Abstract #976395: Case Series: COVID-19 Infection Causing New-Onset Diabetes Mellitus?

Abstract

976395 Case Series: COVID-19 Infection Causing New-Onset Diabetes Mellitus? Author Block: Narasa Madam, MD Co author, Yuma Regional Medical Center; Rujuta Katkar, MD Presenter, Yuma Regional Medical Center Introduction: There is a bidirectional relationship between COVID19 and diabetes. Not only diabetes is associated with an increased risk of severe COVID-19 but also new-onset diabetes and severe metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity for which exceptionally high doses of insulin are warranted, have been observed in patients with Covid-19. This paper seeks to explore the hypothesis of the S26 potential diabetogenic effect of SARS-COV-2 (Severe Acute respiratory syndrome coronavirus). Case Description:We present a case series of observations among 8 patients of age group ranging from 34 to 74 years with a BMI range of 26.61 to 53.21 Kilogram/square meters that developed newonset diabetes after COVID-19 infection. There was no past medical history of diabetes, pre-diabetes in our patients as evidenced by lab work/Hba1c done prior to hospitalization by their primary care doctors. At admission, they were diagnosed to have COVID-19 based on PCR testing. All patients had severe COVID-19 infection (defined by requiring nasal cannula oxygen therapy of more than 3litres/minute to maintain pulse saturation above 93%), which warranted their admission to the hospital. Initial random blood glucose levels in the basic metabolic panel were elevated, which prompted us to check the Hemoglobin A1C, which ranged between 6.7 to 11.8%. All patients received subcutaneous basal-bolus insulin therapy in the hospital for glucose management. As part of the COVID-19 treatment protocol in our hospital, patients received steroids, empirical antibiotics, and were placed on deep vein thrombosis prophylaxis. A dexamethasone loading dose of 8 milligrams and followed by 6 milligrams daily for a total duration of 10 days was given to the patients. All patients followed with outpatient providers, where they continued to require blood glucoselowering treatment despite stopping getting steroids. Out of them, five patients had fasting detectable C-peptide ranging between 2-3ng/ml (0.80-3.85 ng/mL) with negative GAD(Glutamic acid decarboxylase)-65 antibody levels. Discussion: The 8 patients without a past medical history of diabetes admitted with COVID-19 infection developed new-onset diabetes mellitus due to plausible interaction of SARS-COV-2 with ACE 2 receptors. SARS-COV-2 binds to Angiotensin-converting enzyme-2(ACE-2) receptors located in essential metabolic tissues including the pancreas, adipose tissue, small intestine, and kidneys. The resulting downregulation of ACE-2 and ACE-2 receptor expression caused islet-call damage resulting in diabetes. The resulting observation has the potential to adversely impact a significant number of the globally affected population. Screening patients with COVID-19 for diabetes routinely can help in early detection, significantly reducing morbidity and mortality associated with diabetes. Due to limitations of observational studywith a small sample size will require further investigation in the form of Clinical trial. https://doi.org/10.1016/j.eprac.2021.04.525