Marked hyperglycemia and ketosis in a non-obese patient with new onset diabetes and very mild COVID-19 symptoms: A case report

Ghosh, Amerta; Misra, Anoop

doi:10.1016/j.dsx.2020.12.036

Cited by 10 publications

(12 citation statements)

References 9 publications

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“…In fact, the type of new-onset diabetes in the course of COVID-19 has usually been determined based on parameters such as patient age, absence or presence of risk factors for T2D such as obesity, prediabetes, family history, etc. Autoantibodies were not always examined despite the presence of DKA [11,12,[14][15][16]. GAD-65, islet cell, and insulin antibodies, on the other hand, were all negative in certain patients with COVID-19 presenting with DKA [13,17].…”

Section: Discussionmentioning

confidence: 99%

Emergence of Autoimmune Type 1 Diabetes and Acute Adrenal Crisis Following COVID-19

Oğuz

Gürlek

2021

Preprint

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Objective: Several case reports have indicated a possible link between Coronavirus Disease 2019 (COVID-19) and new-onset autoimmune disorders while co-precipitation of autoimmune type 1 diabetes and Addison’s disease has never been reported to date. Case Description: A 60-year-old male presented with extreme fatigue and weight loss three weeks after testing positive for COVID-19. The course of COVID-19 was mild, without pulmonary involvement. The patient showed symptoms and laboratory signs of new-onset diabetes without ketoacidosis and acute primary adrenal insufficiency, latter of which was confirmed with an ACTH stimulation test. GAD-65 antibody and antibodies to the adrenal cortex were positive in high titers, and the patient also had primary hypothyroidism associated with autoimmune thyroiditis. Previous medical records of the patient revealed no hyperglycemia or electrolyte abnormalities prior to current admission, but an earlier test result compatible with primary hypothyroidism. The patient was diagnosed with autoimmune polyglandular syndrome type II (APS II). Clinical and laboratory findings improved after starting appropriate hormone replacement therapies along with insulin. Conclusions: Evidence mostly obtained from case reports suggests that COVID-19 may induce a variety of autoimmune disorders in susceptible subjects. In our case, COVID-19 might have simply precipitated T1D and adrenal crisis in whom autoimmune thyroiditis may have been the first manifestation of an undiagnosed APS II. Or, COVID-19 may have triggered autoimmunity in the patient who was possibly predisposed to autoimmune disorders, and led to the development of APS II. Anyhow, more research is required to evaluate the possible link between COVID-19 and autoimmune disorders.

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Section: Discussionmentioning

confidence: 99%

Emergence of Autoimmune Type 1 Diabetes and Acute Adrenal Crisis Following COVID-19

Oğuz

Gürlek

2021

Preprint

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“…Ghosh et al presented a similar case about a 41-year-old non-obese man [48] . Auto-antibody testing was not reported in both studies [48] .…”

Section: Introductionmentioning

confidence: 90%

“…The patient had a BMI of 22.6 kg/m 2 and had no evidence of insulin resistance [49]. Ghosh et al presented a similar case about a 41-year-old non-obese man [48]. Autoantibody testing was not reported in both studies [48].…”

Section: A Spectrum Of Covid-induced Diabetesmentioning

confidence: 98%

“…Furthermore, some case reports have presented lean COVID-19 patients with normal HbA1c results presenting with signs of insulin resistance [48,49]. Chee et al published a case of a 37-year-old COVID-19 positive male who presented in DKA [49].…”

Section: A Spectrum Of Covid-induced Diabetesmentioning

confidence: 99%

“…Follow-up at 14 months: not insulin dependent anymore. Case 1BMI: 28.6 kg/m 2 HbA1c: 9.6%No C-peptide reportedAnti-GAD antibody negativeCase 2BMI: 26.2 kg/m 2 HbA1c: 12.6%No C-peptide reportedAnti-GAD antibody negativeCase 3BMI: 27.3 kg/m 2 HbA1c: 12%No C-peptide reportedAnti-GAD antibody negative Hollstein et al [46] 19-year-old male with auto-antibody negative insulin-dependent diabetes Authors suggest type 1B diabetes mellitus subtype BMI not reportedHbA1c: 16.8%C-peptide level: 0.62 µg/LAnti-GAD antibody negative Tyrosine phosphatase IA2 and zinc transporter 8 antibodies negative Chee et al [49] 37-year-old male presenting in DKA with no sign of insulin resistance BMI: 22.6 kg/m 2 HbA1c: 14.2% No C-peptide reportedNo antibody tests reported Ghosh et al [48] 41-year-old male presenting with marked hyperglycaemia and 6kg weight loss over 1 month BMI: 21.3 kg/m 2 HbA1c: 14.9%C-peptide: 1.44 ng/mL No antibody tests reported Alizadeh et al [51] 16-month-old infant presenting in DKA and new-onset type 1 diabetes HbA1c: 9.5%Positive anti-GAD, zinc transporter 8, and islet antigen 2 antibodies Soliman et al [50] 8-month-old infant presenting in DKA and new-onset type 1 diabetes HbA1c: 8.5%Positive anti-GAD antibodies …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

COVID-19 induced Diabetes: A novel presentation

Joshi

Pozzilli

2022

Diabetes Research and Clinical Practice

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New-Onset Diabetes Mellitus in COVID-19: A Scoping Review

Pantea Stoian,

Bica,

Salmen

et al. 2023

Diabetes Ther

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Introduction The coronavirus disease 2019 (COVID-19) pandemic became superimposed on the pre-existing obesity and diabetes mellitus (DM) pandemics. Since COVID-19 infection alters the metabolic equilibrium, it may induce pathophysiologic mechanisms that potentiate new-onset DM, and we evaluated this issue. Method A systematic review of the literature published from the 1 January 2020 until the 20 July 2023 was performed (PROSPERO registration number CRD42022341638). We included only full-text articles of both human clinical and randomized controlled trials published in English and enrolling adults (age > 18 years old) with ongoing or preceding COVID-19 in whom hyperglycemia was detected. The search was based on the following criteria: “(new-onset diabetes mellitus OR new-onset DM) AND (COVID-19) AND adults”. Results Articles on MEDLINE ( n = 70) and the Web of Science database ( n = 16) were included and analyzed by two researchers who selected 20 relevant articles. We found evidence of a bidirectional relationship between COVID-19 and DM. Conclusions This link operates as a pathophysiological mechanism supported by epidemiological data and also by the clinical and biological findings obtained from the affected individuals. The COVID-19 pandemic raised the incidence of DM through different pathophysiological and psychosocial factors.

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Marked hyperglycemia and ketosis in a non-obese patient with new onset diabetes and very mild COVID-19 symptoms: A case report

Cited by 10 publications

References 9 publications

Emergence of Autoimmune Type 1 Diabetes and Acute Adrenal Crisis Following COVID-19

Emergence of Autoimmune Type 1 Diabetes and Acute Adrenal Crisis Following COVID-19

COVID-19 induced Diabetes: A novel presentation

New-Onset Diabetes Mellitus in COVID-19: A Scoping Review

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