Post-COVID diabetes mellitus in cross-sectional study: autoimmune disease with endothelial dysfunction?

Abstract Purpose: To study the characteristics of diabetes occurring after COVID-19. Methods: Hemostasis parameters, vitamin D, and beta cell-specific autoantibodies in 70 patients with post-COVID-19-diagnosed diabetes were tested. 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 majorityof patients with type 1 DM had mild COVID-19 and did not use corticosteroids during acute COVID-19. Patients with not only severe but also mild COVID-19 also had a risk for 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 cases were registered 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 had high levels of D-dimer and von Willebrand factor. Type 1 DM patients – both adults and children – also had increased levels of D-dimer and von Willebrand factor. VCAM-1 levels were high in all patients, including children, with the highest levels 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 the disease and timely insulin treatment. Type 1 DM developed after COVID-19 should be treated as a disease with cardiovascular disease with endothelial dysfunction.