Autoantibody-negative insulin-dependent Diabetes after COVID-19

Abstract

<jats:title>Abstract</jats:title> <jats:p>Here we report the manifestation of insulin dependent diabetes after a COVID-19 infection in the absence of typical autoantibodies for type 1 diabetes. A 19-year-old Caucasian male subject presented to our emergency department with diabetic ketoacidosis (DKA). C-peptide levels accounted to 0.62µg/L in the presence of blood glucose concentrations of 30.6 mmol/L (552 mg/dL). The patient´s case history revealed a COVID-19 disease 6-8 weeks prior to admission. This is of interest, since COVID-19 internalization into host cells is mediated via Angiotensin-converting enzyme 2 (ACE2) <jats:sup>[1]</jats:sup>, a transmembrane glycoprotein which amongst others is crucial for β-cell homeostasis and function <jats:sup>[2,3,4]</jats:sup>. Detailed laboratory testing was performed, revealing no serum-antibodies against islet-cells (ICA), glutamic acid decarboxylase (GAD65-AA), tyrosine phosphatase (IA-2-AA), insulin (IAA) and zinc-transport-8 (ZnT8-AA), but against COVID-19. Hence, this is a presentation of an insulin-dependent diabetes mellitus in the absence of markers of autoimmunity, which might suggest direct cytolytic effects of COVID-19 on pancreatic β-cells presumably mediated via ACE2.</jats:p>

COVID-19-Related Complications

“…A case report on a 19-year old male from Germany who presented with DKA and insulin-dependent DM five to seven weeks after asymptomatic COVID-19 infection indicated that he did not have the typical autoantibodies associated with DM 1 [33]. This raises the question as to the pathogenesis of DM 1 in this patient.…”

“…This raises the question as to the pathogenesis of DM 1 in this patient. The authors suggest that since the beta pancreatic cells express the ACE2 receptors which the SARS-COV2 binds to, the direct destruction of the beta pancreatic cells by the virus leads to the lack of the diabetic auto bodies typically seen in DM 1 [33]. Patients with COVID-19 who present with DKA require higher doses of insulin to achieve better control [34].…”