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| LETTER TO THE EDITOR |
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| Year : 2022 | Volume
: 7
| Issue : 4 | Page : 196-197 |
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New-onset diabetes in COVID-19: An emerging threat to global health
Thirunavukkarasu Sathish
Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| Date of Submission | 19-Nov-2022 |
| Date of Acceptance | 21-Nov-2022 |
| Date of Web Publication | 07-Jan-2023 |
Correspondence Address:
Thirunavukkarasu Sathish
Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jncd.jncd_83_22
How to cite this article:
Sathish T. New-onset diabetes in COVID-19: An emerging threat to global health. Int J Non-Commun Dis 2022;7:196-7 |
Dear Editor,
The White Paper article published by Farkouh et al. in the International Journal of Non-communicable Diseases in November 2021 discusses how noncommunicable diseases and coronavirus disease-2019 (COVID-19) interact.[1] This article focused on acute myocardial infarction, mental health, substance use, and symptoms after recovery (e.g., myalgia and pain). In addition to these conditions, one other major noncommunicable disease that requires attention is diabetes. While the authors have briefly pointed out that diabetes worsens the clinical course of COVID-19 patients, it is also important to acknowledge the effect of COVID-19 on diabetes.
Several studies have reported an unusually high number of COVID-19 patients developing diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome, requiring exceptionally high doses of insulin.[2] More intriguingly, during the early phase of the pandemic (August–October 2020), researchers postulated a hypothesis that COVID-19 may precipitate new-onset diabetes.[3] Since then, there has been growing evidence to support this lethal relationship. The first-ever meta-analysis published in March 2021 showed that the pooled prevalence of new-onset diabetes among 3711 hospitalized COVID-19 patients from eight studies was 14.4% (95% confidence interval [CI] 5.9–25.8).[4] As the pandemic continues, long-term follow-up studies are emerging. A recent (November 2022) meta-analysis of nine studies with nearly 40 million participants showed a pooled incidence rate of 15.5 (95% CI 7.9–25.6) per 1000 person-years for new-onset diabetes following COVID-19.[5] Interestingly, studies have shown that new-onset diabetes observed during the acute stage of the illness persists after recovery in the so-called long-COVID phase.[5] Alarmingly, COVID-19 patients with new-onset diabetes have been shown to experience severe illness, including mortality, at levels higher than those with preexisting diabetes, the reasons for which are unknown.[2]
Several potential mechanisms explaining the occurrence of new-onset diabetes after COVID-19 have been discussed in the literature. These include, but are not limited to, direct or indirect (by triggering cytokines or enhancing autoimmunity) cytolytic effects of the virus on β-cells, activation of the hypothalamic–pituitary–adrenal and sympathoadrenal axes causing an increase in counterregulatory hormones, activation of the renin-angiotensin system resulting in unopposed deleterious actions of angiotensin II, increased surveillance and screening, use of steroids for treatment, and reduced physical activity and access to healthy foods due to lockdown and quarantine measures.[3]
The association between COVID-19 and new-onset diabetes calls for routine screening of patients for glucose and HbA1c during the acute and postacute phases of COVID-19. However, implementing them will be highly challenging for the health system, particularly in low- and middle-income countries. Finally, it is yet to be seen to what extent COVID-19 drives the ongoing diabetes pandemic.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Farkouh M, Bhasin A, Ko D, Roy A, Khurana I, Chockalingam A. Chronic noncommunicable diseases and COVID-19: How they both interact. Int J Non-Commun Dis 2021;6:29-40.  [Full text] |
| 2. | Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in people with diabetes: Understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol 2020;8:782-92. |
| 3. | 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. |
| 4. | Sathish T, Kapoor N, Cao Y, Tapp RJ, Zimmet P. Proportion of newly diagnosed diabetes in COVID-19 patients: A systematic review and meta-analysis. Diabetes Obes Metab 2021;23:870-4. |
| 5. | Zhang T, Mei Q, Zhang Z, Walline JH, Liu Y, Zhu H, et al. Risk for newly diagnosed diabetes after COVID-19: A systematic review and meta-analysis. BMC Med 2022;20:444. |
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