Amid the many problems posed by the pandemic, one positive outcome is that COVID-19 is providing valuable insights that could help researchers unlock the secrets of another intractable disease: diabetes.
At RUSH, researchers are using data gathered during the pandemic to understand the connection between the two diseases and why COVID-19 affects people with diabetes differently.
People with diabetes face higher COVID-19 risks
Over the past two years, data has shown that people with type 2 diabetes are more likely to develop severe COVID-19 that leads to hospitalization and sometimes death 鈥 and the reason is likely inflammation, says Rasa Kazlauskaite, MD, MS, director of the Diabetes Technology Program at 脱衣直播 and a RUSH endocrinologist.
鈥淧eople with type 2 diabetes typically have chronic, low-level inflammation that is difficult to detect in clinical practice,鈥 she says. 鈥淲hen they become infected with SARS-CoV-2, the virus that causes COVID-19, this low-level inflammation can become hyperinflammation that affects their lungs, heart and other parts of the body.鈥 This hyperinflammation is what likely leads to more severe complications from COVID-19, she says.
Having diabetes may also put people at risk for 鈥long COVID,鈥 or what doctors call post-acute sequelae of SARS CoV-2 infection, or PASC, says , vice chair of research and division chief of translational and precision medicine in the Department of Internal Medicine at RUSH.
鈥淚n patients with diabetes, there鈥檚 a disordered metabolic environment that actually enhances the replication of the virus,鈥 Landay says. 鈥淭hat may create a higher susceptibility to the virus, and it may also affect the clinical outcomes in those patients. But it鈥檚 not one-size-fits-all.鈥
To find out why only some people with diabetes develop COVID-19 complications, scientists at RUSH and the nonprofit research institute RTI International have been monitoring COVID-19 in patients with diabetes in Chicago as well as in Malaysia for comparison. So far, scientists have tracked differences in outcomes by age, sex, race/ethnicity, body mass index and other factors in 5,712 patients, with results to be published later this year.
Insights into different ways that diabetes develops
Beyond trying to understand why some people with diabetes have worse outcomes from COVID-19 than others, researchers also hope to gain more insights into how diabetes develops. Scientists already know that for some people, it鈥檚 not just a faulty immune system that triggers type 1 diabetes or insulin resistance that leads to type 2 diabetes. recognizes more than 50 different ways that a person can develop diabetes, from defects in a single gene to other health issues like liver disease.
鈥淚deally, we would like to investigate each and every one of those 50 causes,鈥 Kazlauskaite says. 鈥淎nd we are finding that some people have several diabetes causes at the same time. In other words, a patient may not just have the purely insulin-resistant type of diabetes, what鈥檚 typically defined as type 2, but they might also be affected by steroids or autoimmune diabetes at the same time.鈥 Doctors may call this 鈥渉ybrid diabetes,鈥 suggesting that the etiology, or cause, of diabetes may be much more complex than originally believed.
Could COVID-19 be a new cause of diabetes?
It鈥檚 possible, Kazlauskaite says. A recently published in the medical journal Lancet found that people who survived COVID have a 40% higher risk for developing diabetes. She believes many of the new cases of type 2 diabetes are occurring in people with pre-diabetes who don鈥檛 know it.
鈥淧eople might have pre-diabetes with chronic, subclinical inflammation before they get COVID-19. So, when they do get infected with the virus, they could develop hyperinflammation that causes metabolic stress and more insulin resistance. As a result, they manifest overt diabetes,鈥 she says.
Another theory is that COVID-19 disrupts the immune system. 鈥淲e know hyperinflammation can cause autoimmune disease. When this happens, the immune system gets 鈥榗onfused鈥 and starts attacking its own tissues, including insulin-producing cells in the pancreas,鈥 she says. This is the process that causes type 1 diabetes, which primarily develops in childhood but may also affect adults.
A third theory is that steroids given during COVID-19 treatment could cause diabetes because they often raise blood glucose, Kazlauskaite says. For some patients, glucose levels return to normal after the steroids have been discontinued, but for others, the effects are lasting.
A fourth reported hypothesis is that COVID-19 can cause severe inflammation of the pancreas (known as pancreatitis), where the body鈥檚 insulin-producing cells reside. This can trigger diabetes, although it is relatively rare, Kazlauskaite says.
Testing better ways to treat diabetes
Beyond trying to understand the link between COVID-19 and diabetes, doctors at RUSH strive to improve care for patients with both conditions. Like other types of infections, COVID-19 can make existing diabetes worse. That is why controlling glucose in hospitalized patients with both conditions is so critical, Kazlauskaite says.
To help nurses monitor blood sugar levels in these patients at RUSH, Kazlauskaite and her team have been testing that allows nurses to keep an eye on patients鈥 glucose from the nurses鈥 station.
Called inpatient glucose telemetry, the technology alerts nurses before a patient鈥檚 blood sugar gets into the danger zone. The telemetry project at RUSH was made possible through a generous donation from Thomas and Aferdita Merkel (Aferdita received her bachelor鈥檚 and master鈥檚 degrees in nursing from the Rush University College of Nursing). So far, data suggests that patients with COVID-19 and diabetes fare better when their glucose is well controlled.
鈥淚t鈥檚 not only a good thing for patient safety, but it鈥檚 also good from the nurses鈥 perspective,鈥 Kazlauskaite says.
Learn more about the RUSH approach to diabetes care.
