A 19-one year-frail German man developed form 1 diabetes following asymptomatic COVID-19 an infection, researchers said.
The affected person presented to the emergency department with diabetic ketoacidosis, low blood glucose stages, and elevated HbA1c, having examined obvious for COVID-19 antibodies nearly two months prior, reported Matthias Laudes, MD, of University Medical Centre Schleswig-Holstein in Kiel, Germany, and colleagues.
Alternatively, the affected person didn’t occupy serum antibodies conventional for form 1 diabetes mellitus, the authors wrote in a Nature Metabolism research letter.
They emphasized they could not place causality between COVID-19 and form 1 diabetes. Nonetheless this skill that of SARS-CoV-2 entry receptors corresponding to ACE2 are expressed on pancreatic β-cells, “we point out that … COVID-19 also can negatively occupy an set on pancreatic goal” and impair insulin secretion, Laudes and colleagues wrote.
“Diabetologists could composed be attentive to the different of insulin-dependent diabetes as an acute complication in sufferers infected with SARS-CoV-2.”
Infection with obvious viruses, corresponding to enterovirus, rotavirus, mumps, and cytomegalovirus has been associated with form 1 diabetes. Pre-scientific models and in vitro research even counseled flu could even be linked to rising form 1 diabetes.
When it comes to COVID-19, Laudes and colleagues cited prior research indicating acute diabetic ketoacidosis linked to COVID-19 an infection, and the “marked invent bigger” in diabetic ketoacidosis in German young folks and children for the length of the pandemic. Besides, they infamous that “a orderly different of folks” occupy developed hyperglycemia while experiencing COVID-19, “no matter any past scientific history of diabetes.”
Their affected person presented to the emergency department with irregular fatigue, exhaustion, and a few 25 lb weight reduction over several weeks. He additionally exhibited elevated polydipsia for the earlier 2 months and nocturia 2-3 occasions a night time, besides intermittent postprandial left side flank pains after a meal. He didn’t drawl fever or chest pains.
Lab assessments published a blood glucose concentration of 30.6 mmol/L (550 mg/dL), C-peptide of 0.62 μg/L, and HbA1c of 16.8%, besides obvious urinary ketones and glycosuria. Nonetheless the affected person had no antibodies in opposition to islet cells, glutamic acid decarboxylase, tyrosine phosphatase, insulin, or zinc transporter 8. This, Laudes and colleagues said, indicates that the man had an autoantibody-negative form 1B form of diabetes.
Genetically, the affected person had a maternal cousin with autoantibody-obvious form 1 diabetes mellitus, and a maternal grandmother with form 2 diabetes, besides a leukogen antigen genotype (HLA DR1-DR3-DQ2), which is associated with “a a dinky bit elevated risk” of rising form 1 diabetes versus the total inhabitants.
The affected person’s COVID-19 history published a doubtlessly telling timeline: His folks developed COVID-19 indicators on March 16, and the affected person developed diabetes indicators on April 6. He examined obvious for SARS-CoV-2 IgG, but not IgM antibodies on April 29, and visited the emergency department on May per chance per chance well unbiased 5.
Laudes and colleagues acknowledged one counterpoint to the premise that COVID-19 prompted the diabetes: the affected person’s ultrahigh HbA1c stage at presentation suggests that the hyperglycemia had already been recent for a appreciable time. On the the same time, though, research doesn’t “rule out” acute onset of form 1 diabetes for the length of that time, which is supported by the onset of indicators after the an infection of SARS-CoV-2.
Extra examination could composed be pursued in sufferers who produce β-cell failure and insulin-dependent diabetes following COVID-19, the researchers proposed, which could uncover “doable virus-brought on cytolytic processes in T1DM pattern.”
The authors disclosed no conflicts of interest.