Endocrine Abstracts

Introduction: The COVID pandemic was a challenge in terms of physiopathology and therapeutics. Diabetics represent more than 40% of patients hospitalized for COVID. There was many new cases of diabetes declared during or after a COVID. The purpose of this report is to raise the link between Sars-Cov-2 infection and the appearance of glycemic disorders and new cases of diabetes.

Case Presentation 1: A 28-years-old man who had a serious COVID-19 a month ago, treated in intensive care with corticosteroid therapy. He had no diabetic family history. His BMI was in the normal range. He presented classic type 1 diabetes symptoms with ketoacidosis. His glycated hemoglobin was at 8.8%. His serum anti-GAD and anti IA2 antibodies were negative. He received insulin therapy.

Case Presentation 2: A 34-year-old overweight woman who had a mild Sars-cov-2 infection treated at home; she has an obvious autoimmunity history. No diabetic family history. She presented few months later severe symptoms of hyperglycemia and ketosis, her glycated hemoglobin was at 12.9%. She had negative antibodies. She was on insulin.

Discussion: The relationship between diabetes and COVID-19 is bidirectional. Diabetes exposes to a higher risk of severe COVID and more mortality. Furthermore, COVID exposes to more metabolic complications and possible diabetes new cases. This issue have been raised after an increase in new cases of diabetes after the pandemic stated in multiple studies. Several cases of post COVID diabetes with negative antibodies have been reported in the literature. Most of them were patients between 26 and 50 years-old, who all had a type 1 diabetes clinical presentation with a post-COVID delay ranging from one week to 3 months. They all had negative antibodies. Some of the cases reported were no longer on insulin, which the authors attributed to a possible transient pancreatic dysfunction. The mechanisms of the pancreatic dysfunction suggested were: A direct effect of the virus on the pancreatic beta-cell; the triggering of the immune reaction leading to type 1 diabetes; the systemic inflammatory response or the cytokine storm; the effect of prescribed corticosteroid therapy and the effect of the lock-down independently of the viral infection itself. A study confirmed the presence of Sars-cov-2 in beta cells of patients who died of COVID.

Conclusion: Current data have confirmed the hyperglycemic power of Sars-cov-2 virus, through a complex and multifactorial mechanism, but do not confirm its direct role in the appearance of a new diabetes type.