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March 25, 2022

COVID May Increase Risk for Diabetes, Research Suggests

COVID May Increase Risk for Diabetes, Research Suggests

Living with diabetes requires a lot of mental energy, and COVID-19 has added even more to think about. For the past three years, scientists have been working at breakneck pace to learn as much as possible about SARS-CoV-2 and how it affects the body. One thing that became evident early on: People with chronic health issues, including diabetes, are at greater risk for severe COVID infection and related complications. 

People with diabetes who get COVID may also experience a worsening of their symptoms, the Centers for Disease Control and Prevention (CDC) reports. The CDC cautions, however, that having COVID could also increase the risk for diabetes in people who do not already have the condition—even kids.

In fact, a January 14 CDC report revealed that people younger than 18-years old with COVID-19 are more likely to be newly diagnosed with diabetes more than 30 days after their infection than those without COVID and those who had acute respiratory infections before the pandemic began.

Additional research, including an April 2021 study published in Nature, also suggests that COVID may increase the risk for diabetes. Using the national health-care databases of the Department of Veterans Affairs, researchers found that COVID survivors were about 39 percent more likely to have a new diabetes diagnosis in the six months after infection than those who weren’t infected.

This begs the question: Why?

There may be many factors involved. Some of these new diabetes cases may simply have occurred in people with prediabetes—a condition which already affects one in five U.S. teens.

People with prediabetes have higher than normal blood sugar levels and they are already at increased risk for going on to develop type 2 diabetes.

Another possible explanation: COVID-19 could have increased diabetes risk indirectly. Excess body weight is a risk factor for severe COVID-19 as well as diabetes. And over the past few years, the healthy eating and exercising habits of many Americans suffered amid illnesses, lockdowns, closures, physical distancing, and other pandemic-related consequences.  

One October 2020 study published in Frontiers in Endocrinology estimated that COVID-19 isolation is linked to a 33 precent decline in physical activity and a nearly 29 percent jump in sedentary behavior. 

In a separate September 2021 report, the CDC cautions that school closures, disrupted routines, increased stress, and fewer opportunities for physical activity and healthy eating has resulted in weight gain, particularly among kids and teens. Younger children and those who were already overweight when the pandemic began were among those with the largest increase in body mass index (BMI), the agency revealed.

COVID harms insulin-producing cells
COVID-19 could also increase diabetes risk directly by attacking cells in the pancreas. The coronavirus gains entry into human cells by latching on to receptors called ACE2 (angiotensin converting enzyme 2).

ACE2 is present in many organs, including the lungs and heart, making them vulnerable to COVID infection. Insulin-producing cells in the pancreas also highly express ACE2. These cells can be directly attacked and damaged when the coronavirus invades. This can disrupt the production of insulin—a hormone that helps move sugar from the blood into cells where it can be used as energy.

Diabetes also tied to severe COVID
Generally, viral infections can increase inflammation in people with diabetes and lead to blood sugar spikes that are more difficult to control.

"With any infection, diabetes control can suffer," says Robert Eckel, MD, president of medicine and science for the American Diabetes Association, and professor emeritus at the University of Colorado School of Medicine, Anschutz Medical Campus in Aurora, Colorado.

There are a few reasons why this is concerning. High blood sugars can interfere with the immune system’s ability to fight infection. It’s possible that they could even create an environment that would enable SARS-CoV-2 to thrive. 

“If people with diabetes have uncontrolled glucose, they are at higher risk for complications from a viral infection,” says Karl Nadolsky, DO, a spokesperson for the American Association of Clinical Endocrinologists and a clinical endocrinologist at Spectrum Health in Grand Rapids, Michigan.

Over time, consistently having higher than normal blood sugar levels can interfere with the response of your immune system—specifically white blood cells that help fight infections,” Dr. Nadolsky explains.

A 2018 paper published in the Journal of Diabetes Research suggested that diabetes or obesity were not only associated with the improper functioning of white blood cells, but also greater production of inflammatory molecules called cytokines.

Normally, cytokines help coordinate the body’s response to infection. But in some cases, this response can range out of control, doing more harm than good. This so-called cytokine storm can damage the blood vessels and organs and lead to blood clots, which may help explain why some people with COVID-19 develop more serious complications.

Managing diabetes-related complications
When people with diabetes get a viral infection, their risk for potentially deadly diabetes-related complications also increases.

One possible complication is diabetic hyperglycemic hyperosmolar syndrome, which occurs when the kidneys get rid of extra blood sugar through the urine, leading to dehydration. Once a patient becomes dehydrated, the kidneys are no longer able to get rid of the extra sugar, allowing it to accumulate to extremely high levels in the blood. The amount of salt, sugar and other substances in the blood also becomes more concentrated, which pulls water out of vital organs, including the brain.

The risk for DKA (diabetic ketoacidosis) also increases. DKA occurs when the body lacks enough insulin to usher sugar from the blood into cells where it can be used for energy. As a result, the body begins to burn fat for energy, which produces chemicals called ketones. As these ketones accumulate in the blood, it becomes more acidic.

DKA is dangerous on its own but if you have COVID-19, it can also make it more difficult to manage complications associated with the disease, including sepsis.

Diabetes also increases the risk for a slew of other serious health issues, including heart and kidney disease as well as stroke. It’s possible that these diabetes-related conditions may also play a role in worse outcomes among people with COVID-19.

“There are a lot of underlying risks that patients bring in addition to their diabetes,” Eckel says.

How to protect yourself
Everyone should take precautions to prevent the spread of COVID-19. This includes being vaccinated and up-to-date on your COVID shots, which means getting a booster as soon as you’re eligible. Amid the Omicron surge, which has led to record number of new cases and hospitalizations in the United States, other precautions remain essential, such as testing after exposure or before travel and wearing a mask around others indoors, particularly in crowded or poorly ventilated spaces.

It’s also important to wash your hands well and often with soap and water and avoid touching your face with unclean hands.

If you have diabetes, it’s also essential be vigilant about following your diabetes treatment plan and maintaining strict control of your blood sugar levels—checking it regularly or as often as your doctor recommends.  

Call your doctor if your blood sugar level stays above 250 mg/dL. If you have type 1 diabetes and your blood sugar rises above this level, you could be at risk for DKA.

It’s also important to keep your ketone levels down and avoid preventable trips to the emergency room during the COVID-19 pandemic.

Other precautions you should take:

Stock up on your medication and essential supplies. Make sure you have enough prescription medications and give yourself plenty of time to get refills.

It’s also important to have essentials on hand, such as glucose tablets and testing strips as well as syringes or insulin pen or pump supplies, including batteries and alcohol swabs, Nadolsky advises. Check with your pharmacy to find out if the items you need could be mailed to your home.

Adhere to your treatment plan. Do not stop taking any of your prescriptions unless your doctor instructs you to do so. This is true even if you’re taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The American College of Cardiology, the American Heart Association, the Heart Failure Society of America, and the European Society of Cardiology have all issued guidelines saying patients should not stop taking these drugs, pointing out that there is no evidence to suggest they could contribute to more severe cases of COVID-19.

Try to stick to your routine. Maintaining a healthy diet and keeping up with your exercise regimen can help keep your blood sugar levels in a normal range, Eckel advises. The immune system is better to able to fight infection when blood sugar levels are under control than when they are high, he adds.

Don’t skip your check-ups. It’s important to stay in touch with your doctor and keep all necessary follow up appointments.

Telemedicine has emerged as a valuable tool for doctors and patients during the pandemic. The ability to talk to your doctor and discuss your concerns virtually—or by video conference on your smartphone, tablet, or computer—can help you manage your condition.

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