11 Dec 2020

COVID-19 does cause diabetes: A new Monash-led global initiative is investigating why

Prof Paul Zimmet explains that a registry, CoviDIAB, has
been established to track first time incidence of diabetes in
  COVID-19 patients.
See video. His most recent paper shows
a pooled proportion of 14.4% (1 in 7) for newly diagnosed
diabetes in hospitalised COVID-19 patients. See more from
the video of our 9 Dec forum on CCS COVID-19 registries.

by Matt Cull
Monash University is investigating a link between COVID-19 and diabetes which is not yet fully understood, though it is becoming clear that COVID-19 is indeed causing first-time onset of diabetes.
In collaboration with King’s College in London, Monash University has established a register of patients, called CoviDIAB, who reported having developed diabetes after confirmed exposure to the disease COVID-19 which is caused by the coronavirus SARS-CoV-2.
Many patients had no known instances of diabetes in their family and were not believed to have been at high risk for the illness prior to being infected with the coronavirus.

 Professor Paul Zimmet of Monash Medicine’s Department of Diabetes said that he had been contacted by numerous individuals and families, who reported suspicious cases of diabetes after falling ill and suspected a causal connection.
“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,” Professor Zimmet said.
“This was a very strange situation, so I decided we should set up a register to record new cases of diabetes coming from people with COVID.”
According to Professor Zimmet, the underlying concern is whether COVID-19 is causing diabetes in patients, or whether a pre-existing and undiagnosed case of diabetes in some people is increasing their vulnerability to the coronavirus disease.
“When we realized we had a pandemic on our hands here in Australia, I was concerned what this meant for people with diabetes,” he said.
“The question is whether, in fact, COVID was causing diabetes, or diabetes was making people more likely to contract infections.”
Professor Zimmet said it was not uncommon for people to have diabetes without knowing it, and that chronic illnesses such as COVID-19 can precipitate or worsen the disease. There is also the possibility that diabetes decreases the chance of being asymptomatic with COVID-19.
The Monash University-Kings College London medical register has already recorded over 50 cases from different parts of the world, providing a multi-ethnic sample group that makes clear the correlation is indeed a global phenomenon, requiring global attention.
The register is the first of its kind, and the interaction between COVID-19 and diabetes is still poorly understood.
“We’re hopeful we can contribute to a better understanding of whether COVID can cause diabetes and get some leads as to what the mechanisms are, as well as what treatment may be appropriate,” Professor Zimmet said.
Beyond the initial diagnosis of diabetes, the team will continue to monitor patients on the register to see if further complications and morbidities arise as a result of the COVID-19 infection. Experts across various fields have already begun compiling data suggesting that the disease may indeed cause or at least inflame a number of chronic illnesses, especially at a coronary level.
It is also suspected of causing a rare acute inflammatory illness in children known as Paediatric Inflammatory Multisystem Syndrome (PIMS-TS), which can lead to death. 

Professor Zimmet noted that the emergence of diabetes after infection was not limited to adults but was also being observed in children, providing another reason to suspect that even benign cases of COVID-19 may in fact lead to an increased likelihood of medical complications far into the future, for people of all ages.
“This is a new game: we still don’t know very much about COVID-19, and it’s a learning process,” he said.
“We anticipate that this register will have a very important role globally.”


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