COVID-19 has brought in a number of additional health issues along with the existing comorbidities in some individuals and recently, researchers have identified another troubling connection- hyperglycaemia. This article briefs on the recently found complication and throws light on how these patients' immunity reacted to medication protocol.

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Beyond the illness, hyperglycaemia lingered

The research looked at the health of 551 individuals who were admitted to a hospital in Italy between March and May 2020. A six-month follow-up period was included following admission to the hospital. Hyperglycaemic individuals also exhibited more clinical problems than those with no indications of glucose abnormalities: more intensive care treatment, longer hospitalisations, poorer clinical symptoms, a greater demand for oxygen and a higher need for ventilation.

“We wanted to figure out why these individuals performed so badly compared to others who didn't have hyperglycaemia,” adds study author Fiorina, who previously published a study demonstrating that COVID-19 made diabetics' glucometabolic control worse. Nature Metabolism recently published the present research.

Hormonal imbalance - A major concern

All patients were given a glucose monitor when they were admitted. The researchers discovered many anomalies in glucose metabolic regulation in hyperglycaemic individuals throughout time. They also discovered that individuals with hyperglycaemia had aberrant hormone levels. They were found to be significantly hyperinsulinaemic, meaning they generated too much insulin. Pro-insulin, an insulin precursor, was also abnormally high, as were indications of altered islet beta cell activity. Insulin is produced and secreted by beta cells in the islets.

In general, the hormonal profile indicated that in COVID-19 individuals, endocrine pancreas function is impaired and that this abnormality remains even after recovery.

Inflammation caused by an overabundance of cytokines

The number of inflammatory cytokines, such as IL-6 and others, was also abnormally high in hyperglycaemic individuals. Researchers hypothesised that inhibiting IL-6, and perhaps other cytokines, would improve beta-cell function, and our hypothesis was confirmed. When compared to those who did not get the drug, those who received anti-IL-6 treatment (tocilizumab) showed a larger improvement in glycaemic control.

Is a surge of diabetic patients on the horizon?

While some individuals' glucometabolic problems improved over time, especially after COVID-19 infection, other issues persisted. In the post-COVID-19 era, many patients exhibited elevated post-prandial (after eating) glucose levels and aberrant pancreatic hormones.

This is the first study to demonstrate that COVID-19 has a direct effect on the pancreas. It suggests that the virus is also targeting the pancreas, possibly impacting not just the acute period of hospitalisation but also the long-term health of these individuals.

Concerning treatment, there are still unanswered questions regarding how to care for patients with COVID-19-related glucose abnormalities. Should patients be treated only with anti-diabetic medications such as insulin sensitisers, or should anti-inflammatory medications such as tocilizumab and other medications be used?

If you continue to target and block insulin while also having a significant and persistent inflammatory response, chronic harm may result. Larger trials are required to evaluate anti-diabetic and anti-inflammatory therapy. When we examine how many people have been hospitalised and continue to be hospitalised globally with COVID-19, we may observe a significant rise in the diabetic population.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.