Call for ‘international efforts’ to examine link between COVID-19 and new-onset diabetes

A comprehensive review led by ARC East Midlands has explored ‘COVID-19, hyperglycemia and new-onset diabetes’.

An international team of researchers have been involved and have commented that early identification and treatment of people who fall into this category could improve their long-term outcomes.

Professor Kamlesh Khunti, Director of ARC East Midlands and Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, said: “Given we are still in the midst of a global COVID-19 pandemic, we are likely to see even larger numbers of people globally with new-onset diabetes. International efforts need to be established to study COVID-19 associated new-onset diabetes with follow-up of large numbers of patients.”

Several studies conducted during the pandemic have reported that COVID-19 is associated with hyperglycaemia in people with and without known diabetes. The authors of this latest research also acknowledge that the phenomenon of new-onset diabetes following admission to hospital has been seen previously with other viral infections. 

The perspective, published in the American Diabetes Association’s journal, Diabetes Care, explores the possible reasons for the link between COVID-19 and new-onset diabetes.

The authors discuss four possible explanations:

• Pre-existing undiagnosed diabetes. People admitted to hospital may have had undetected diabetes prior to admission, which could be a result of recent weight gain due to lifestyle changes and worsening of hyperglycaemia due to self-isolation; social distancing; reduced physical activity; and poor diet linked to mental health issues.
• Stress hyperglycaemia and new-onset diabetes following acute illness. The phenomenon of hyperglycaemia and new-onset diabetes following admission to hospital with acute illness has previously been identified. In COVID-19, stress hyperglycaemia may be even more severe due to the cytokine storm – an inflammatory syndrome.
• Viral infections and new-onset diabetes. Viral infections may have an effect on the pancreas. Previous studies have reported acute inflammation in the pancreas due to other viruses.
• In hospital steroid-induced hyperglycaemia. Steroid-induced hyperglycaemia is common in hospitalised patients. Previous studies have shown that between 53 and 70 per cent of non-diabetic individuals develop steroid-induced hyperglycaemia.

The authors also focused on the management of people with new-onset diabetes following COVID-19 and made a series of recommendations for future research. 

Professor Khunti said: “There is an urgent need for research to help guide management pathways for these patients. In view of increased mortality in people with new-onset diabetes, hospital protocols should include efforts to recognise and manage acute hyperglycaemia, including diabetic ketoacidosis, in people admitted to hospital.”

Read the review in full here.