Abbott: A few baseline ideas as we begin. How can active infections affect glucose?
Kazemi: Immediately after being diagnosed, people may have some element of insulin resistance that could manifest as high glucose seen with many infections.

So that's common across many viruses, not specific to COVID-19?
Correct.

And what should we know about the role of viruses in type 1 diabetes?

A large number of type 1 cases occur in childhood. Not all but a large number. So there is this hypothesis that having a genetic predisposition is brought out by some form of a viral infection that sets off the cascade of auto-immunity that results in type 1 diabetes. As anyone who has kids knows, they get a lot of viral infections. So your immune system basically goes haywire pumping out more antibodies that then start attacking parts of yourself that it shouldn’t be attacking.

Is that what researchers found in this study?

Not exactly. Keep in mind, they're not saying that the rate of diagnosis of type 1 is increased. They're saying that the rate of diagnosis of diabetes overall is increased, which is what makes this a bit tricky. Because we know that for type 2 diabetes, we do not have any clear evidence for antecedent viral infection causing that.

OK, so some increase in diabetes overall, as you said. Back to our search that started this: What could explain the connection between COVID-19 and diabetes?

They actually fall back on the hypothesis — which, to me, is the more likely scenario — is that by getting COVID, you set your body up for this kind of chronic inflammation.

And that's why "post-30 days" matters?

Yes. There's acute inflammation from the actual viral infection. But then, after you're done fighting off the acute viral infection, there’s seems to be this low-lying chronic inflammation from COVID symptoms. We see it with autonomic dysfunction, cardiac symptoms, etc. And maybe diabetes is part of that.

But maybe it's not just that?

It's a bit of a chicken-and-egg argument because, in those other chronic inflammatory conditions, people also get treated with drugs that definitely predispose toward diabetes. Things like steroids. So is it the actual drug you’re giving or is it the actual inflammation?

It's hard to pin down with so many factors. What else could be at play?

People who are at higher risk for complications from COVID — individuals who are older, who have higher BMI, have other comorbidities — are also people who we tend to think of for having a higher risk of diabetes. But there seems to be the ability for COVID infection to exacerbate a pre-existing tendency toward diabetes.

Unfortunately, when you add COVID to the equation, that just might be the straw that breaks the camel's back, if you will.

Again, can we say that definitively? No. But that could be a very reasonable hypothesis.

So what should I do?

The message, medically, is that if you’re at high risk for COVID complications, keep an eye out for diabetes as well.

And I can talk to my doctor about this? Could this change the care I receive?

Certainly. From a primary care perspective — three years ago, before the pandemic — if you brought up a scenario where you have a rapid pulse in someone who just had a viral infection, the usual differential could be a myocarditis, a pericarditis, something directly from a viral infection area.

Now, three years later, something that wouldn’t even be on that list in the top 20 is probably in the top 5, something called POTS (Postural Orthostatic Tachycardia Syndrome), which was very obscure medical condition that was seen only by rheumatologists in certain very rare medical conditions. All of a sudden, it's like everywhere because of COVID.

So you have to keep in mind certain things post-COVID that you wouldn't normally think about necessarily in other infections.

Like if someone came in with a cold, would I be worried about screening them for diabetes two months out? No. Or if they came in even with the flu, would I be worried about screening them for diabetes two months out? No.

But now I know if someone comes in with COVID and it's two months out and they’re having some symptoms that might be suggestive, I should probably think about diabetes.

But that's after a diagnostic, which can help you know if you have contracted COVID-19.

And if, following COVID, I'm diagnosed with diabetes?

Abbott can help. If you are living with diabetes, we have sensing technologies — like the FreeStyle Libre systems — and nutritional products to help you manage your condition.

Good advice. Last thing: Where do we go from here?

Remember, for this study, a lot of these people were infected before vaccination. So does that risk for diabetes still hold true? Or does having a vaccine actually help get you to the point where you have as significant of an immune response?

It definitely is interest generating. Let's see what happens.