Just six months after a mild case of COVID-19, the Crown
Point, Indiana, boy was diagnosed with Type 1 diabetes. His parents were
floored — it didn’t run in the family, but autoimmune illness did and doctors
said that could be a factor.
Could his diabetes also be linked with the coronavirus,
wondered Nolan’s mom, a respiratory therapist. Turns out scientists in the U.S.
and elsewhere are asking the same question and investigating whether any
connection is more than a coincidence.
It’s clear that in those who already have diabetes, COVID-19
can worsen the condition and lead to severe complications. But there are other
possible links.
Emerging evidence shows that the coronavirus — like some
other viruses — can attack insulin-producing cells in the pancreas — a process
that might trigger at least temporary diabetes in susceptible people. Rising
cases might also reflect circumstances involving pandemic restrictions, including
delayed medical care for early signs of diabetes or unhealthy eating habits and
inactivity in people already at risk for Type 2 diabetes.
A Centers for Disease Control and Prevention report looked
at two large U.S. insurance databases that included new diabetes cases from
March 2020 through June 2021. Diabetes was substantially more common in kids
who’d had COVID-19. The report didn’t distinguish between Type 1, which
typically starts in childhood, and Type 2, the kind tied to obesity.
Rates of both types of diabetes have risen in U.S. kids in
recent years, but reports from Europe and some U.S. hospitals suggest the pace
may have accelerated during the pandemic.
“I think we’re all a little worried,” said Dr. Inas Thomas,
a specialist at the University of Michigan’s Mott Children’s Hospital.
Her hospital has seen a 30% increase in Type 1, compared
with pre-pandemic years, Thomas said. It is not known how many had COVID-19 at
some point, but the timing raises concerns that there could be a connection,
she said.
Type 1 diabetes occurs when the pancreas produces little or
no insulin, a hormone that regulates blood sugar. It is thought to involve an
autoimmune reaction, with the body attacking insulin-making cells in the
pancreas. Patients must use manufactured insulin to manage the chronic
condition.
Experts have long theorized that some previous infection may
trigger that autoimmune response.
With COVID-19, “We don’t know if it’s a direct effect or
some other factor that’s not fully understood yet, but we are hoping that this
trend may help us figure out the trigger for what causes Type 1 diabetes,”
Thomas said.
At Rady Children’s Hospital in San Diego, Type 1 diabetes
cases jumped almost 60% during the first year of the pandemic, compared with
the previous 12 months, researchers reported recently in JAMA Pediatrics. Just
2% of those children had active COVID-19 and the report lacked information on
any prior infections. But the sharp increase was striking and “clearly there’s
a lot more work to be done to try to answer why is this happening,″ said
co-author Dr. Jane Kim.
Type 2 diabetes, which mostly affects adults, impairs how
the body uses insulin, leading to poorly regulated blood sugar. Causes are
uncertain but genetics, excess weight, inactivity and unhealthy eating habits
play a role. It can sometimes be treated or reversed with lifestyle changes.
Globally, more than 540 million people have diabetes,
including about 37 million in the United States. Most have Type 2 diabetes, and
many more have higher than normal blood sugar levels, or prediabetes. Doctors
worry that COVID-19 or sluggish pandemic lifestyles might be among things that
push them over the edge.
A diabetes center at Chicago’s La Rabida Children’s Hospital
has seen a pandemic surge in prediabetes. Center co-director Rosemary Briars
suspects long, sedentary hours of online learning played a role.
Dr. Rasa Kazlauskaite, a diabetes specialist at Chicago’s
Rush University Medical Center, said steroid drugs that are sometimes used to
reduce inflammation in hospitalized patients with infections including COVID-19
can cause blood sugar increases leading to diabetes. Sometimes it resolves
after steroids are stopped, but not always, she said.
The physical stress of severe COVID-19 and other illnesses
can also cause high blood sugar and temporary diabetes, she said.
To learn more, scientists in Denmark are enrolling adults
recently diagnosed with Type 1 diabetes, including some who had COVID-19. Over
time, the researchers will check whether the condition progresses faster in
those who had COVID-19, which could help clarify the infection’s role, if any,
in developing diabetes, said researcher Dr. Morten Bjerregaard-Andersen, a
diabetes specialist at the Hospital of South West Jutland.
“The theory is if you had COVID-19, then your own insulin
production will be more compromised than if you weren’t infected,”
Bjerregaard-Andersen said.
Researchers at King’s College London and Monash University
in Melbourne, Australia, have launched an international COVID-19-diabetes
registry. Among things they hope to learn: Does diabetes in COVID-19 patients
persists after they recover; do they face higher risks of getting diabetes
again; could diabetes in COVID-19 patients be an entirely new type of diabetes.
Nolan Balcitis, now 12, says he knew nothing about diabetes
before his diagnosis last year. He was nervous at first about all that’s
involved in managing the disease — counting carbohydrates, checking blood
sugar, insulin shots. But a wearable insulin pump lets him skip daily
injections, and a sensor on his arm makes monitoring a breeze.
A typical kid who likes baseball and playing with his yellow
Labrador retriever, Callie, Nolan shrugs off his condition.
“I’m just kind of used to it now,” the boy said with the
nonchalance of an almost-teenager. -AP
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