There has been a lot written about COVID-19 being linked to type 1 and type 2 diabetes, and another paper discusses the risk of diabetes after a long COVID-19 infection. This is convincing evidence that we should consider diabetes to be one of the long COVID sequelae and that the COVID-19 vaccines reduce the risk of diabetes.
Research like this debunks the idea that COVID-19 isn’t dangerous, despite the millions of people who have died from the disease. You might recover quickly from COVID-19 without too much effort only to find out you have type 1 or type 2 diabetes, a chronic illness that will affect your life in ways that you cannot comprehend (unless you have experienced diabetes).
Let’s take a look at this study.
What is diabetes?
Type 1 diabetes is an autoimmune disease that is characterized by autoreactive T lymphocytes (T-cells) that destroy pancreatic islet beta cells, which produce insulin. Essentially, these lymphocytes mistakenly attack the islet cells as if they were a foreign body, as they are supposed to do with a viral or bacterial infection.
In addition, regulatory T-cells (which are often called Tregs) modulate the immune system and would normally reduce the effect of an autoimmune attack. Tregs act like brakes that normally prevent mistaken attacks, like on the pancreatic islet cells, without affecting the whole immune system. A branch of diabetes research has suggested that abnormal Tregs could be the key to finding treatments to reverse type 1 diabetes.
Once the pancreatic islet cells are damaged, they no longer produce insulin, which is critical to regulating the levels of blood glucose. Without insulin, the blood glucose levels increase rapidly leading to long-term damage to eyesight, kidneys, limbs, heart, and other organs.
In fact, type 1 diabetes can be deadly if uncontrolled blood sugar leads to a life-threatening condition called diabetic ketoacidosis. Without regular insulin injections, a patient has little chance of living beyond a short period of time, and even then it could lead to a horrifically painful demise.
It is not known what causes this autoimmune disease, although there is strong evidence that genetics is the most important factor. However, other things may be implicated, like vaccine-preventable diseases, which could be important co-factors in the development of the disease. Just to be clear, vaccines are not linked to type 1 diabetes.
Currently, there are no known cures for type 1 diabetes. The only treatment for the disease is regular injections of human insulin, manufactured from genetically engineered E. coli cultures. In addition, careful diet and lifestyle management help regulate blood glucose levels, although it cannot replace insulin injections.
Type 2 diabetes is a substantially different disease from type 1. Mostly, type 2 diabetics produce insulin, just an insufficient amount to regulate glucose levels, or their cells have become resistant to insulin because of lifestyle issues. These lifestyle issues may include obesity, lack of exercise, and diet. However, there also appears to be a genetic component because there are individuals who have a “good” lifestyle who will still contract type 2 diabetes.
There is almost no relationship between type 1 and type 2 diabetes, except they share the same symptoms of high blood sugar.
Long COVID-19 and diabetes — new paper
In a paper published on 21 March 2022 in the respected Lancet Diabetes & Endocrinology, Ziyad Al-Aly, MD, and Yan Xie, MPH, both from the Clinical Epidemiology Center and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, used a cohort study to examine 181,280 veterans who tested positive for COVID-19 in national databases of the US Department of Veterans Affairs.
Here’s what Al-Aly and Xie found:
- There was a 40% higher risk for incident diabetes during the post-acute phase of the disease compared with the control group (HR =1.40).
- Over 12 months, there was also a significantly higher excess burden of new diabetes among those with a positive COVID test — 13.46 excess cases of diabetes per 1,000 people.
- Individuals who survived the post-acute phase of a COVID-19 infection (the first 30 days) had an 85% higher risk of needing a new antihyperglycemic medication, a sign of type 2 diabetes, following infection compared with controls (HR 1.85).
- The 12-month burden of incident antihyperglycemic use was 12.35 per 1,000 people higher than controls.
- The control group had an incident diabetes burden of 34.42 per 1,000 people over 12 months, individuals admitted to the intensive care unit (ICU) with COVID-19 had an incident diabetes burden of 123.48 per 1,000 people.
- The researchers found several clinical and sociodemographic risk factors to be associated with a higher risk for developing diabetes after infection — age over 65 years, Black race, body mass index (BMI) of 25-30 or above 30, and presence of cardiovascular disease, hypertension, hyperlipidemia, or prediabetes.
- The researchers determined that COVID survivors had a 46% increased risk for both incident diabetes and antihyperglycemic use and an excess burden of 18.03 per 1,000 more people for this composite outcome 12 months later.
- Although the study was not powered to determine the risk differences between type 1 and type 2 diabetes, the researchers stated that in excess of 99% of diabetes reported was type 2.
If these data hold up, you should think about this — approximately 80 million people have had COVID-19 in the USA alone. that would mean that there could be an additional 1 million diabetes cases as a result of the pandemic. That has an immense personal and economic cost to the country (and the world).
There are possible mechanisms including initiation of autoimmunity or acceleration of disease progression. In other words, long COVID-19 could induce the autoimmune disorder that causes type 1 diabetes or it could accelerate an already underlying disease.
The evidence that diabetes (both type 1 and type 2) is one of the sequelae of long COVID is becoming overwhelming.
I know many of my readers (not a majority by any means) think that COVID-19 is not a dangerous disease, but it can be treated easily with drugs or other therapies. A lot of you, after getting all of the vaccines, are out in the world without masks or anything.
But, I’m not sure that is wise. Diabetes is a chronic disease that shortens your life, puts you at risk of a lot of comorbidities, and is a challenge to control. If you don’t think COVID-19 is deadly, and it is, you better know that diabetes is definitely a killer.
And diabetes is just one of the sequelae of long COVID-19. They all are scary to me.
Get vaccinated. Wear your mask. Try to avoid being around people who couldn’t care less about COVID-19. And maybe, just maybe, you can avoid diabetes.
- Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol. 2022 May;10(5):311-321. doi: 10.1016/S2213-8587(22)00044-4. Epub 2022 Mar 21. PMID: 35325624; PMCID: PMC8937253.