From the Guidelines
New onset diabetes in young individuals after COVID-19 infection requires immediate medical attention, including fasting blood glucose, HbA1c, and antibody testing to distinguish between Type 1 and Type 2 diabetes. The precise mechanisms for new-onset diabetes in people with COVID-19 are not known, but may include previously undiagnosed diabetes presenting early or higher levels of pandemic-related distress associated with reduced motivation, physical inactivity, and sedentary behavior 1.
Diagnosis and Treatment
Treatment depends on the type of diabetes diagnosed, with Type 1 requiring insulin therapy (typically starting with basal-bolus regimen like glargine/detemir plus rapid-acting insulin with meals) and Type 2 potentially managed with metformin (starting at 500mg daily, increasing to 1000-2000mg daily in divided doses as tolerated) 1. Blood glucose monitoring is essential, typically 2-4 times daily initially.
Management and Follow-up
All patients should receive education on diabetes management, including recognition of hypoglycemia symptoms, proper nutrition, and regular physical activity. Regular follow-up appointments are crucial to adjust treatment as needed, especially as the relationship between COVID-19 and diabetes continues to be understood 1. People with diabetes who have been infected with SARS-CoV-2 should be followed up in the longer term to assess complications and symptoms of long COVID-19, and new-onset diabetes cases should receive routine clinic follow-up to determine if the condition is transient 1.
Prevention
People with diabetes should be prioritized and offered SARS-CoV-2 vaccines and vaccine boosters to prevent COVID-19 infection and its potential complications 1. COVID-19 may trigger diabetes through direct damage to pancreatic beta cells, inflammatory responses affecting insulin production or sensitivity, or by unmasking pre-existing metabolic vulnerabilities. Some cases may be temporary, while others require long-term management.
Key Considerations
- Higher levels of pandemic-related distress have been linked to higher A1C 1
- Greater pandemic-related life disruptions have been related to higher distress in parents of youth with diabetes 1
- Factors to consider for prioritization should include demographics, socioeconomic status, education levels, established complications, comorbidities, and modifiable risk factors, which are associated with high risk of progression of diabetes-related complications 1
From the Research
New Onset Diabetes in Young Post COVID
- The risk of new-onset diabetes mellitus after COVID-19 infection has been explored in several studies 2, 3.
- A scoping review found that except for one, all studies suggested an increased risk of new-onset diabetes mellitus 4 weeks after acute infection, with the risk appearing most in the first six months after the acute COVID-19 infection 2.
- A systematic review and meta-analysis of cohort studies assessing new-onset diabetes after COVID-19 found that the incidence of diabetes after COVID-19 was 15.53 per 1000 person-years, and the relative risk of diabetes after COVID-19 infection was elevated (RR 1.62) 3.
- The relative risk of type 1 diabetes was RR=1.48 and type 2 diabetes was RR=1.70, compared to non-COVID-19 patients 3.
- At all ages, there was a statistically significant positive association between infection with COVID-19 and the risk of diabetes, with the risk increasing 1.17-fold after COVID-19 infection compared to patients with general upper respiratory tract infections 3.
- Patients with severe COVID-19 were at higher risk (RR=1.67) of diabetes after COVID-19, and the risk of diabetes was highest in the first 3 months after COVID-19 3.
Possible Mechanisms
- The possible mechanisms of new-onset diabetes mellitus after COVID-19 infection are not fully understood, but may be related to the severity of the initial COVID-19 infection 2.
- Vaccination that reduces the severity of acute COVID-19 infection might help to reduce the risk of post-COVID-19 diabetes mellitus 2.
- The use of certain glucose-lowering drugs, such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i), may be associated with a higher risk of incident severe COVID-19 and 30-day mortality in patients with COVID-19 4.
Management of New Onset Diabetes
- The management of new-onset diabetes after COVID-19 infection is not well established, but may involve optimizing treatment and counteracting clinical inertia that predates the pandemic 5.
- Restarting patients on optimal antidiabetic therapy after recovering from COVID-19 may provide an opportunity to optimize treatment and improve glycaemic control and cardiorenal protection 5.