https://www.nature.com/articles/d41586-020-01891-8 - https://www.nature.com/articles/d41586-020-01891-8

Mounting clues suggest the coronavirus might trigger diabetes

Evidence from tissue studies and some people with COVID-19 shows that the virus damages insulin-producing cells.

Smriti Mallapaty   24 JUNE 2020 

In mid-April, Finn Gnadt, an 18-year-old student from Kiel, Germany, learnt that he had been infected with the SARS-CoV-2 coronavirus despite feeling well. Gnadt’s parents had fallen ill after a river cruise in Austria, so his family was tested for virus antibodies, which are produced in response to infection.

Gnadt thought he had endured the infection unscathed, but days later, he started to feel worn out and exceedingly thirsty. In early May, he was diagnosed with type 1 diabetes, and his physician, Tim Hollstein at the University Hospital Schleswig-Holstein in Kiel, suggested that the sudden onset might be linked to the viral infection.

In most people with type 1 diabetes, the body’s immune cells start destroying β-cells — which are responsible for producing the hormone insulin — in the pancreas, often suddenly. In Gnadt’s case, Hollstein suspected that the virus had destroyed his β-cells, because his blood didn’t contain the types of immune cells that typically damage the pancreatic islets where the β-cells live.

Diabetes is already known to be a key risk factor for developing severe COVID-19 and people with the condition are more likely to die. “Diabetes is dynamite if you get COVID-19,” says Paul Zimmet, who studies the metabolic disease at Monash University in Melbourne, Australia.

Now Zimmet is among a growing number of researchers who think that diabetes doesn’t just make people more vulnerable to the coronavirus, but that the virus might also trigger diabetes in some. “Diabetes itself is a pandemic just like the COVID-19 pandemic. The two pandemics could be clashing,” he says.

Growing evidence

Their hunch is based on a handful of people such as Gnadt, who have spontaneously developed diabetes after being infected with SARS-CoV-2, and on evidence from dozens more people with COVID-19 who have arrived in hospital with extremely high levels of blood sugar and ketones, which are produced from fatty deposits in the liver. When the body doesn’t make enough insulin to break down sugar, it uses ketones as an alternative source of fuel. “In science, sometimes you have to start off with very small evidence to chase a hypothesis,” says Zimmet.

Researchers cite other evidence, too. Various viruses, including the one that causes severe acute respiratory syndrome (SARS), have been linked with autoimmune conditions such as type 1 diabetes. And many organs involved in controlling blood sugar are rich in a protein called ACE2, which SARS-CoV-2 uses to infect cells.

The latest clue comes from an experimental study in miniature lab-grown pancreases published last week suggests that the virus might trigger diabetes by damaging the cells that control blood sugar.

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This just goes from bad to worse....