editorial in the New England Journal of Medicine, more than 350 institutions from across the world responded, he said.
This database is accumulating patients, over 150 so far although it will take months for researchers to sift through the data to draw any conclusions. “We really need to dig deeper,” Rubino said. “But it sounds like we do have a real problem with COVID and diabetes.”
Importantly some of the cases reported to his database do not fit the usual profile of Type 1 diabetes, in which the pancreas produces little or no insulin, or Type 2, in which people become insulin resistant, he said.
Typically, a patient with one type of diabetes will experience specific complications; for instance, those with Type 1 may burn through their fat stores, or those with Type 2 may experience a syndrome that can involve severe dehydration and coma as the body pumps excess blood sugar into the urine. In some patients with COVID-19, though, complications cross types.
Dr Rubino warned, “There’s a good chance that the mechanism of the diabetes isn’t typical. There could be a hybrid form. It’s concerning.”
Dr Rubino is especially worried about reports of diabetes diagnoses after mild or asymptomatic coronavirus infections. As the number of novel coronavirus infections continues to rise, he said, “you could see a significant new volume of diabetes diagnoses.”
At present, diabetes already is increasing at an alarming rate in the United States and also in many countries across the world.
In America alone, an estimated 34.2 million people, or 10.5 percent of the population, have the disorder, according to federal health data. And approximately 1 in 3 Americans, or 88 million people, have prediabetes, which indicates they are on a path to Type 2.
Should the disease be left uncontrolled, the disease can damage many parts of the body and is associated with serious complications including heart disease, stroke, blindness, kidney failure and nerve damage.
However whether those with diabetes that is newly diagnosed after COVID-19 will have a lifelong problem is unclear.
Interestingly after the 2003 SARS pandemic, Chinese researchers tracked 39 patients with no history of diabetes who had developed acute diabetes within days of hospitalization with SARS. For all but six, blood sugar level had fallen by the time they were discharged, and only two still had diabetes after two years.
The researchers also found evidence that the SARS virus might attack insulin-producing beta cells in the pancreas. https://link.springer.com/article/10.1007/s00592-009-0109-4
The Beta cells play starring roles in both types of diabetes: The bodies of those with Type 1 attack and destroy the cells altogether, halting insulin production. Type 2 diabetics become resistant to the insulin they produce, so the beta cells make more and more, and eventually are worn out.
Dr Katie Colbert Coate, a diabetes researcher and research instructor in medicine at Vanderbilt University Medical Center told Thailand Medical News, “If scientists could figure out how or if viral infection can damage beta cells, or what role viruses play in the development of the disease, it would be a real turning point.”
Although individuals with diabetes are no more susceptible to contracting COVID-19 than those without, they are at much higher risk of severe complications or death once they do.
It was reported that in the early days of the pandemic, just over a third of those who died of COVID-19 in British hospitals had preexisting cases of diabetes. Doctors in Wuhan also noticed that those with newly diagnosed diabetes were more likely to need intensive care than those who had diabetes before they contracted COVID-19.
Interestingly new diagnoses of diabetes in people with no classic risk factors also are scattered throughout case reports: A 37-year-old, previously healthy Chinese man who went to the hospital with a severe, and in some cases fatal, diabetes complication; a 19-year-old German who developed Type 1 diabetes five to seven weeks after a novel coronavirus infection but who lacked the antibodies commonly associated with the autoimmune disease.
Physicians at a Children’s Hospital Los Angeles, meanwhile, noticed an increase in the number of Type 2 diagnoses in children, as well as a severe complication of diabetes. After some of them showed evidence of past coronavirus infections, Dr Senta Georgia, an investigator in the hospital’s Saban Research Institute, began looking deeper. Her research, which repurposes tissue from primates used in vaccine tests, is undergoing peer review. https://www.biorxiv.org/content/10.1101/2020.02.14.949321v1
Dr Georgia said. “Only with the scientific public square can we put all of this data out there, evaluate its strengths and weaknesses … until we really get the information we need.”
It is such reports also have increased the sense of urgency for researchers like Dr Coate, who dropped other work and began looking for keys to understanding the mechanism of the disease by examining how COVID-19 might damage beta cells or other structures in the pancreas. She and others are asking whether certain COVID symptoms predict whether a patient is vulnerable to diabetes and, most important, whether the disease’s onset is an effect of the immune response or a result of the virus directly attacking insulin-producing cells.
The ACE2 receptor cells, the novel coronavirus’s entryway into the body, could provide one answer. When the spike proteins that surround the virus latch onto a host cell with an ACE2 receptor, they open up a cellular doorway that allows the virus to hijack the cell. https://www.thailandmedical.news/news/covid-19-research-cases-of-covid-19-patients-developing-diabetes-for-first-time-can-be-due-to-high-ace2-expression-in-pancreatic-islet-cells-during-in
To date, strong evidence of ACE2 receptors on beta cells could confirm the long-standing suspicion that viruses trigger diabetes. But the research findings are inconclusive: Since the pancreas breaks down quickly after death, obtaining good samples from autopsied humans is difficult. And each study has its own limitations.
In middle of 2020, Cornell University researchers grew human pancreas cells and managed to infect them with SARS-CoV-2, as the novel coronavirus is technically known. They found ACE2 receptors on the cells, but the cells had been cultivated in a laboratory, not a human body.
Dr Coate and her colleagues at Vanderbilt University were able to confirm the presence of ACE2 receptors in the physical structures of the pancreas, but their study focused on patients without COVID-19 and found no evidence of the receptors on the insulin-producing beta cells. https://www.thailandmedical.news/news/scientists-at-odds-on-what-s-causing-diabetes-in-covid-19-patients-as-two-studies-show-that-ace-2-is-not-expressed-in-pancreatic-beta-cells
An Italian study did find the receptors in beta cells, but the donors did not have COVID-19, either. Until receptors in pancreatic beta cells in tissue from COVID-19 patients can be consistently confirmed by other researchers, the hunt for the mechanism underlying the diabetes-COVID-19 connection continues. So does research on ways COVID-19 might harm other parts of the endocrine system, which also might play a role in the disease mechanism. https://www.frontiersin.org/articles/10.3389/fendo.2020.596898/full
However for newly diagnosed patients such as nurse practitioner Tanisha Flowers, the answers can’t come soon enough. Infected in April while working in a COVID-19 ward in a Richmond, Va., hospital, the 40-year-old was diagnosed with diabetes in October. She now takes daily medications, watches her diet and is all too aware that she may be diabetic for life.
Flowers said, “I’m not myself anymore,” “No one knows what the lasting outcomes are.”
There are thousands of similar stories among so called “recovered” or Long Haul COVID patients and many were asymptomatic or were only experiencing mild symptoms.
Physicians and healthcare staff worldwide need to be aware of this growing phenomenon and take extra care when examining post COVID-19 individuals especially when they are also reporting conditions of being tired or experiencing chronic fatigue as this too is a condition often associated with diabetes.
Individuals need to pay more attention to this growing condition and get their blood sugar levels checked and also watch their dietary habits.
In the meanwhile researches are still uncovering whether is this a normal type of diabetes that is being triggered by the SARS-CoV-2 coronavirus or is it a new complete class of diabetes by itself that warrants different treatment approaches.
Thailand Medical News is also pursuing studies on this subject alongside researchers from various countries and are also developing special new blends of herbal and phytochemical teas to help address the management of these new health conditions materializing from the COVID-19 disease including not just diabetes but also myocarditis, acute kidney injury etc.
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