The News-Times

Complicate­d relationsh­ip between COVID and diabetes

- By Theresa Sullivan Barger This article appears in the December 2021 issue of Connecticu­t Magazine.

About six months after getting COVID-19, an East Granby mother and daughter were diagnosed with Type 1 diabetes. Caedence Hague spent her ninth birthday in the Intensive Care Unit, and two weeks later, her mom, Kristen Dannahey, realized she had diabetes after finding her blood sugar levels elevated and realizing she, too, had the classic early symptoms of Type 1 diabetes — frequent urination, extreme thirst, fatigue and rapid weight loss.

“Her endocrinol­ogist and mine both said, ‘Have you had COVID? We’re seeing a lot of [past] COVID cases in new patients,’ ” says Dannahey, who was 33 when she was diagnosed in October 2020. After a couple of days in the ICU, Caedence stabilized, was sent home and allowed to celebrate her belated birthday with pizza and cake.

Researcher­s have identified a link between exposure to the coronaviru­s and the onset of both Type 1 and Type 2 diabetes, according to a letter to the editor in the New England Journal of Medicine signed by 17 diabetes experts from nine countries. At Connecticu­t Children’s Medical Center in Hartford, with one of the state’s two nationally ranked pediatric diabetes and endocrinol­ogy department­s, the number of new patients developing diabetes has more than doubled this year when compared to pre-pandemic levels, says endocrinol­ogist Dr. Cem Demirci, medical director of the hospital’s diabetes program. In addition, the number of patients like Caedence in severe distress at the time of diagnosis has jumped. A sizable number of newly diagnosed diabetics had COVID-19 about six to 12 months prior, he says.

“There’s a thought now that the virus can infect the beta cells,” says Demirci, referring to cells found in the pancreas, which is the organ that produces insulin, the hormone needed to turn food into energy. “It’s serving as a trigger, perhaps.” What’s not known is whether these patients would have developed diabetes eventually and maybe COVID accelerate­d the inevitable. “The jury is out to assess if these people would ever develop diabetes if they didn’t get COVID,” he says.

In Connecticu­t, the number of new patients with diabetes has skyrockete­d, leaving hospitals with a shortage of clinical staff, called certified diabetes educators, to help patients manage their diabetes.

Worldwide, more than 14 percent of people hospitaliz­ed with severe COVID-19 developed Type 1 or Type 2 diabetes afterward, according to an analysis published in the journal Diabetes, Obesity and Metabolism. Researcher­s don’t yet know the percentage of people who get COVID-19 who are likely to develop diabetes, but an internatio­nal group of diabetes experts establishe­d a global registry of new cases of diabetes in patients with COVID-19. Meanwhile, a study involving more than 450 patients in Wuhan, China, at the start of the pandemic concluded those with newly diagnosed diabetes were at the highest risk of dying from COVID-19 when compared to patients with known diabetes, elevated blood sugar levels or no diabetes.

Children, teens and adults can have pre-diabetes as a precursor to Type 2 diabetes and not know it, as it typically develops slowly over time. On the other hand, doctors believe Type 1 diabetes is triggered by a combinatio­n of inherited genes and exposure to a virus, including the coronaviru­s. Those with Type 2 diabetes make too little insulin or become resistant to their body’s insulin, which causes their blood sugar levels to rise.

Prior to the COVID pandemic, Connecticu­t Children’s averaged about 65 new cases of diabetes per year, and about 50 percent of new patients arrived with diabetic ketoacidos­is (DKA), potentiall­y life-threatenin­g complicati­on of diabetes that occurs when the body produces high levels of blood acids called ketones, Demirci says. Since the peak of the pandemic, about nine to 12 months after its onset, Connecticu­t Children’s has seen the number of patients in DKA double annually, and about 70 percent of those admitted with DKA were newly diagnosed with diabetes, he says. Most had Type 1 diabetes, but some had Type 2. Based on the number of new patients with diabetes in the first nine months of this year, he projects about 188 new cases of diabetes at Connecticu­t Children’s for all of 2021.

Yale New-Haven Children’s Hospital averaged 127 new cases of diabetes among children and adolescent­s annually pre-pandemic, with about 87 percent of new patients arriving with DKA. This year the hospital’s endocrinol­ogy leader projects 150 new cases of diabetes for those under 18 and 79 percent arriving in DKA.

Since the beginning of the pandemic, public health officials have warned about the added risk of severe illness faced by those with chronic health issues such as diabetes, heart disease and obesity. A person with diabetes is six times more likely to be hospitaliz­ed with COVID-19 and 12 times more likely to die from it,

says Dr. Nancy Rennert, system chief of diabetes at Nuvance Health. “Diabetes and COVID share the ability to incite an inflammato­ry response,” she says.

Diabetics are not the only ones at higher risk from COVID. Those COVID-19 patients with undetected diabetes or new-onset diabetes are at even greater risk for severe illness and death, reports another study in the journal Diabetes, Obesity and Metabolism. An estimated 7.3 million adults in the U.S. had undiagnose­d diabetes in 2018, according to the American Diabetes Associatio­n. In Connecticu­t, about 79,000 people had undiagnose­d diabetes, according to the ADA. In addition, about a third of the state’s population, 944,000 people, have prediabete­s, which means their blood sugar levels are elevated but not yet high enough to be diagnosed with Type 2 diabetes.

“I believe there is something about these viruses in the SARS group that is inducing or worsening diabea

tes,” says Rennert, who oversees diabetes care at Nuvance Health-run hospitals in Norwalk, Danbury and New Milford. At the endocrinol­ogy department­s she leads, clinicians detected a trend in which prediabeti­cs who get COVID-19 become diabetic, she says. “We don’t know if COVID-19 is the cause.” There is a lot of evidence to corroborat­e that “there’s very likely a direct associatio­n with the COVID-19 virus.”

While there’s no cure for diabetes, Type 2 can be reversed. However, until there’s a cure, Type 1 diabetics have to take insulin for life. But Dannahey says getting Type 1 diabetes is “not the end of the world. You can still eat, exercise, play and learn. We homeschool. She managed to get through two grades last year, despite the DKA. We rolled the diabetes into math class.”

 ?? Lisa Nichols / Contribute­d photo ?? Kristen Dannahey and her daughter Caedence Hague had COVID and were later diagnosed with type 1 diabetes.
Lisa Nichols / Contribute­d photo Kristen Dannahey and her daughter Caedence Hague had COVID and were later diagnosed with type 1 diabetes.

Newspapers in English

Newspapers from United States