Can the COVID-19 Virus Cause Diabetes?

Patients with COVID-19 may be at risk for developing stress-related hyperglycemia, which in turn could increase diabetes risk.

There are too many unknown variables to say with certainty that COVID-19 can cause diabetes; however, there is a possibility. The increased blood sugar seen in patients with COVID-19 has many causes, including decreased glucose tolerance and insulin production. These things can be caused by inflammation as well as having overweight or obesity. This increase in blood sugar seems to be a common occurrence in patients with COVID-19, raising the question as to whether this is a coincidence or something more. 

There seems to be an increased occurrence of ketoacidosis in patients with both diabetes and COVID-19 infection. This increased occurrence of ketoacidosis is very abnormal and raises a question. Can COVID-19 target the cells responsible for the production and storage of insulin? Many patients admitted to the hospital for a COVID-19 infection show up in a state of ketosis. They are also usually running fevers and dehydrated, which can cause their electrolyte irregularities. These factors can affect the cells responsible for insulin production and storage.  

It has still yet to be discovered whether or not COVID-19 can damage insulin-producing cells. Surveys taken toward the start of the pandemic of single-cell RNA have shown no signs of the COVID-19 receptor in the insulin-producing cells. There are surveys, however, that have had opposite results and found COVID-19 receptors in these cells. For COVID-19 alone to cause damage to these cells, the virus would have to be present in a tremendous amount. For this to be the case, patients who experience diabetic ketoacidosis after COVID would require insulin therapy. Most of these patients do not end up needing insulin therapy.  

Part of the issue with the recovery of these insulin-producing cells is that steroids are becoming more commonplace in COVID-19 treatment. It is believed that an increased incidence of type 1 diabetes would have been seen if COVID-19, in particular, could cause diabetes, but this has yet to be observed. Whether COVID-19 can cause diabetes may not be known because not everyone with the virus ends up in the hospital. Many COVID-19 patients ride out the virus with no treatment or see their primary care physician. Because not every patient ends up in the hospital, type 1 diabetes incidence in COVID-19 patients could be undercounted.  

People with pre-existing conditions and comorbidities are at a higher risk of developing COVID-19. Diabetes is one of these pre-existing conditions. Although not enough research has been done to confirm that COVID-19 can cause diabetes, we should not dismiss the theory entirely. More studies need to be done before we can know for sure. In the meantime, patients with diabetes must do everything in their power to control their blood sugar to not end up with severe COVID-19, along with all of the other virus safety precautions.  

Practice Pearls: 

• It has not been proven that COVID-19 can cause an individual to develop diabetes later on down the line, but it is possible. 
• There are too many unknown variables surrounding the hyperglycemia experienced by COVID-19 patients to know the actual cause. 
• Patients with diabetes must keep their blood sugar in check to reduce their risks for severe COVID-19 and hospitalization. 

Accili, Domenico. “Can COVID-19 Cause Diabetes?” Nature News, Nature Publishing Group, January 11, 2021. 

Luxiang Shanga, Mengjiao Shao. Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis. Science Direct, October 2020. 

Oluwatayo Ishola, PharmD. Candidate, South College, School of Pharmacy 

See more about hyperglycemia in diabetes and its role in COVID-19 and other conditions.