POST-COVID-19 DIABETES MELLITUS IN A CROSS-SECTIONAL STUDY: AUTOIMMUNE DISEASE WITH ENDOTHELIAL DYSFUNCTION?
Keywords:
post-COVID-19, endothelial dysfunction, ICAM-1, VCAM-1, diabetes-specific antibodiesAbstract
Purpose: To study the characteristics of diabetes occurring after contracting COVID-19. Methods: Hemostasis parameters, vitamin D levels, and beta cell-specific autoantibodies were tested in 70 patients with post-COVID-19-diagnosed diabetes. Results: In our cross-sectional study, we found a relatively high incidence of type 1 DM (16.7%) and LADA (4.76%) among adults who were diagnosed with DM after COVID-19. Adult patients with type 1 DM were younger, predominantly female, and had a high rate of family history of DM. The majority of patients with type 1 DM had mild COVID-19 and did not use corticosteroids during acute COVID-19. Patients with severe or mild COVID-19 also had a risk of diabetes onset. All patients with newly diagnosed DM had low vitamin D levels, although Uzbekistan has good insolation. New cases of DM were registered within 0 to 24 months after COVID-19. The majority of type 1 patients were diagnosed during the first 2 months and at 15-20 months after acute COVID-19. The incidence of new type 2 DM cases was consistent during the 2-year period after COVID-19. As expected, patients with type 2 HELLP syndrome had high D-dimer and von Willebrand factor levels. Type 1 DM patients, both adults and children, also had increased D-dimer and von Willebrand factor levels. VCAM-1 levels were high in all patients, including children, with the highest levels occurring in patients with LADA, indicating endothelial dysfunction. Conclusion. The increased incidence of type 1 DM with positive diabetes-specific antibodies after COVID-19 indicates damage to islet cells and their components by SARS-CoV-2 with further activation of autoimmune mechanisms. Young females with a family history of DM who were diagnosed with diabetes after COVID-19 should be tested for diabetes-specific antibodies for proper differentiation of the type of disease and timely insulin treatment. Type 1 DM that develops after COVID-19 should be treated as a disease associated with CVD and endothelial dysfunction.
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