Global data effort investigates whether Covid causes diabetes
Take the example of three men who presented to a hospital in northern India, weak, feverish and with no history of diabetes. They all tested positive for SARS-CoV-2. And when their blood tests returned, they all had dangerously high buildups of glucose and ketones, which the body makes when it doesn’t have enough insulin to break down sugar. The official term for the life-threatening complication is diabetic ketoacidosis, and it is typically seen in children with type 1 diabetes.
Mohammad Shafi Kuchay, an endocrinologist who has consulted on the cases, told WIRED via email that he and the other doctors assigned to the cases assumed the virus had somehow destroyed the insulin-making cells of those patients, giving them type 1 diabetes. And so the doctors put the men on a regimen of insulin injections. But as the months went by, they needed less and less injections. They were moved to oral antidiabetic drugs, and have been doing this for over two months now. “This means that the patients are suffering from type 2 diabetes,” Shafi Kuchay wrote. The damage caused by the virus to the insulin-secreting cells of these patients appears to be transient. Further monitoring will be needed to determine if their diagnosis of type 2 diabetes is also short-lived.
Will other patients also find that their blood sugar problems go away when their infection clears up? Or will Covid-19 cause lifelong diabetes? “None of these issues could be addressed with just the anecdotal case reports that were coming out,” Rubin says. That’s why he and an international group of scientists decided to act on their intuition and create a global repository for tracking information on coronavirus-linked diabetes.
The CoviDiab Registry allows doctors around the world to upload anonymized data on Covid-19 patients with abnormal blood sugar levels who have no history of diabetes. This includes the basics like the person’s age, gender, medical history, and details of the progression of the disease: do they end up in the intensive care unit or on a ventilator? But the registry also asks doctors to catalog the drugs they administer, in case it’s not the coronavirus infection that triggers the diabetes, but an unknown side effect of something used to treat it.
The purpose of this information-gathering effort is to measure the scale and scope of the problem, as well as potential solutions. How often is Covid-19 associated with new-onset diabetes? And what flavor – type 1, type 2 or some new form of disease? What exactly causes metabolic dysfunction? How long do such cases of diabetes last and what are the best ways to treat them? It may take some time before there is sufficient data to answer questions about prevalence and mechanism. But Rubin believes they might have information on the most common types of diabetes in Covid-19 patients – and what might predispose people to this particular complication of coronavirus – by the end of the year .
This is not the first registry to track the overlap between people with Covid-19 and other conditions. Similar data sharing efforts was launched early this year for people with inflammatory bowel disease, chronic liver disease, and rheumatoid disorders, among others. Eric Topol, a leading cardiologist at the Scripps Research Translational Institute, argued for a similar approach to monitoring heart complications from Covid-19. The diabetes database was launched in June, and since then, more than 275 doctors have requested access to share data on at least one patient who meets the criteria. Verification of each contributing physician takes time, and after that, registry organizers need to put in place data sharing agreements in line with Strict European data protection laws. But so far dozens of cases have been uploaded. And what is clear, says Rubin, is that this is not just an anecdotal problem. “From what we’ve seen so far, diabetes linked to Covid-19 will not be a widespread problem that affects the majority of people,” he says. “But now we know it is a possibility, although it is not common.”