Newly diagnosed diabetes in COVID-19 patients

Published:August 27, 2020DOI:https://doi.org/10.1016/j.pcd.2020.08.014
      To the Editor,
      The article by Papadokostaki et al. in the recent issue of Primary Care Diabetes has highlighted several critical issues related to the bi-directional relationship between coronavirus disease-19 (COVID-19) and diabetes [
      • Papadokostaki E.
      • Tentolouris N.
      • Liberopoulos E.
      COVID-19 and diabetes: what does the clinician need to know?.
      ]. These are highly relevant for clinicians to optimize care for patients with diabetes that are inflicted with COVID-19. The authors briefly pointed out the possibility of COVID-19-induced new-onset diabetes. With respect to this, we would like to add that in addition to precipitating new-onset diabetes, COVID-19 may also unmask previously undiagnosed diabetes by causing pleiotropic alterations in glucose metabolism [
      • Li H.
      • Tian S.
      • Chen T.
      • Cui Z.
      • Shi N.
      • Zhong X.
      • Qiu K.
      • Zhang J.
      • Zeng T.
      • Chen L.
      • Zheng J.
      Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19.
      ]. Further, patients with newly diagnosed diabetes, whether it is new-onset diabetes or previously undiagnosed diabetes, tend to have increased levels of inflammatory markers (e.g., interleukin-6) and indicators of multi-organ injury (e.g., high alanine transaminase for liver damage), thereby experiencing severe or critical illness of COVID-19 [
      • Li H.
      • Tian S.
      • Chen T.
      • Cui Z.
      • Shi N.
      • Zhong X.
      • Qiu K.
      • Zhang J.
      • Zeng T.
      • Chen L.
      • Zheng J.
      Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19.
      ]. They are also more susceptible to develop acute hyperglycemic crisis including, diabetic ketoacidosis and hyperosmolar hyperglycemic state [
      • Heaney A.I.
      • Griffin G.D.
      • Simon E.L.
      Newly diagnosed diabetes and diabetic ketoacidosis precipitated by COVID-19 infection.
      ,
      • Suwanwongse K.
      • Shabarek N.
      Newly diagnosed diabetes mellitus, DKA, and COVID-19: causality or coincidence? A report of three cases.
      ], requiring exceptionally high doses of insulin. Most importantly, compared with those with normal glucose, COVID-19 patients with newly diagnosed diabetes are more likely to die than those with known diabetes [
      • Li H.
      • Tian S.
      • Chen T.
      • Cui Z.
      • Shi N.
      • Zhong X.
      • Qiu K.
      • Zhang J.
      • Zeng T.
      • Chen L.
      • Zheng J.
      Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19.
      ]. Clinicians need to be aware of these issues and should screen all COVID-19 patients with blood glucose and HbA1c at the time of admission, irrespective of their prior diabetes history, and closely monitor their glycemia status. This will help to manage patients with hyperglycemia early, as optimal glycemic control is shown to reduce disease severity and mortality in COVID-19 patients with diabetes [
      • Sardu C.
      • D’Onofrio N.
      • Balestrieri M.L.
      • Barbieri M.
      • Rizzo M.R.
      • Messina V.
      • Maggi P.
      • Coppola N.
      • Paolisso G.
      • Marfella R.
      Outcomes in patients with hyperglycemia affected by COVID-19: can we do more on glycemic control?.
      ]. Clinicians working in the infectious disease and non-communicable disease disciplines should come together to fight this dual pandemic of diabetes and COVID-19.

      Funding

      None.

      Financial disclosures

      None of the authors have any financial disclosures.

      Conflict of interest

      None of the authors have any conflict of interest.

      References

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        COVID-19 and diabetes: what does the clinician need to know?.
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        Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19.
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        Newly diagnosed diabetes and diabetic ketoacidosis precipitated by COVID-19 infection.
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        Newly diagnosed diabetes mellitus, DKA, and COVID-19: causality or coincidence? A report of three cases.
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        Outcomes in patients with hyperglycemia affected by COVID-19: can we do more on glycemic control?.
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