Cross sectional study to explore a causative link between COVID-19 infection and a subsequent prediabetes diagnosis

Abstract

Evidence suggests that SARS‐CoV-2 binds to the ACE2 receptors on pancreatic islets and can impair their insulin tolerance, potentially causing an acute diabetic presentation. However, there has perhaps been less exploration into whether infection with SARS-COV-2 can increase the prevalence of prediabetes as well as diabetes. Compared with type 2 diabetes, prediabetes is highly common, the prevalence is rapidly increasing, and most people are unaware of their high-risk status. Prediabetes is a long-lasting state with impaired glucose tolerance preceding type 2 DM. Concerning the pathophysiology of prediabetes and alterations in the immune system of the affected individuals a similar outcome of COVID-19 in prediabetes would be plausible. To identify whether an infection with COVID19 can be directly linked to the development of prediabetes. The prediabetes register in UK primary care setting was searched to identify relevant cohorts diagnosed before and after 31/01/2020. Data searches were carried out on the pre-diabetes register with positive PCR for ‘SARS-CoV-2’. The event dates of the positive PCR and prediabetes diagnosis were compared. If a positive PCR was recorded prior to a prediabetes diagnosis, the number of days between these events was calculated. 148 out of 254 people on the prediabetes register, were diagnosed on 31/01/20. 23 of these patients had a positive PCR test, 7 had positive PCR prior to their diagnosis. 106 patients were diagnosed before 31/01/20, 13 of these had had a positive PCR test. The rate of diagnosis post-positive PCR was significantly lower than the rate expected. However, our analysis did show that the prevalence of prediabetes during the pandemic was significantly higher than the pre-pandemic rate. The prevalence of prediabetes during the pandemic was significantly higher. However, this does not appear to be directly a result of COVID19 infection. Instead, it could be due to the changes in lifestyle during the lockdowns increasing the risk factors associated with developing prediabetes.