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After a few weeks, after carefully reviewing the medical records of millions of patients, they came back with the same conclusions. Until then, Z. Al-Aly had also scrutinized the scientific literature and was already acknowledging the troubling facts: Not only is COVID-19 much more dangerous for people with diabetes, it also promotes metabolic disease for many who have not. had before.
“It took me time to convince myself of this information,” said Z. Al-Aly, chief of Veterans Affairs at the Center for Clinical Epidemiology. Louis Health Care System in Missouri. “It was hard to believe that COVID-19 could be capable of that.”
Among the many consequences of COVID-19, the deterioration of the diabetes situation around the world could have a devastating effect on public health.
The main mechanisms that cause new cases of diabetes are unclear, although some doctors suspect that the SARS-CoV-2 virus can damage the pancreas, the gland that produces insulin, which is necessary for normal regulation and maintenance of glucose in blood.
A sedentary lifestyle during quarantine may also have played a role, as may late diagnosis of the disease, as people avoid visiting doctors. Even children with a mild form of coronavirus can suddenly develop diabetes later in some cases, the researchers found.
Considered a lung disease in the early days of the pandemic, COVID-19 is increasingly recognized as a disease that can damage many organs and body systems, causing chronic, sometimes debilitating symptoms in about one in ten people with COVID-19. months after recovery.
Prolonged metabolic complications, sometimes requiring high doses of insulin, suggest that some COVID-19 patients develop diabetes. And the ranks of people living with this chronic disease, there are more than 463 million, they are filling up.
Two studies
In diabetes, the human body does not produce enough insulin or cannot use the insulin it produces effectively. Before the COVID-19 pandemic, the cost of treating diabetes was estimated at $ 760 billion. USD per year. Poorly controlled diseases are dangerous due to the development of life-shortening complications (blindness, kidney failure, limb amputation, vascular, heart, nerve diseases, etc.).
Mr. Al-Aly and his colleagues were the first to assess the impact in the United States based on information from the Department of Veterans Affairs national health care databases.
They found that 39% of COVID-19 survivors diabetes are diagnosed more often six months after infection than uninfected users of the VA (Veterans Health Administration) health care system.
This risk is estimated at approximately 6.5 new cases of diabetes for every 1,000 non-hospitalized COVID-19 patients. Patients admitted to the hospital for COVID-19 are up to 37 per thousand patients, and even more if the patients needed intensive care.
According to Al-Aly, such indicators should be considered in the context of the scope of the prevalence of COVID-19. During the peak of winter, more than 130,000 COVID-19 patients were hospitalized in the United States alone.
Globally, SARS-CoV-2 has infected more than 153 million people. people, including more than 20 million. India, home to the largest number of people with diabetes after China.
A pandemic is coming
Al-Aly’s data was published in April in the journal Nature three weeks after a study of nearly 50,000 hospitalized COVID-19 patients in England found they were 50% more likely to develop diabetes about 20 weeks after discharge from the hospital. hospital than healthy controls.
“We are at risk of crossing two pandemics,” said Professor Francesco Rubino, Head of the Department of Metabolism and Bariatric Surgery at Royal College London, co-author of the COVID-19 Global Diabetes Registry with Paul Zimmet, Professor of Diabetes at Monash University in Melbourne.
The researchers suggested hypothetical trajectories for how COVID-19 might increase the likelihood of a diabetes diagnosis, including the possibility that insulin-secreting pancreatic beta cells are destroyed by a virus or by the body’s response to infection.
There are other explanations, such as an acute response to stress, an infection, treatment with steroids that help survive but raise blood sugar, or simply the detection of previously undiagnosed diabetes, says John Nicholls, professor of clinical pathology at the Hong University. Kong.
Case tracking
Almost 500 physicians from around the world have agreed to share the data through F. Rubin’s diabetes registry. They will share information about the patient’s known risk factors, laboratory tests, clinical signs, treatment, disease course – data to help identify the most common form of the disease, possible causes, and likely predictions.
To date, about 350 cases have been documented in the registry, and emails with descriptions of episodes are received almost daily from concerned patients and parents.
“People write to us and ask us: ‘My son has just been diagnosed with diabetes. Eight for him. You got sick with COVID-19 last month or two months ago. Could it be related? ”, Says F. Rubino.
The question of whether SARS-CoV-2 can cause diabetes is controversial. Tracking diabetes cases based on population data could be a clearer way to assess the impact of a pandemic, says Jonathan Shaw, deputy director of the Baker Heart and Diabetes Institute in Melbourne.
Worried about children
In Los Angeles, meanwhile, doctors report a worrying trend for children to develop type 2 diabetes (type II CD), a chronic form associated with obesity and sedentary lifestyles that is more common among adults.
They found that one in five children with type 2 diabetes last year required hospitalization for diabetic ketoacidosis when acid built up due to insufficient insulin in the blood. Meanwhile, in 2019, only 3 percent. New diabetic patients have faced this serious and life-threatening disease. Although no active form of COVID-19 was detected in any children in 2020, doctors did not routinely test them for SARS-CoV-2 infection. Of those tested, a third tested positive.
“Could this explain, at least in part, such an increase in cases? We really don’t know, ”says Lily Chao, chief of the diabetes department at Children’s Hospital Los Angeles. “But we don’t stop looking for an answer to that question.”
Canadian doctors believe that less frequent use of medical services during a pandemic may have prevented the early detection of new cases of type 1 diabetes in children, a rarer form caused by an autoimmune reaction that destroys insulin-producing cells in the pancreas. A study in the province of Alberta found that the incidence of acute diabetic ketoacidosis among these patients more than doubled in 2020, to 27 percent.
Lifestyle changed
L. Chao sees other likely factors associated with COVID-19. The pandemic itself has significantly changed people’s lifestyles and this can put children at risk for developing diabetes.
“Schools in Los Angeles have been closed all year,” he said. – Many of our children were at home all the time and actually did not eat healthier and gained weight as a result. The situation is difficult. “
Rubino hopes to publish preliminary findings based on data from the diabetes registry by mid-year, but is already in a hurry to warn: there is ample evidence for the long-term effects of COVID-19, which should be avoided at any age. . “It’s not the flu for you, we get sick and forget it,” he said. – Even then, things may not end. It’s serious business. “
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