A very strange respiratory virus: coronavirus can lead to the development of diabetes

COVID-19 is capable of infecting and altering the function of insulin-producing cells in the pancreas, potentially explaining why some previously healthy people develop diabetes after being infected with the virus. The issue was described in more detail by the edition The Guardian.

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Doctors are concerned about the growing number of patients who develop diabetes either during infection with the coronavirus or shortly after recovery.

Various theories have been put forward to explain this increase. First, the virus infects pancreatic cells through the same ACE2 receptor, which is found on the surface of lung cells and interferes with their ability to produce insulin, a hormone that helps the body regulate blood glucose levels. Either an overly strong antibody response to the virus could accidentally damage pancreatic cells, or inflammation elsewhere in the body could make the tissue less sensitive to insulin.

To investigate, Professor Shuibing Chen of Weill Cornell Medicine in New York tested various cells and organelles (lab-grown clusters of cells that mimic organ function) to determine which ones might be infected with COVID-19. The results showed that the lungs, colon, heart, liver and pancreatic organelles can be infected, as can dopamine-producing brain cells.

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Further experiments showed that insulin-producing beta cells in the pancreas are also susceptible, and after infection, they can produce less insulin, as well as hormones normally produced by various cells in the pancreas.

“We call this transdifferentiation,” said Chen, who presented the findings at the annual meeting of the European Association for the Study of Diabetes. “These cells change their function, so instead of being beta cells that secrete a lot of insulin, they start mixing different hormones. This helps provide a deeper understanding of the pathological mechanisms of COVID-19.”

Scientists have observed a similar phenomenon in some people with type XNUMX diabetes, although the disease is more due to the fact that body tissues become less sensitive to insulin.

It is unclear whether the changes caused by COVID-19 will last for long.

“However, we know of cases where some patients have recovered. While they were in the hospital, the level of cluse in the blood was exceeded. Over time, after recovering from COVID-19, it returned to normal. This suggests that the pancreatic problems may be temporary,” Chen said.

A separate study by Professor Francesco Dotta of the University of Siena in Italy and his colleagues confirmed that COVID-19 attacks pancreatic cells by acting on the angiotensin-converting enzyme 2 (ACE2) protein on their surface. These cells produce insulin.

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They also demonstrated that ACE2 levels are elevated in inflammatory conditions, which is important because people with existing type XNUMX diabetes may already have some inflammation in the pancreas.

“This means that these insulin-producing beta cells may be even more susceptible to viral infection when inflamed,” Dotta noted.

That is, people with existing diabetes or prediabetes are at greater risk of pancreatic dysfunction if they become infected with COVID-19.

“Patients with diabetes are generally no more susceptible to COVID-19 infection in terms of frequency, but once infected they develop more severe complications and significant metabolic abnormalities,” Dotta said.

Professor Francesco Rubino, Chair of the Department of Metabolic Surgery at King's College London, commented: “These studies appear to consistently support the biological rationale for the idea that COVID-19 can increase the risk of developing diabetes in people who are either predisposed to it, or even perhaps completely from scratch. "

He is co-leading an international effort to build a global database of COVID-19-related diabetes cases to better understand whether an infection could trigger a new form of diabetes or trigger the stress response that leads to diabetes.

“Whether such changes are sufficient to allow this virus to cause diabetes is a question that these studies do not answer. But this allows us to assume that this is possible,” he emphasized.

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However, this may not be the only way the virus increases the risk of diabetes.

“At least clinically, we see that sometimes patients who already had type 19 diabetes exhibited severe insulin resistance, which is a typical feature of type XNUMX diabetes,” Rubino explained. “This refers to how cells in other parts of the body respond to insulin after COVID-XNUMX infection.”

Dr. Lucy Chambers, Head of Research, Diabetes UK, said: “People with diabetes have been disproportionately affected by COVID-19, and as a result, many have tragically died with the disease. Diabetes is a well established risk factor for serious illness. New evidence is emerging today that COVID-19 can cause new cases of diabetes. But how these two states are biologically related is not yet fully understood.

“This study deepens our understanding of how diabetes and COVID-19 may interact biologically. This will help develop new effective treatments for people at risk of or living with diabetes. Vaccination against COVID-19, including booster vaccination when offered, remains the best form of protection against this insidious virus,” Chambers concluded.

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