COVID-19 & the need for follow-up vigilance on new-onset Non-Communicable Diseases

COVID19 is teaching us one more new lesson – to look for new-onset diabetes and other non-communicable diseases in COVID19 patients by post-COVID19 vigilance.

Diabetes is among the most frequently reported comorbidities in patients infected with COVID-19 and, diabetes is a strong risk factor for developing severe, critical and fatal forms of COVID-19. Understanding the pathophysiological mechanisms underlying the impact of diabetes on COVID-19 progression is now critically subjected to several current investigations so as to maximize the therapeutic outcomes. “On the other hand, there is a new school of thought that COVOD-19 infection and its devastating ravage on multiple organs could be causally linked to new-onset diabetes and perhaps other non-communicable diseases (NCDs) too” - says Dr.M.Balasubramanyam, Disease-Biologist, Dean of Research & Senior Scientist from the Madras Diabetes Research Foundation (MDRF), Chennai, India.

In one of his articles recently published in the journal, Exploratory Research and Hypothesis in Medicine1, he comments that ‘Does COVID-19 Warn Us to Revisit Virus-Induced Diabetes?’. As reviewed in this article by Balasubramanyam based on the original hypothesis by Rubino et al2, it seems that there could be a potential diabetogenic effect of COVID19 – as it affects multiple organs including pancreas. Good news is that brain-stormed by an international group of leading diabetes researchers, a global registry of patients with COVID-19–related diabetes called “CoviDIAB’ for follow-up studies is being under establishment3. This registry is specifically designed to establish the extent and characteristics of new-onset, COVID-19-related diabetes, and to investigate its pathogenesis, management and outcomes. 

With great vision and future directions, such studies are expected to answer the following questions: a) Whether the alterations of glucose metabolism that occur with a sudden onset in severe Covid-19 are persistent or transient? b) Will it remit when the infection resolves? c) How frequent is the phenomenon of new-onset diabetes, and is it a classical type 1 diabetes (T1D) or type 2 diabetes (T2D) or a sub-stratified new type of diabetes? and d) Do these patients remain at higher risk for diabetic ketoacidosis and other complications? Balasubramanyam also proposes a few more interesting questions: a) If hyperglycemia in Covid19 patients is transient, will it pose a potential risk for later T2D development in a subset of patients, like the phenomenon very well established in gestational diabetes mellitus? b) Will Covid19 infection exploit individuals with prediabetes for early development of T2D?  and c) As COVID19 also affects those youth with early onset T2D (more so common in developing countries like India), will it accelerate early diabetic complications in them? “Answers to these questions need frequent monitoring and follow-up in COVID patients subsequent to their recovery for months/years” – says Balasubramanyam.

Diabetogenic effects of COVID-19 is totally a new school of thought originating from the in-depth observations on COVID-19 patients from December 2019 to till date. “As more and more studies are coming up, there is an increasing attention in studying the bidirectional relationship between COVID-19 and diabetes, and indeed, COVID-19 patients should be monitored for new-onset NCDs as a whole” – says Balasubramanyam.

Frightening flash news. Apart from causing respiratory pathology, it seems COVID-19 can also infiltrate and result in several extrapulmonary manifestations4 that include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. “It is important that global health organizations, clinicians and scientists should recognize, monitor and investigate the wide spectrum of manifestations in COVID19 patients so as to develop research priorities and therapeutic strategies for all organ systems involved as they are all linked to etiological origin and worsening of NCDs as well as poor mental health” – concludes Balasubramanyam.

Dr.M.Balasubramanyam, PhD., FAMS., MNASc., FAPASc., FASCh
Dean of Research Studies & Senior Scientist
Madras Diabetes Research Foundation (MDRF)
(ICMR- Centre for Advanced Research on Diabetes)
4, Conran Smith Road, Gopalapuram
Chennai - 600086, India
Email: [email protected]

Published: 29 Jul 2020

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1. Balasubramanyam M. Does COVID-19 Warn Us to Revisit Virus-Induced Diabetes? Exploratory Research and Hypothesis in Medicine 2020; doi: 10.14218/ERHM.2020.00046.

2. Rubino F, Amiel SA, Zimmet P, Alberti G, Bornstein S, Eckel RH et al. New-Onset Diabetes in Covid-19. N Engl J Med. 2020; doi: 10.1056/NEJMc2018688

3. CoviDIAB registry - (

4. Gupta A, Madhavan MV, Sehgal K, Nair, N, Mahajan S, Sehrawat TS et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020;