From The Lancet, October 2020:
As the global COVID-19 pandemic continues to evolve, it has also become clear that the interplay between COVID-19 and diabetes entails a complex pathophysiology. Not only are COVID-19 outcomes more severe in people with diabetes and metabolic dysfunction, but recent data also suggest that COVID-19 could precipitate acute metabolic complications of diabetes, such as diabetic ketoacidosis and hyperglycaemia. The mechanisms underlying these links remain unclear, but are likely to involve the angiotensin converting enzyme 2 (ACE2) receptor, a binding site for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is expressed in key metabolic organs, such as the pancreas, and in β cells in particular. Potentially, the SARS-CoV-2 tropism for β cells could lead to cell damage and an impairment in insulin secretion, triggering hyperglycaemia and ketoacidosis.
It has also been postulated that SARS-CoV-2 exposure can precipitate type 1 diabetes onset. Data collected between March and June, 2020, from five paediatric inpatient units from four National Health Service Trusts in London, UK, indicate an increase in the number of new type 1 diabetes cases in children compared with a typical year, although causality cannot be established at this stage. Important information is likely to emerge from much larger and comprehensive datasets. To this end, in June, 2020, an international group of diabetes experts announced the launch of CoviDIAB, a global registry of COVID-19-related diabetes. This registry aims to investigate the extent and pathogenesis of new-onset diabetes and metabolic dysfunction in pre-existing patients with diabetes to help uncover novel mechanisms of disease and define the best interventions.
www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30315-6/fulltext