Just six months after a mild case of COVID-19, the boy in Crown Point, Indiana, was diagnosed with type 1 diabetes. His parents were worn out – it did not run in the family, but autoimmune disease did, and doctors said it could be a factor.
Could his diabetes also be linked to coronavirus, Nolan’s mother, a respiratory therapist, wondered. It turns out that researchers in the United States and elsewhere are asking the same question and examining whether a connection is more than a coincidence.
Clearly, in those who already have diabetes, COVID-19 can worsen the condition and lead to serious complications. But there are other possible links
New evidence shows that coronavirus – like some other viruses – can attack insulin-producing cells in the pancreas – a process that can trigger at least temporary diabetes in susceptible humans. Rising cases may also reflect circumstances involving pandemic restrictions, including delayed medical treatment for early signs of diabetes or unhealthy eating habits and inactivity in people already at risk for type 2 diabetes.
A report from the Centers for Disease Control and Prevention looked at two major U.S. insurance databases that included new diabetes cases from March 2020 to June 2021. Diabetes was significantly more common in children who had had COVID-19. The report did not distinguish between type 1, which typically starts in childhood, and type 2, the kind associated with obesity.
The incidence of both types of diabetes has increased among U.S. children in recent years, but reports from Europe and some U.S. hospitals suggest the pace may have accelerated during the pandemic.
“I think we’re all a little worried,” said Dr. Inas Thomas, a specialist at the University of Michigan’s Mott Children’s Hospital.
Her hospital has seen a 30% increase in type 1 compared to pre-pandemic years, Thomas said. It is not known how many had COVID-19 at one time, but the time raises concerns that there could be a connection, she said.
Type 1 diabetes occurs when the pancreas produces little or no insulin, a hormone that regulates blood sugar. It is thought to involve an autoimmune reaction in which the body attacks insulin-producing cells in the pancreas. Patients should use manufactured insulin to manage the chronic condition.
Experts have long theorized that a previous infection can trigger the autoimmune response.
With COVID-19, “We do not know if it is a direct effect or another factor that is not fully understood yet, but we hope this trend can help us find out what causes type 1 -diabetes, “Thomas said.
At Rady Children’s Hospital in San Diego, type 1 diabetes cases increased by nearly 60% during the first year of the pandemic, compared to the previous 12 months, researchers recently reported in JAMA Pediatrics. Only 2% of these children had active COVID-19, and the report lacked information on previous infections. But the sharp rise was striking, and “it is clear that much more work needs to be done to try to answer why this is happening,” said co-author Dr. Jane Kim.
Type 2 diabetes, which mostly affects adults, degrades how the body uses insulin, leading to poorly regulated blood sugar. The causes are uncertain, but genetics, obesity, inactivity and unhealthy eating habits play a role. It can sometimes be treated or reversed with lifestyle changes.
Globally, more than 540 million people have diabetes, including about 37 million in the United States. Most have type 2 diabetes, and many more have higher than normal blood sugar or pre-diabetes. Doctors worry that COVID-19 or sluggish pandemic lifestyle may be among the things pushing them over the edge.
A diabetes center at Chicago’s La Rabida Children’s Hospital has seen a pandemic increase in pre-diabetes. Center-middle director Rosemary Briars suspects that long, sedentary hours of online learning have played a role.
Dr. Rasa Kazlauskaite, a diabetes specialist at Chicago’s Rush University Medical Center, said steroid drugs, sometimes used to reduce inflammation in inpatients with infections including COVID-19, can cause high blood sugar levels leading to diabetes. Sometimes it disappears after steroids are stopped, but not always, she said.
The physical stress of severe COVID-19 and other diseases can also cause high blood sugar and temporary diabetes, she said.
To learn more, researchers in Denmark enroll adults who have recently been diagnosed with type 1 diabetes, including some with COVID-19. Over time, researchers will investigate whether the condition develops faster in those who had COVID-19, which may help clarify the role of the infection in the development of diabetes, says researcher Dr. Morten Bjerregaard-Andersen, diabetes specialist at the Hospital. of Southwest Jutland.
“The theory is that if you had COVID-19, then your own insulin production would be more compromised than if you were not infected,” said Bjerregaard-Andersen.
Researchers at King’s College London and Monash University in Melbourne, Australia, have launched an international COVID-19 diabetes registry. Among the things they hope to learn: Does diabetes persist in COVID-19 patients after they recover? they face a greater risk of getting diabetes again; diabetes in COVID-19 patients may be a completely new type of diabetes.
Nolan Balcitis, now 12, says he knew nothing about diabetes before his diagnosis last year. At first he was nervous about everything involved in dealing with the disease – counting carbs, checking blood sugar, insulin injections. But a portable insulin pump lets him skip daily injections, and a sensor on his arm makes monitoring a breeze.
A typical kid who likes baseball and playing with his yellow labrador retriever, Callie, Nolan withdraws from his condition.
“I’m just a little used to it now,” said the boy with the nonchalance of an almost teenager.
Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.
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