A wave of diabetes coming? The link with COVID-19
Researchers are observing a new long-term health problem in patients hospitalized with COVID-19 – an increase in recently-onset hyperglycemia that lasts for months after infection. An Italian study found that about half of patients admitted to hospital with COVID-19 at the start of the pandemic had new cases of hyperglycemia, or high blood sugar levels. They also had poorer results.
“These people were not diabetics before,” says lead author Paulo Fiorina, MD, PhD, which is affiliated with the Division of Nephrology at Boston Children’s Hospital. “But on admission, about 46% of the patients presented with new hyperglycemia.” While most cases resolved, about 35 percent of newly hyperglycemic patients remained so for at least six months after infection.
Hyperglycemia persisted beyond infection
The study assessed the health of 551 people admitted to hospital in Italy from March to May 2020. A follow-up period included six months after hospital admission.
Compared to patients with no signs of blood glucose abnormalities, hyperglycemic patients also had more serious clinical problems:
- longer hospitalizations
- worst clinical symptoms
- a higher need for oxygen
- increased need for ventilation
- no need for intensive care
“We wanted to understand the mechanism why these patients performed poorly compared to those who did not have hyperglycemia,” says Fiorina, who published a previous article showing that COVID-19 worsened glucometabolic control in diabetics. . the current study was published in Natural metabolism.
Hormones also unbalanced
To find out more, all patients were fitted with an admission blood glucose sensor. Over time, researchers have detected numerous abnormalities in metabolic glucose control in hyperglycemic patients.
They also found that hyperglycemic patients had abnormal hormone levels. “We found that they were severely hyperinsulinemic; they were making too much insulin, ”says Fiorina. They also exhibited abnormal levels of proinsulin, an insulin precursor, and markers of impaired islet beta cell function. Islet beta cells make and secrete insulin.
“Basically, the hormonal profile suggests that pancreatic endocrine function is abnormal in patients with COVID-19 and persists long after recovery,” he says.
Inflammation due to excess cytokines
Hyperglycemic patients also had severe abnormalities in the amount of inflammatory cytokines, including IL-6 and others.
“We thought that blocking IL-6, and potentially even other cytokines, would be beneficial for beta cell function, ”adds Fiorina, whose theory has proven to be true. Patients treated with anti-IL-6 therapy (tocilizumab) had greater improvement in glycemic control compared to those who did not receive the drug.
A wave of diabetic patients to come?
While the glucometabolic abnormalities decreased over time in some patients – especially after COVID-19 infection – other issues remained. Many patients had higher post-meal (after eating) glucose levels and abnormal pancreatic hormones during the post-COVID-19 period.
“This study is one of the first to show that COVID-19 has a direct effect on the pancreas,” explains Fiorina. “This indicates that the pancreas is another target of the virus affecting not only the acute phase during hospitalization but potentially the long-term health of these patients as well.”
The study highlights the importance of assessing pancreatic function in patients hospitalized for COVID-19 – in hospital and long-term. “This goes beyond fasting blood sugar testing, as we observed metabolic glucose abnormalities during the day that weren’t always present in a normal fasting test,” says Fiorina.
In terms of treatment, questions remain about how to manage patients with glucose abnormalities linked to COVID-19. Should patients be treated only with an anti-diabetic drug such as an insulin sensitizer, or should anti-inflammatory drugs such as tocilizumab and other drugs be used?
“If you continue to target and block insulin, but have strong, chronic inflammation, it can lead to chronic damage,” says Fiorina, who suggests that larger studies need to be done to test diabetes therapy and anti-inflammatory. “When you consider the number of patients hospitalized with COVID-19 and who continue to be hospitalized around the world, we can see a huge increase in the diabetic population. “
Learn more about our COVID-19 Research Findings.