8 Oct 2020

New COVID-19 Diabetes registry already building up numbers

A global registry of COVID-19 related diabetes is already
collecting participants

by Riya Kiran

A team of international diabetes researchers from Monash University and King’s College London have established a global registry to investigate the possible connection between COVID-19 and diabetes.

Following the eruption of the COVID-19 pandemic, diabetes researcher Professor Paul Zimmet AO was bombarded with questions concerning this.

“I was getting emails from people in different countries saying their sons or daughters who had been infected with COVID-19 had, sometime soon after their infection, developed diabetes,” said Professor Zimmet. "What was going on?"

An existing two-way relationship has been uncovered between the two diseases. Diabetes is being associated with an increased risk of severe COVID-19, while new-onset diabetes and serious life-threatening metabolic complications had been observed in patients infected with the virus.

Prof Zimmet said, “Patients presenting into intensive care units [ICUs] were found to now have diabetes, when they previously had no history of the illness.

“From studies of ICU mortality rates, up to 40% of the deaths were people who either had diabetes or had developed it at the time they were admitted."

Why do the two different illnesses of COVID-19 and diabetes interact with such serious outcomes for each other?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the virus that causes COVID-19. Viral particles bind to a protein which is common on the surface of many cell types in the body, known as angiotensin-converting enzyme 2 (ACE2) receptors. They are present in key organs and tissues including the lungs, pancreatic cells, the small intestine and kidneys. Therefore, scientists thought it was  possible that SARS-CoV-2 was causing alterations of glucose metabolism that would complicate the process of preexisting diabetes or lead to a new onset of the disease.

Professor Zimmet further explains how there is some evidence to support the hypothesis that for type 1 diabetes the virus accesses the body through a metabolic pathway that is related to diabetes.

“It sneaks into the cells via the ACE2 receptors, and once inside, starts to cause damage.

“The pathway is very important for the pancreas, which is the body’s insulin factory. When insulin production is disrupted, diabetes begins,” he said.

Infection followed by new-onset diabetes has a history. There have been other common viruses which have led to type 1 diabetes; the Coxsackie virus, the Rubella (German measles) virus, and around 2003, the SARS virus which occurred in the South Asian region, after which  new cases of diabetes were reported.

With the looming implications of the current viral epidemic, leading diabetes researchers participating in the CoviDIAB Project established a registry of patients with COVID-19 related diabetes. The aim of this registry is to explore the epidemiologic features and development of COVID-19 related diabetes, whilst also uncovering important clues regarding the virus’s longer term effects in both individuals and populations.

The team is hoping that the registry will serve long term needs as the data registered will document not only the immediate effects of the virus but the ongoing and later emerging problems for patients, who will need to be followed for 5-10 years.

“We’re in new territory with this virus,” said Professor Zimmet.

“We need to continue to monitor these people who have been infected, looking very closely over a longer term, because that's when we're going to get the knowledge we need if this virus comes back again in the next couple of years.”

Although only in its early stages, the register has already collected 38 cases, originating primarily from India and the Middle East. Ultimately they are expecting hundreds.

Rubino F, Amiel SA, Zimmet P, et al. New-Onset Diabetes in Covid-19. N Engl J Med. 2020;383(8):789-790. doi:10.1056/NEJMc2018688

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