Complicated relationship between COVID and diabetes
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.”