Newly-onset Autoimmune Diabetes Mellitus triggered by Covid 19 infection: A case based review.

ABSTRACT

The devastating global pandemic Coronavirus disease 2019 (Covid 19) which was isolated in China in January 2020 is responsible for outbreak of pneumonia and other multisystemic complications. The clinical picture of the infection has an extreme variability it goes from asymptomatic patients or mild forms with fever, cough, fatigue and loss of smell and taste, to severe cases ending up in the intensive care unit (ICU). This is due to possible cytokine storm that may lead to multi organ failure, septic shock, or thrombosis. Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV -2) which is the virus that causes Covid 19, binds to angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in key metabolic organ and tissues including pancreatic beta cells, adipose tissue, the small intestine and the kidneys. Therefore it is possible to state tht newly-onset diabetes is triggered by Covid 19 infection. Although there have been many hypotheses which clarify the potential diabetogenic effect of Covid 19, only few observations were reported during this pandemic. Two male patients who were admitted to us with devastating hyperglycemia symptoms were diagnosed as type 1/autoimmune diabetes mellitus within 3 months following Covid 19 infection. Autoantibodies and decreased C peptide levels were detected in these patients. We speculated that autoimmune insulitis and pancreatic beta-cell destruction might be triggered by Covid 19 infection through several mechanisms. Our purpose is to raise awareness on the possible link between SARS-CoV-2 and newly onset type 1 diabetes mellitus. Further studies are needed to determine a more definitive link between the two clinical entities.