COVID-19 May Trigger New Diabetes: NEJM
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There is a bidirectional relationship between Covid-19 and diabetes. On the one hand, diabetes is associated with an increased risk of severe Covid-19. On the other hand, new-onset diabetes and severe metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity for which exceptionally high doses of insulin are warranted, have been observed in patients with Covid-19. These manifestations of diabetes pose challenges in clinical management and suggest a complex pathophysiology of Covid-19–related diabetes.

SARS-CoV-2, the virus that causes Covid-19, binds to ACE2 receptors, which are expressed in key metabolic organs and tissues, including pancreatic beta cells, adipose tissue, the small intestine, and the kidneys. Thus, it is plausible that SARS-CoV-2 may cause pleiotropic alterations of glucose metabolism that could complicate the pathophysiology of preexisting diabetes or lead to new mechanisms of disease.

There are also several precedents for a viral cause of ketosis-prone diabetes, including other coronaviruses that bind to ACE2 receptors. Greater incidences of fasting glycemia and acute-onset diabetes have been reported among patients with SARS coronavirus 1 pneumonia than among those with non-SARS pneumonia.

In the aggregate, these observations provide support for the hypothesis of a potential diabetogenic effect of Covid-19, beyond the well-recognized stress response associated with severe illness.

However, whether the alterations of glucose metabolism that occur with a sudden onset in severe Covid-19 persist or remit when the infection resolves is unclear.

Source: https://www.nejm.org/doi/full/10.1056/NEJMc2018688
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