Spotlight on COVID-19 and diabetes

As researchers continue to examine the relationship between COVID-19 and diabetes, several recent articles provided broad analyses of what's known so far.

A narrative review published by Diabetic Medicine on Dec. 29, 2020, discussed the pathophysiology of COVID-19 in people with diabetes and offered some considerations for their inpatient treatment. The authors searched research and other publications on the topic published through November 2020 to develop their summary. They noted that further research is needed to optimize care for patients with both conditions, but in the interim, they made some recommendations, including that diabetes patients admitted for COVID-19 should have their blood glucose level, HbA1c, ketones, and venous blood gas checked on admission to assess their glycemic state and screen for diabetic ketoacidosis and hyperosmolar hyperglycemic state. During admission, “increased glucose and ketone monitoring, substitution of insulin for some oral antihyperglycemic medications, and careful monitoring for complications of diabetes such as diabetic ketoacidosis should be considered,” the authors said.

A recent study, published by The Lancet Diabetes & Endocrinology on Dec. 23, 2020, looked at the entire population of Scotland to quantify the risk of COVID-19 that was fatal or required critical care in people with diabetes. It found that 5.8% of the more than 5 million residents of Scotland had diabetes at the start of the pandemic. Death or ICU admission due to COVID-19 occurred in 0.3% of them (89.8% ≥age 60 years), compared to 0.1% of the nondiabetic population. The researchers calculated odds ratios for COVID-19 of 2.396 (95% CI, 1.815 to 3.163; P<0.0001) with type 1 diabetes and 1.369 (95% CI, 1.276 to 1.468; P<0.0001) with type 2 diabetes. Among people with diabetes, death or ICU admission was associated with male sex, living in residential care or a more resource-deprived area, retinopathy, reduced renal function, worse glycemic control, a diabetic ketoacidosis or hypoglycemia hospitalization in the past five years, polypharmacy, and smoking history. “We have shown that, among those with diabetes, the risk of severe disease varies widely and is predictable. This insight should inform shielding policies and vaccine prioritisation strategies,” the authors said.

A commentary, published by Diabetes Therapy on Dec. 26, 2020, looked at the evidence that COVID-19 may lead to new-onset diabetes mellitus, even in patients without predisposing factors. The authors noted that this suggests a bidirectional relationship between diabetes and COVID-19, which they term a “fearful symmetry.” The commentary also cited cases of diabetic ketoacidosis among patients with COVID-19, with or without pre-existing diabetes. They called for early recognition of diabetic ketoacidosis symptoms in patients hospitalized with COVID-19 and offered some potential biological explanations for the association between the two diseases. A case report of one such patient who developed new diabetes when infected with COVID-19 was published by Diabetes & Metabolic Syndrome: Clinical Research & Reviews on Dec. 25, 2020. The patient developed marked hyperglycemia and ketosis, although he was not obese and had only mild COVID-19 symptoms.