Does SARS-CoV2 infection increase hyperglycemia risk? Case series and review: Does SARS-CoV2 infection increase hyperglycemia risk

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has been observed to cause serious complications  and higher mortality in patients with type 2 diabetes mellitus (DM). Conversely, new-onset diabetes and metabolic complications of pre-existing diabetes (including DKA and hyperosmolarity) have also been seen in patients with COVID-19.

Materials and Methods

We report a  series of 7 patients with  mean age of 30.71+/-1.38 years. Our series included 2 female patients. None of our patients had any  underlying known comorbidity. All patients were RT PCR positive for SARS-Cov2.  All patients had lymphopenia at presentation and raised inflammatory markers. All patients received IV steroids (methylprednisolone)  for 5 days and subsequently oral. All patients improved with no major complication except one patient developed hyperglycemia on day 3 of institution of steroids. His Hba1c was suggestive of prediabetic status (6.1%). No other treatment related complication was observed. 

Discussion

Given the capability of COVID-19 to trigger an intense inflammatory response, it has been challenging to disentangle whether hyperglycemia in COVID-19 is a cause or a consequence of severe disease. Some authors have hypothesized a potential diabetogenic effect of COVID-19, in addition to the well-recognized stress-induced hyperglycemia associated with critical illnesses. However, we observed that not all patients had hyperglycemia despite receiving steroids at the same dose and for the same duration.

Conclusion

We postulate that the combination of SARS-CoV2 infection and steroids impairs the glucose metabolism resulting in hyperglycemia only in patients who have underlying risk factors for the same.