糖尿病合併症と医学のジャーナル

Denovo Diabetes Mellitus among Patients of COVID-19

Abstract

Tanvi Banait, Pankaj Wagh, Adarshlata Singh, Saiprasath Janaarthanan, Shashank Banait, and Jyoti Jain

There are increasing evidence that coronavirus disease-19 (COVID-19) can lead to development of denovo diabetes mellitus (DM) (new onset DM). It has also been observed during last 21 months that there is a bidirectional relationship between COVID-19 and DM. On the one hand, pre-existing diabetic patients has an increased risk of severe COVID-19 disease, intensive care unit (ICU) admissions, need for mechanical ventilation, severe metabolic complications and high doses of insulin requirement. It is an independent predictor of mortality in COVID-19 patients. On the other hand, development of fasting hyperglycaemia and acute-onset denovo DM, have been observed and reported among patients with Covid-19. Various postulated mechanism for development of denovo DM are direct virus-mediated beta-cell damage by angiotensin converting enzyme (ACE) receptor present in endocrine pancreas, triggering of beta-cell autoimmunity by COVID-19 virus which leads to activation of autoreactive T-lymphocytes and further destruction of remaining beta-cell mass, disorganized and exuberant immune response of host to COVID-19 infection which has diabetogenic effects and iatrogenic hyperglycaemia in COVID-19 due to corticosteroids such as dexamethasone which have become the mainstay of management of severe COVID-19 infection. The novel mechanisms of disease leading to DM, its frequency among COVID-19 patients, its natural history, and progression is still unclear. This association of COVID-19 and DM poses a great major challenge to patients and healthcare systems during this pandemic. It is essential that the physicians should be aware of the denovo diabetes mellitus and its proper management to reduce further morbidity and mortality among these patients.