COVID19 Induced Diabetes; New Type of Diabetes Mellitus? Viral Genetic Material a Step Towards Cure of Diabetes?

Abstract

The worldwide pandemic of coronavirus disease 2019 (COVID-19), seen in multiple races, ethnicities, age groups, with various co-morbidities. The bidirectional relationship between COVID-19 and diabetes (DM) is already established. The associations of DM with a variety of virus infections have been reported previously. COVID-19 infection could be causally linked to new-onset of DM. We report 13 cases of new type of COVID-19 induced DM. While working in noncovid endocrine clinic we could notice 5 patients presented with fever and URI or osmotic symptoms or post URI cramps in legs. All 5 cases was having hyperglycemia with ketonuria and HbA1c more than 11% with fasting or premeal C peptide levels more than 10 ng/ml. All five patients have new onset DM and they are neither obese nor having family history of DM. Presentation includes fever with cough and/OR osmotic symptoms with hyperglycemia, weight loss in weeks. Out of five, in four patients either RT PCR OR Rapid Antigen Test was positive. One patient presented with cramps in legs with past history of URI without fever. In her COVID 19 IgG antibody was positive. All patients initially treated with insulin but on follow up they are controlled with metformin plus gliptin. All patients have HbA1c less than 6.7 on follow up at 3 months. We have retrospectively analysed data at COVID hospital. We have used inclusion criteria as1Not known diabetes 2Either RT PCR + ve OR COVID-19 Ag +ve OR HR CT SCAN show atypical pneumonia or COVID-19 Ab positive 3Presented as hyperglycemia RBG > 200 mg% 4HbA1c > 7 with Urine Ketones + Exclusion Criteria Received steroids in recent past <2 wk. Total 30 patients presented with hyperglycemia at admission in last one month (September). Out of these, 8 patients who are neither obese nor having family history of DM, nor received steroids in last 2 weeks. All 13 patients (5 + 8) are of new onset DM with BMI around 24, presented with ketonuria, with no family history of DM and who did not received steroids. Hence we propose COVID-19 can cause switch in metabolism to form new type of DM. There are case reports are published about COVID-19 induced DM with ketoacidosis. In another retrospective analysis of 658 COVID-19 patients, 42 presented with ketosis.(Am J Emerg Med 2020:S0735-6757(20)30488-5) Out of these 27 were newly diagnosed DM. But other features like BMI, family history of DM, C peptide levels, use of steroid are missing. We coined new type of DM which cause metabolic switch in metabolism leading to ketosis with HbA1c more than 11 & high normal C peptide requiring insulin initially but later controlled with metformin and gliptin with HbA1c less than 6.7!We further propose that genetic material of virus can cause switch in metabolism, then why should not we use other viral genetic material to reswitch leading towards cure of DM. Further research is needed in this direction.