Type 1 diabetes onset triggered by COVID-19

Abstract

<jats:title>Abstract</jats:title> <jats:p>The epidemic of coronavirus disease-2019 (COVID-19) is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus. Some data describing characteristics and prognosis of patients with COVID-19 and diabetes are now available, for example for hospitalized patients in the CORONADO study. Potential links between diabetes and COVID-19 infection were already described. Indeed Angiotensin-converting-enzyme 2 (ACE2) has been identified as the receptor for the coronavirus spike protein, and ACE is expressed on pancreatic beta cells. It was suggested that SARS-CoV2 could induce beta cell damage and new onset diabetes, but the phenotype of these new cases of diabetes has not been described.This observation presented in that paper highlights the fact that COVID-19 infection may also trigger type 1 diabetes onset. Viral infection, in particular by enteroviruses but also by coronaviruses, is a well-known environmental trigger for the development of type 1 diabetes. In the case presented herein, there was a short delay between COVID-19 infection and diabetes onset. It remains to determine if the hyperinflammation/cytokine storm described with this infection could accelerate the onset of type 1 diabetes in genetically susceptible individuals.The relationship between SARS-CoV2 exposition and autoimmune diabetes development must be further studied, and incidence of type 1 diabetes will be carefully observed in the next months.</jats:p>

ACE2 and SARS-CoV-2 Expression in the Normal and COVID-19 Pancreas

“…Autopsy studies of pancreas have been limited, likely due to challenges related to its post-mortem autolysis and presumed limited clinical significance for COVID-19. However, recent studies (Barron et al, 2020;Fignani et al, 2020;Goldman et al, 2020;Holman et al, 2020;Li et al, 2020;Marchand et al, 2020;Unsworth et al, 2020;Wang et al, 2020) spurred interest in ACE2 expression in the pancreas, particularly the endocrine compartment, to address a potential relationship between diabetes and COVID-19. SARS-CoV-2 entry into cells via ACE2 can be facilitated by the mucosal serine proteases, TMPRSS2 and TMPRSS4 (Lee et al, 2020b;Zang et al, 2020).…”

“…Indeed, recent reports have raised the question of whether SARS-CoV-2 might infect the pancreas and possibly potentiate or exacerbate diabetes in either of its predominant forms, type 1 or type 2 diabetes (i.e., T1D or T2D, respectively). These studies noted elevated serum levels of the exocrine pancreatic enzymes, amylase and lipase, as well as development or worsening of hyperglycemia in SARS-CoV-2 positive individuals (Wang et al, 2020), high prevalence of diabetic ketoacidosis in hospitalized COVID-19 patients (Goldman et al, 2020;Li et al, 2020), increased COVID-19 mortality in patients with T1D and T2D (Barron et al, 2020;Holman et al, 2020), increased incidence of new-onset T1D in specific geographic clusters (Unsworth et al, 2020), case reports linking the timing of T1D onset to COVID-19 (Marchand et al, 2020), and pancreatic expression of angiotensin-converting enzyme-2 (ACE2), through which SARS-CoV-2 gains access to cells (Chen and Hao, 2020), potentially including in insulin-producing β -cells (Lee et al, 2020b;Yang et al, 2020). These reports have collectively led to the hypothesis that SARS-CoV-2 expression in β -cells may potentiate or exacerbate T1D or T2D.…”

Macrophages in diabetes mellitus (DM) and COVID-19: do they trigger DM?

“…The possibility that COVID-19 may elicit DM in susceptible patients has been evoked recently (Rubino et al 2020;Caruso et al 2020). It seems to be confirmed by recent case reports (Marchand et al 2020). Such a hypothesis has been already proposed following the SARS epidemic in 2002 (Yang et al 2010).…”

Immune Response to COVID-19

“…In a case report, a 29 years old patient, non-DM with a normal glucose level was diagnosed with COVID-19. Two weeks after recovered from COVID-19 was diagnosed with DM1 [106].…”