How COVID-19 Can Lead to Diabetes
Posted on by Dr. Francis Collins
Along with the pneumonia, blood clots, and other serious health concerns caused by SARS-CoV-2, the COVID-19 virus, some studies have also identified another troubling connection. Some people can develop diabetes after an acute COVID-19 infection.
What’s going on? Two new NIH-supported studies, now available as pre-proofs in the journal Cell Metabolism [1,2], help to answer this important question, confirming that SARS-CoV-2 can target and impair the body’s insulin-producing cells.
Type 1 diabetes occurs when beta cells in the pancreas don’t secrete enough insulin to allow the body to metabolize food optimally after a meal. As a result of this insulin insufficiency, blood glucose levels go up, the hallmark of diabetes.
Earlier lab studies had suggested that SARS-CoV-2 can infect human beta cells . They also showed that this dangerous virus can replicate in these insulin-producing beta cells, to make more copies of itself and spread to other cells .
The latest work builds on these earlier studies to discover more about the connection between COVID-19 and diabetes. The work involved two independent NIH-funded teams, one led by Peter Jackson, Stanford University School of Medicine, Palo Alto, CA, and the other by Shuibing Chen, Weill Cornell Medicine, New York. I’m actually among the co-authors on the study by the Chen team, as some of the studies were conducted in my lab at NIH’s National Human Genome Research Institute, Bethesda, MD.
Both studies confirmed infection of pancreatic beta cells in autopsy samples from people who died of COVID-19. Additional studies by the Jackson team suggest that the coronavirus may preferentially infect the insulin-producing beta cells.
This also makes biological sense. Beta cells and other cell types in the pancreas express the ACE2 receptor protein, the TMPRSS2 enzyme protein, and neuropilin 1 (NRP1), all of which SARS-CoV-2 depends upon to enter and infect human cells. Indeed, the Chen team saw signs of the coronavirus in both insulin-producing beta cells and several other pancreatic cell types in the studies of autopsied pancreatic tissue.
The new findings also show that the coronavirus infection changes the function of islets—the pancreatic tissue that contains beta cells. Both teams report evidence that infection with SARS-CoV-2 leads to reduced production and release of insulin from pancreatic islet tissue. The Jackson team also found that the infection leads directly to the death of some of those all-important beta cells. Encouragingly, they showed this could avoided by blocking NRP1.
In addition to the loss of beta cells, the infection also appears to change the fate of the surviving cells. Chen’s team performed single-cell analysis to get a careful look at changes in the gene activity within pancreatic cells following SARS-CoV-2 infection. These studies showed that beta cells go through a process of transdifferentiation, in which they appeared to get reprogrammed.
In this process, the cells begin producing less insulin and more glucagon, a hormone that encourages glycogen in the liver to be broken down into glucose. They also began producing higher levels of a digestive enzyme called trypsin 1. Importantly, they also showed that this transdifferentiation process could be reversed by a chemical (called trans-ISRIB) known to reduce an important cellular response to stress.
The consequences of this transdifferentiation of beta cells aren’t yet clear, but would be predicted to worsen insulin deficiency and raise blood glucose levels. More study is needed to understand how SARS-CoV-2 reaches the pancreas and what role the immune system might play in the resulting damage. Above all, this work provides yet another reminder of the importance of protecting yourself, your family members, and your community from COVID-19 by getting vaccinated if you haven’t already—and encouraging your loved ones to do the same.
 SARS-CoV-2 infection induces beta cell transdifferentiation. Tang et al. Cell Metab 2021 May 19;S1550-4131(21)00232-1.
 SARS-CoV-2 infects human pancreatic beta cells and elicits beta cell impairment. Wu et al. Cell Metab. 2021 May 18;S1550-4131(21)00230-8.
 A human pluripotent stem cell-based platform to study SARS-CoV-2 tropism and model virus infection in human cells and organoids. Yang L, Han Y, Nilsson-Payant BE, Evans T, Schwartz RE, Chen S, et al. Cell Stem Cell. 2020 Jul 2;27(1):125-136.e7.
 SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Müller JA, Groß R, Conzelmann C, Münch J, Heller S, Kleger A, et al. Nat Metab. 2021 Feb;3(2):149-165.
COVID-19 Research (NIH)
Type 1 Diabetes (National Institute of Diabetes, Digestive and Kidney Disorders/NIH)
Jackson Lab (Stanford Medicine, Palo Alto, CA)
Shuibing Chen Laboratory (Weill Cornell Medicine, New York City)
NIH Support: National Institute of Diabetes and Digestive and Kidney Diseases; National Human Genome Research Institute; National Institute of General Medical Sciences; National Cancer Institute; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development
Very interesting work – thank you for sharing it Dr. Collins – it raises the applicability of another NIH-NICHD sponsored project-that of RNA Replicase inhibition by Tempol. https://www.nih.gov/news-events/news-releases/nih-researchers-identify-potential-new-antiviral-drug-covid-19 The wider the scope of SARSCoV2 infection, the greater the need for broad spectrum therapeutics. In my view the inhibition of replicase is as broad as they come. What do you think?
this vaccines HAS NOT been tested long enough to know whats going to happen in the long run … i will not get one.
It is the disease Covid-19, not the vaccination, that is associated with these after effects! Get the vaccination to PREVENT COVID-19 and these potential sequalae!
Vaccines hasn’t been linked to these effects yet because they haven’t been studied long enough. You cannot yet discard RNA-based vaccines will not produce the same effect if the mRNA expresses off target in pancreas.
Is there any evidence that an asymptomatic COVID-19 infection can lead to type 1 diabetes?
Would it be temporary or permanent??
I got diabetes type 1 after Covid-19
same here. No family history whatsoever then i thought i had a cold and couple months later type 1 diagnosis.
Any update? My son just got diagnosed with T2 out of nowhere. No family history, Very little insulin currently needed.
I too want to know whether diabetes type 1 after covid 19 is temporary or permanent and what type of measure could be adopted.
Yes, this is what happened with my 10th grade daughter. Diagnosed with Covid 9/11/2020, and with Type 1 Diabetes on 12/7/2020. Children’s Healthcare of Atlanta staff mentioned many times a >300% increase in new T1D diagnoses that fall. Children weren’t typically as severely symptomatic, perhaps not as well documented, but they were rather sure Covid was the cause. My daughter’s symptoms were not severe – only a low-grade fever, mostly headache and sore throat, fatigue. I don’t even think she coughed much. 3 months later, craving sweets, increasingly thirsty, having to use the restroom every hour or so, lost 15 lbs., using shoelaces in her belt loops to hold her jeans up. I’m glad I knew about these signs, and that her school nurse knew what to do.
Quite similar happened to my 9 year child. Got mild covid fever in April 2021, and got diagnosed with T1D couple of weeks back, with similar story Cheryl. We do not have any family history. We don’t know a single child in our circle with this condition.
Is it temporary, reversible? Are there other side effects?
So sorry to hear about your daughter. I myself have had T1D since 1977, back then it was chickenpox that triggered the immune response that caused the condition to happen. My daughter, 13 is in the TEDDY study because she is more likely to have the same thing happen to her. I imagine the same thing is happening just with COVID now.
Did your daughter have the TEDDY test done after birth? Was your daughter vaccinated?
Will be praying for your daughter’s continued health and management of T1D.
For more than a year, the whole planet is suffering from the corona pandemic. It caused a lot of panic, fear, and anxiety.
People started to worry more about themselves, their families, and their beloved ones, which led them to take some more protective actions.
A lot of our daily routine has changed; staying home is all we can do now. And if we have to go out a lot of precautions must be taken. i hope to be safe soon
I’m looking at T2D after Covid . Nothing I do seems to help except medication, and I’d rather not unless absolutely necessary. I’m hoping it is reversible.
Any update? My son just got diagnosed with T2 out of nowhere. No family history, Very little insulin currently needed.
I’m still working through it. I have found that going off all grains and sugar excluding fruit has helped. I have to exercise more. My numbers were better when I was exercising. When it as too cold to exercise outdoors, my numbers went up. Then I got really fatigued. I’m fighting the excessive fatigue now and the elevated sugars. Originally, they were around 6.4. Then I got them down to 5.4 which was great. Then Easter came, and I cheated, and they went back up to 5.7. I’m not using any Rx for it because I have weird side effects. I focus mostly on all natural supplements, diet, and exercise.
Very interesting work – thank you for sharing it Dr. Collins . . .
Thank you for your work, Dr. Collins. I also have no family history or typical conditions related to developing diabetes but since a break-through Covid-19 infection in July ’21, my labs a month post-infection, are throwing flags. My glucose is high and my A1C is pre-diabetic. I am concerned that over the next few months instead of resolving it may cross to diabetes. My TSH dropped into hyperthyroid range, too. It came back into low normal range (barely) but I am having symptoms common for both thyroid and diabetes. My father had Giant Cell Arteritis and I am worried there could be vascular problems associated with Covid-19, as well. GCA is not typically inherited but can be. Are there data yet that after infection the conditions resolve or is this like Lyme disease, the spirochetes hide, become dormant and change form while under attack by the immune system or treatment? So much of Covid reminds me of what I’ve been through with Lyme and I wonder if the “die-off” of Covid can be toxic and cause problems, too. Does it remain in the synovial fluid etc… Does “long-haul” Covid have the same characteristics as Chronic Lyme? What does it mean if you have both? My best friend had a Covid infection early in 2020. He was recently diagnosed with Corticobasal Degeneration, at first they diagnosed Parkinson’s. He is slowly becoming disabled and life expectancy is only 6-8 years from onset. He is only 57 and was previously very healthy. Does Covid cross the blood-brain barrier and cause nerve cell death? My heart is broken and I’m terrified about what is happening to him. Is it possible that he is being misdiagnosed? There is no data about the effects of Covid-19 and brain degeneration. Could the viral therapeutics coming online help slow or stop the degeneration? He is open to any clinical trials or treatments to stay alive. Any advice or help with any of these questions about my friend or myself would be beyond appreciated. Take Care, Stay safe and do not get Covid!
Same here, no family history and been diagnosed with type 1 after covid infection. There needs to be something done and raise awareness for more research and guidance to how to manage.
Thank you very much for sharing this extremely valuable information . . .
I’m curious about the impact of COVID in patients who take ACE inhibitors. My husband developed type 2 diabetes a few years after taking the blood pressure medication and has been on metformin ever since. He has since changed blood pressure medication, but since receiving the vaccine, he has had issues with his sugar and neuropathy.
Has anyone else noticed that the common factor in ALL serious COVID cases involves people with mild hypothermia. Seniors with low metabolisms and very low body temperatures are at the top of the list but if you study the “underlying conditions” like Diabetes, Obesity, Dementia, Alzheimer’s, Schizophrenia, Asthma, Stroke, Heart and Kidney Diseases, Cancer and many more, they ALL present with what is called Body Temperature Decreased or mild hypothermia. Even certain drugs like Ibuprofen can decrease body temperatures into the hypothermic range below 36°C. Chinese Researchers theorized (2003) the SARS-CoV1 virus had a maximum replication temperature of 36°C and if that is true, COVID Pneumonia would only occur in lungs below 36°C, Long COVID would only occur outside the respiratory tract in organs below 36°C ie. stomach, pancreas, head, AND in EXTREMITIES like fingers and toes. Could cold stomach contents be lowering the temperature of the pancreas enough to allow virus replication and damage enough to cause diabetes? I know the concept is way out there but everything seems to fit a temperature link between low body temperature and serious COVID outcomes.
I would like to know if there are any studies about the biodistribution of the Modena and Pfizer-BioNTech mRNAs in human tissues.
Nice article author. Thank you. Keep it up.
Insulin insufficiency isn’t type 1 diabetes it is Type 2. Type 1 diabetes is when insulin producing cells are DESTROYED – NO insulin is produced. NO insulin isn’t the same as not enough insulin. It’s treated differently.
I got covid19 in Jan 2021. I received a BAM infusion. In June 2021 I was hospitalized. I was diagnosed with pulmonary embolism in both lungs and diabetes type 2. Dr said both were caused by covid19. One year later, I’m still struggling to feel better.
Is there a case study being done?
I am struck by your sentences: [The Jackson team also found that the infection leads directly to the death of some of those all-important beta cells. Encouragingly, they showed this could avoided by blocking NRP1.] Is anyone following up by changing covid treatment protocols to do this?
Anyone diagnosed with T1D have any updates on whether it has been permanent or not?
Mine is permanent, diagnosed after reaction from the second Covid shot! Type 1.
Nice blog author. Thank you. Keep it up.