Long-term consequences of diabetes: An infection with SARS-CoV-2 can apparently trigger diabetes in some cases, as a case report has now confirmed. A young man developed type 1 diabetes a few weeks after his mild Covid 19 disease. Cell tests and increased cases of diabetes in seriously ill Covid patients suggest that the coronavirus can directly damage the insulin-producing cells of the pancreas.
In contrast to type 2 diabetes acquired through diet, obesity and other factors, the is Typ-1-Diabetes an autoimmune disease: the body makes antibodies against the insulin-producing cells in the pancreas and destroys them. As a result, the body can no longer produce insulin and thus no longer regulate blood sugar. Typically, this form of diabetes manifests itself in childhood.
Type 1 diabetes is partly congenital and genetic. But there is also evidence that certain Virus infections can greatly increase a child’s risk of developing this autoimmune disease in the first few months of life.
Coronavirus can attack islet cells
In the course of the corona pandemic, there is now increasing evidence that SARS-CoV-2 can also cause diabetes. Chinese doctors working with Jin-Kui Yang from the Beijing Tongren Hospital recently reported that of 120 seriously ill Covid-19 patients in the intensive care unit, around half developed blood sugar disorders and diabetes.
Studies also show that the insulin-producing islet cells of the pancreas also carry the ACE2 receptor on their cell surface – the docking point through which the coronavirus binds to the cells and can penetrate into it. “This is supported by a current study that demonstrated that the cells of the pancreas of adults are susceptible to infection by SARS-CoV-2,” report Tim Hollstein from the Schleswig-Holstein University Medical Center in Kiel and his colleagues.
The SARS pandemic of 2002/2003 provided further information: “SARS-CoV-1, the predecessor of SARS-CoV-2, is known to be able to damage islet cells and cause diabetes in people,” the researchers said.
Diabetes practically out of nowhere
Now another case confirms the connection between Covid-19, SARS-CoV-2 and diabetes. As Hollstein and his team report, it is a 19-year-old man who came to the hospital emergency room with exhaustion, weight loss and abnormally strong thirst. Analyzes of blood and urine revealed a greatly increased blood sugar level and molecular markers of severe diabetes. “This is why type 1 diabetes was suspected,” the scientists report.
The only strange thing is that the young man had never shown any signs of diabetes before and, according to genetic analyzes, was not a carrier of high-risk genes for this autoimmune disease. His genetic makeup contained only one gene variant that confers a slightly increased risk of diabetes – around 1.7 times higher than in the general population. Immunological tests also showed that, contrary to expectations, the young patient had no antibodies against the islet cells or other components of insulin production in the blood.
Long-term consequences of the corona infection
All of this spoke against diabetes caused by an autoimmune reaction. However, the islet cells in the young man’s pancreas were severely damaged. But what? Closer questioning of the patient revealed that he had been infected with the corona virus five to seven weeks earlier in Austria. The infection remained asymptomatic, but was detected in an antibody test in late April.
According to the doctors, this time course, combined with the atypical diabetes that is not due to an autoimmune reaction and the lack of other risk factors, suggests that the coronavirus infection caused the severe diabetes. “We assume that the SARS-CoV-2 virus itself attacked the beta cells here,” says Hollstein’s colleague Matthias Laudes.
“Consider Viral Diabetes”
Despite the asymptomatic course of Covid-19 in this patient, the virus apparently damaged his insulin-producing cells so badly that he developed diabetes. “We suspect that the SARS-CoV-2 infection can impair the function of the pancreas – possibly through a direct effect of the virus on the islet cells,” the researchers explain. “Diabetologists should therefore consider the possibility of insulin-dependent diabetes as an acute complication in patients with coronavirus infection.” “Nature Metabolism, 2020; doi: 10.1038 / s42255-020-00281-8; Preprint MedRxiv, doi: 10.1101/2020.04.08.20058040)
Source: University of Kiel
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