Article written by :
Dr. Anupam Maity
MD (General Medicine)
Consultant General Medicine
Since the COVID 19 outbreak across the globe, lot of attention has been given to people with co- morbidities or presence of two or more diseases. In the initial phase or first wave of the pandemic, many individuals with co-morbidities like diabetes, hypertension, cardiac problems, kidney problems and COPD lost their lives. A major focus was given on individuals with diabetes as India is the diabetic capital of the world with the largest number of diabetic patients. Doctors and researchers have been saying that diabetes increases the risk of complications including death among these individuals. Presently, India is going through the 2nd wave of the SARS-CoV-2 infection. During the last 3 months, we have seen that increasing number of patients who have been discharged after treatment of COVID 19 are having elevated levels of blood sugar. This is a reason of concern now.
Researchers and doctors are trying to find out the reason behind development of diabetes in the post treatment phase of COVID 19 infection. But here I would like to share a few facts which are assumptions, yet hold great importance regarding development of diabetes in these recovering patients.
It is possible that these patients already had diabetes which remained undiagnosed earlier. To rule out this possibility, a test can be performed which will confirm the same. HbA1c is the test which gives an average level of blood sugar over a period of three consecutive months. If the test shows a result of above 6.5%, it would indicate that the person already had diabetes beforehand.
Patients with moderate or severe COVID 19 infection are mostly being treated with corticosteroids. A systemic inflammatory response occurs due to the viral infection which can lead to lung injury and multisystem organ dysfunction. It has been proposed that the potent anti-inflammatory effects of corticosteroids will prevent or mitigate the inflammatory response. The efficacy of combination therapy of corticosteroids and an antiviral agent targeting SARS-CoV-2 for the treatment of COVID-19 has been meticulously studied in clinical trials. Any corticosteroid including dexamethasone which is being used is also seen to increase blood sugar level. This can trigger diabetes in patients who are being treated with it, mostly in the pre-diabetic stage. Hence this can also be a reason which cannot be neglected.
There is another perspective which holds importance. Many Indians have a genetic predisposition which puts them at higher risk for diabetes. The inflammatory markers which increase during COVID may expedite the process. There is also a possibility that the virus can directly affect the pancreas and reduce insulin secretion which is very important to control the blood sugar level.
The above mentioned points are all possibilities which may be responsible for triggering diabetes in patients who are getting treated for COVID 19. But we are still in the process of finding out more about this through extensive research. In the mean time, it is a request to everyone; please maintain a healthy lifestyle through healthy food habits, regular physical activity and other precautionary measures to keep your sugar level in the normal range. Also monitor your blood sugar levels regularly in the post COVID phase along with HbA1c. Following up with your doctor on a regular basis is also very important to keep your health in proper shape.