Mild COVID-19 may increase diabetes risk

• A recent study followed people with mild COVID-19 to investigate whether they had an increased chance of developing type 2 diabetes.
• As a control, they also tracked people with an acute upper respiratory tract infection (AURI).
• The researchers concluded that individuals with mild COVID-19 had a higher chance of developing type 2 diabetes than those with an AURI.
• The authors say more research is needed to determine whether this is a short-term or long-term health issue.

Following a SARS-CoV-2 infection, some people develop long COVID. These individuals may experience fatigue, brain fog, and general pain that can last for months.

A group of researchers recently investigated whether COVID-19 might also increase the risk of developing type 2 diabetes. They published their findings in the journal Diabetologia.

According to the Centers for Disease Control and Prevention (CDC), type 2 diabetes — the most common form of diabetes — affects approximately 1 in 10 people in the United States.

With such huge numbers of people experiencing a SARS-CoV-2 infection, even a relatively small increase in diabetes risk following COVID-19 could put considerable pressure on an already stretched health system.

COVID-19 and diabetes 

According to the authors, the SARS-CoV-2 virus targets the pancreas — the site of insulin production. They also note that “new-onset hyperglycemia and insulin resistance have been reported in patients with” COVID-19.

With this in mind, they set out to study the prevalence of type 2 diabetes following mild cases of COVID-19.

The authors accessed the patient records of 8.8 million people in Germany. Using these records, they honed in on people with either a COVID-19 or AURI diagnosis in a primary care setting.

The patients’ initial visits were made from March 2020 through January 2021. The researchers then searched for individuals with either COVID-19 or AURI who also made follow-up appointments.

In all, the study compared 35,865 COVID-19 patient records with 35,865 AURI patient records.

The authors found that a higher percentage of people with COVID-19 developed type 2 diabetes in the months following infection.

Of those with COVID-19, 15.8 per 1,000 developed type 2 diabetes. Of those with AURIs, 12.3 per 1,000 people developed type 2 diabetes.

This means that the relative risk of developing diabetes was 28% greater in those with COVID-19.

“COVID-19 infection may lead to diabetes by upregulation of the immune system after remission, which may induce pancreatic beta-cell dysfunction and insulin resistance, or patients may have been at risk for developing diabetes due to having obesity or prediabetes, and the stress COVID-19 put on their bodies speeded it up,”

– Prof. Wolfgang Rathmann, lead author

Prof. Rathmann is affiliated with the German Diabetes Center at Heinrich Heine University in Dusseldorf, Germany.

Medical News Today discussed these findings with Dr. Swapnil Khare who was not involved in the study. Dr. Khare is an assistant professor of clinical medicine in the Division of Endocrinology, Diabetes, and Metabolism at Indiana University School of Medicine in Indianapolis.

Speaking about why there might be a link between COVID-19 and diabetes, she said, “Previous studies have shown that there is a link with viral infection and development of diabetes. They suggest that viral infection serves as a second trigger in people who are already predisposed to develop diabetes.”

“We do know that COVID-19 causes an increase in inflammatory markers, which can cause pancreatic dysfunction,” she explained. “Also, some medications used to treat [SARS-CoV-2] infection can increase the risk of diabetes.”

Implications of the study

This study could help shape how people are treated after COVID-19 symptoms clear up.

Dr. Khare told MNT that we need to understand whether “we need to have standard screening for patients with [SARS-CoV-2] infections and when we should do that screening.”

Additionally, the study may give healthcare providers an idea of what to expect in the future regarding patient load.

“Given the large number of people with COVID-19, these absolute numbers might translate into a substantial population-level burden and could further strain already overwhelmed health systems,” Dr. Ziyad Al-Aly posted on Twitter.

Dr. Al-Aly is the director of the Clinical Epidemiology Center and the chief of research and education service at Veterans Affairs St. Louis Health Care System, MO.

Study limitations

The authors note that the study has some limitations. For instance, they could not account for participants’ body mass index (BMI) in their analysis.

Because overweight and obesity are risk factors for diabetes, this may have influenced the results.

Also, as Prof. Rathmann explains, the researchers did not follow the participants for a long period of time:

“Further follow-up is needed to understand whether type 2 diabetes after mild COVID-19 is just temporary and can be reversed after they have fully recovered, or whether it leads to a chronic condition.”

“We do need further studies to see if, type 2 diabetes after COVID-19 is reversible,” Dr. Khare agreed before outlining some of the many remaining questions:

“Are people who have other predisposing factors […] more susceptible to developing diabetes after COVID-19 or are we looking into new factors? Is there a difference between races and ethnicity? [The] average age is early 40s in this study, so we need further data to look into people who are younger and older.”

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