April 15, 2022

About two years after the emergence of the COVID-19 virus, researchers continue to learn more about its impact on diabetes: There is an increased risk of COVID-19 infection in people with diabetes, which was recognized early on. However, there was concern about statistical methods and the retrospective nature of those initial studies; subsequent, higher quality studies have confirmed this association. Therefore, diabetes is recognized as a risk factor for COVID-19 infection. Early vaccination is critical to prevent severe manifestations.

Measures implemented to decrease the spread of COVID-19, such as working from home and sheltering in place, would be expected to have an impact on glucose control in people with diabetes. This outcome would occur based on a decrease in physical activity and perhaps an increase in food intake resulting from these measures.

Subsequent studies have confirmed deterioration of glucose control with changes in mobility because of the pandemic. However, some patients have been able to mitigate effects on glucose control by modifying lifestyle measures.

Yogish C. Kudva, M.B.B.S., Endocrinology, Diabetes, Metabolism, and Nutrition, at Mayo Clinic in Rochester, Minnesota, highlights some key points related to diabetes during the COVID-19 pandemic.

Changes in practice

Dr. Kudva notes: "The pandemic led to expansion of telemedicine, a practice change that has been greatly appreciated by a significant proportion of patients with diabetes. However, a proportion of people with diabetes may find telemedicine visits more difficult to complete, especially if they have diabetes devices requiring downloading and transmission of downloaded information. Clinical practices have found it difficult to provide the extra support needed by patients with technical challenges related to information technology. This situation is especially challenging with successive waves of the pandemic resulting in reassignment of clinical support staff.

"The pandemic also resulted in emergency use authorization of continuous glucose monitors approved for outpatient practice to the inpatient practice. This measure was initially instituted because of the shortage of personal protective equipment in hospitals and remains in place. This situation, in turn, has stimulated research into conducting studies for approval of continuous glucose monitors in the inpatient setting."

Unanswered questions

Dr. Kudva continues: "There has been concern about whether COVID-19 infection can result in type 1 diabetes. A global study was developed in the first year of the pandemic to address this issue with limited resources; to our knowledge, the study is ongoing. In January 2022, the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report published research in which retrospective claims data from March 2020 to June 2021 demonstrated an increased risk of type 1 diabetes development more than 30 days after developing COVID-19 infection in a pediatric population (younger than 18 years)."

Summary

• COVID-19 infection may result in more-severe disease in unvaccinated people with diabetes. Whether vaccinated people with diabetes have an increased risk of severe disease compared to age- and gender-matched controls is unknown.
• Societal and workplace changes forced by the pandemic have potential to result in deterioration of glucose control.
• Telemedicine, accelerated by the pandemic, has been welcomed by patients with appropriate technology infrastructure and skills. "We also acknowledge, however, that it has disadvantaged patients with diabetes who lack broadband infrastructure and technology skills," says Dr. Kudva.
• Continuous glucose monitoring has helped diabetes management in hospitals, especially when inpatient infrastructure has been stressed.
• Whether COVID-19 infection can result in type 1 diabetes is currently unknown and is an area of ongoing study.

For more information

Barrett CE, et al. Risk for newly diagnosed diabetes >30 days after SARS-CoV-2 infection among persons aged <18 years — United States, March 1, 2020-June 28, 2021. MMWR Morbidity and Mortality Weekly Report. 2022;71:59.

Refer a patient to Mayo Clinic.