COVID-19-INDUCED NEW ONSET DIABETES MELLITUS

Abstract

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: COVID-19 infection and diabetes have been intertwined closely since the onset of the pandemic. Presence of diabetes as comorbidity has made infected individuals more prone to severe COVID-19 infection and conversely being infected with COVID19 has led to poor glycemic controls in patients. However, COVID -19 induced new onset diabetes mellitus has been rare and mostly reported in the pediatric population. CASE PRESENTATION: This is a case of a 52-year-old man with past medical history of hyperlipidemia who presented to the emergency department with complaints of generalized weakness, myalgias, vomiting and cough since 3-6 days. Vitals on admission were unremarkable except for sinus tachycardia. Patient was found to be positive for COVID 19. Lab values revealed a diagnosis of DKA with blood sugar 798, anion gap of 25, serum bicarb of 16 and ketonuria. Patient did not have a history of diabetes at presentation. HbA1c was 4.6 and fructosamine done on day 3 of admission was 371. Patient was treated for his DKA as per protocol with insulin gtt and his AG closed. However, unfortunately he passed away from COVID related cardiac complications and multiorgan failure. DISCUSSION: There have been reports of increased incidence of new type 1 DM in children post COVID-19 infection. Most autoimmune diseases have been postulated to be triggered by a viral infection. In the case of type 1 DM, the virus is thought to damage Beta cells by either lysing the cell via replication or damage by host auto reactive T cells. Pancreatic islet cells are abundant in ACE2 receptors, which the virus uses to gain access inside the cell. There is also a component of infection induced inflammation and cytokine activation and insulin resistance leading to stress hyperglycemia. What remains to be seen is if this beta cell damage is temporary and if the virus is readily cleared from the pancreas after resolution of infection. Future data will clarify our understanding on the pathophysiology involved and how to prevent this disastrous viral induced organ damage. CONCLUSIONS: COVID 19 can trigger new onset diabetes in adults through a variety of pathways. As more data emerges, it will help us determine the extent of beta cell damage and the reversibility if at all. We should expect a major shift in prevalence of diabetes in the next few years. REFERENCE #1: Boddu SK, Aurangabadkar G, Kuchay MS. New onset diabetes, type 1 diabetes and COVID-19. Diabetes Metab Syndr. 2020 Nov-Dec;14(6):2211-2217. doi: 10.1016/j.dsx.2020.11.012. Epub 2020 Nov 17. PMID: 33395782; PMCID: PMC7669477. REFERENCE #2: Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol. 2010 Sep;47(3):193-9. doi: 10.1007/s00592-009-0109-4. Epub 2009 Mar 31. PMID: 19333547; PMCID: PMC7088164. DISCLOSURES: No relevant relationships by Humayun Anjum, source=Web Response No relevant relationships by Madiha Khalid, source=Web Response