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Does Covid-19 have a bidirectional relationship with Diabetes?

KATHMANDU: There is a bidirectional relationship between the COVID-19 and diabetes, a UK-based study has suggested.

In an article published in the New England Journal of Medicine, on Friday, it has shown a possibility of bidirectional relationship between diabetes and the coronavirus infection.

Diabetic patients consequential to reduced immunity are at greater risk of contracting the contagion. However, surprisingly, new-onset diabetes and severe complications in metabolical functionings of preexisting diabetes have been noted in COVID-19 patients.

Diabetic ketoacidosis and hyperosmolarity, for which higher doses of insulin are warranted have also been witnessed in the coronavirus infected, which is as much interesting a discovery in the field of medical science as is a management obstacle, given this complex patho-physiology of Covid-19 related diabetes.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the Covid-19 causing pathogen, binds to angiotensin-converting enzyme 2 (ACE2), which is an enzyme attached to the cell membranes of cells in the lungs, arteries, heart, kidney, and intestines. Therefore, it is probable that the infection may result in pleiotropic alterations of glucose metabolism, which could muddle the pathophysiology of already prevalent diabetes or lead to newer mechanisms of ailments.

Increased incidences of fasting glycemia and acute-onset diabetes have been seen in patients of SARS coronavirus 1 pneumonia (the virus binds to ACE2 receptors) than the non-SARS pneumonia.

In summary, these observations hint the possible diabetogenic effect of Covid-19. On contrary, suspicions on whether the irregularities of glucose metabolism persist post the recovery of the infection or resolves with it, is still blurred.

Many questions regarding the occurrence of the phenomenon including frequency of new-onset diabetes, the clarification on the specification of the type of disease, etc. among others is yet to be answered.

In an attempt to address the uncertainties, an international group of diabetes researchers participating in the CoviDIAB Project have formulated a global registry of Covid-19–related diabetes.

As the SARS-CoV-2 has had a short history of human infection, clarity on the development of Covid-19–related diabetes, natural history of the disease, and proper management will be worthwhile. The study of the new-onset diabetes in Covid-19 will also foil the novel mechanisms of the disease.


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