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 Table of Contents  
Year : 2021  |  Volume : 12  |  Issue : 4  |  Page : 538-539

Is diabetes a real challenge in COVID-19 patients?

Department of Internal Medicine and Rheumatology, VPS Lakeshore Hospital, Kochi, Kerala, India

Date of Submission13-Apr-2021
Date of Acceptance04-May-2021
Date of Web Publication12-Jan-2022

Correspondence Address:
Dr. Muhammed Jasim Abdul Jalal
Department of Internal Medicine and Rheumatology, VPS Lakeshore Hospital, Nettoor P.O., Maradu, NH 47—Byepass, 682040 Kochi, Kerala.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jod.jod_46_21

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How to cite this article:
Abdul Jalal MJ. Is diabetes a real challenge in COVID-19 patients?. J Diabetol 2021;12:538-9

How to cite this URL:
Abdul Jalal MJ. Is diabetes a real challenge in COVID-19 patients?. J Diabetol [serial online] 2021 [cited 2022 Jan 27];12:538-9. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/4/538/335588

Dear Sir,

There is a bidirectional link between COVID-19 and diabetes [Figure 1]. COVID-19 causes new-onset diabetes. It unmasks previously undiagnosed diabetes. It complicates new-onset hyperglycemia and acute metabolic decompensation. The aim of this article is to focus on:
Figure 1: COVID-19 and diabetes

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  • A. Pre-existing diabetes and COVID-19 infection;

  • B. COVID-19-related hyperglycemia;

  • C. COVID-19-related new-onset diabetes;

  • D. Challenges in the management of diabetes in COVID-19.

  A. Pre-existing diabetes and COVID-19 infection Top

Pre-existing diabetes is an established risk factor for increased morbidity and mortality in COVID-19 infection. Sathish and Cao[1] studied 3711 hospitalized COVID-19 patients with mean age of 47–65 years, of which 14.4% developed new-onset diabetes whereas 14.8% had pre-existing diabetes.

  B. COVID-19-related hyperglycemia Top

COVID-19-related hyperglycemia is classified into[2] [Figure 2]:
Figure 2: Classification of COVID-19-related hyperglycemia

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  1. Stress-induced hyperglycemia,

  2. Hyperglycemia due to viral damage,

  3. New-onset diabetes,

  4. Drug-induced/secondary hyperglycemia.

  C. COVID-19-related new-onset diabetes Top

CoviDIAB Project is a global registry of COVID-19-related new-onset diabetes. This pathophysiological phenotype of new-onset diabetes is characterized by [Figure 3]:
Figure 3: Pathophysiological phenotype of new-onset diabetes

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  1. Confirmed COVID-19 infection,

  2. Negative history of diabetes,

  3. Hyperglycemia,

  4. History of a normal HbA1c level.

The pathogenesis of new-onset diabetes in COVID-19 can be explained by the autoreactive CD8+ T cells. Genetic susceptibility and pre-existing insulitis when exposed to a viral insult result in[3]

  1. Bystander activation of CD8+ T cells;

  2. Epitope release and spread to local lymph nodes by molecular mimicry; bystander damage of β-cells; and chronic infection of β-cells.

This results in the formation of autoreactive CD8+ T cells, which causes β-cell autoimmunity and chronic destruction leading to type 1 diabetes mellitus.[4]

The possible mechanisms involved with increased risk of diabetes onset from SARS-CoV-2 infection are[5]

  1. Injury to pancreatic β-cells,

  2. Activation of renin–angiotensin system,

  3. Exaggerated proinflammatory cytokine (IL-6; TNFα) response,

  4. Pandemic-related changes in health behaviors.

Compared to normoglycemic and pre-existing diabetic COVID-19 patients, new-onset diabetes has poorer outcomes and significantly higher risks of complications and all-cause death.

  D. Challenges in the management of diabetes in COVID-19 Top

The challenges in the management of diabetes in COVID-19 are:

  1. Poor glycemic control: This increases the length of hospital stay, risk of complications, and overall mortality;

  2. Adverse effects linked to medications

    • a) Hydroxychloroquine can cause potential hypoglycemia;

    • b) Lopinavir and ritonavir cause hyperglycemia and worsen glycemic control;

    • c) Glucocorticoids cause marked hyperglycemia due to decrease in insulin sensitivity and increase in glucagon production.

Financial support and sponsorship

The authors have no financial relationships relevant to this article to disclose.

Conflicts of interest

The authors have no conflicts of interest relevant to this article to disclose.

  References Top

Sathish T, Cao Y. Is newly diagnosed diabetes as frequent as preexisting diabetes in COVID-19 patients? Diabetes Metab Syndr 2021;15:147-8.  Back to cited text no. 1
Singh AK, Singh R. Hyperglycemia without diabetes and new-onset diabetes are both associated with poorer outcomes in COVID-19. Diabetes Res Clin Pract 2020;167:108382.  Back to cited text no. 2
Papachristou S, Stamatiou I, Stoian AP, Papanas N. New-onset diabetes in COVID-19: Time to frame its fearful symmetry. Diabetes Ther 2021;12:461-4.  Back to cited text no. 3
Boddu SK, Aurangabadkar G, Kuchay MS. New onset diabetes, type 1 diabetes and COVID-19. Diabetes Metab Syndr 2020;14:2211-7.  Back to cited text no. 4
Sathish T, Tapp RJ, Cooper ME, Zimmet P. Potential metabolic and inflammatory pathways between COVID-19 and new-onset diabetes. Diabetes Metab 2021;47:101204.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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