While an increased incidence of diabetes has been documented since the start of the COVID-19 pandemic and SARS-CoV-2 is known to infect the pancreas, data are inconclusive as to whether these facts are connected directly, according to the author of a Commentary that reviews 3 research studies published in the May issue of Diabetes Care. The situation is complex with many potential explanations: a rise in sedentary behavior leading to increased obesity, metabolic dysfunction in the pancreas, or perhaps even the emergence of a new form of diabetes.
“We are … left with many unanswered questions,” the author writes. “Can the reports of rising cases of incident diabetes be fully explained, as outlined by the elegant studies from McKeigue et al. and Holman et al.? Based on the observations of other cited and carefully conducted studies, is the increase real? If real, do the new cases after COVID-19 represent a new form of diabetes? Data to date suggest the human pancreas is a target of SARS-CoV-2, and several postulated mechanisms are proposed to contribute to metabolic dysfunction and increase in diabetes. Given that the type or characteristics of diabetes after COVID-19 have not been well described, there is still a great need to conduct the deep metabolic, molecular, and clinical phenotyping.
“Are the reports of rising cases related to significant stress of acute infection or perhaps, as suggested by Sasidharan Pillai et al., a consequence of pandemic conditions? Are we seeing an increase in cases from the contribution of those individuals who were previously undiagnosed or who had prediabetes? With the myriad of factors related to the pandemic state, are these individuals experiencing an accelerated progression or is the condition simply being unmasked? Is the natural history of these cases similar to that of diabetes onset and progression of the disease observed before the pandemic? Do we really appreciate the effect of increased psychosocial stress during the pandemic and its role in diabetes onset?”