There is emerging evidence that COVID-19 infection may cause onset diabetes in normally healthy patients.

But it may be more common among people at risk of metabolic disease.

The observation comes from Italy, where doctors have found frequent cases of a severe diabetic complication in COVID-19 patients being admitted to hospitals.

What makes it more concerning is these patients had no history of diabetes.

Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when your blood sugar is too high, for too long, and you have much less insulin than your body needs.

The blood becomes acidic and you become dangerously dehydrated.

The condition tends to be found in people who, as a matter of course, have taken too long to have their Type-2 diabetes diagnosed.

However, an international panel of experts, in a Lancet paper that offers practical recommendations for the management of diabetes in COVID-19, suggest the coronavirus may be damaging the insulin-producing cells in the pancreas.

This is a theory that is yet to formally be confirmed by sufficient testing.

The report noted that “damage to pancreatic β cells (the cells that make insulin) may lead to direct damage to the function of the pancreas”.

“Although this has not been verified in humans, they suggest that diabetes might not only be a risk factor for a severe form of COVID-19 disease, but also that infection could result in causing new onset diabetes,” the review said.

One of the co-authors of the review is Professor Paul Zimmet from Monash University’s Department of Diabetes.

Professor Zimmet said the review proposed implementing testing for diabetes in people with the COVID-19 infection to identify if previously healthy individuals have developed diabetes as a result of contracting the virus.

“We should consider everyone who gets sick with COVID-19 is also tested for diabetes. They should be tested at the time they become ill as it clearly will influence their medical management and health outcome,” he said.

As the authors note, patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure.

They also note that the risk of dying from COVID-19 was up to 50 per cent higher in people with diabetes, particularly elderly type 2 diabetes cases.

Depending on the global region, between 20 to 50 per cent of patients in the COVID-19 pandemic had diabetes.

In Australia, one-third of the 46 people who had died from COVID-19 by April 12 had diabetes, while 20 per cent of the 752 people treated in hospital with the virus had diabetes.

Professor Zimmet said there should also be a warning to health professionals with diabetes who are engaged in care of COVID-19 patients to ensure they have the protection they need to prevent contracting the virus.

In general, people with all forms of diabetes are at increased risk of infection because of defects in innate immunity affecting phagocytosis (the process by which harmful foreign particles, bacteria, and dead or dying cells are cleaned out of the body) and cell-mediated immunity.

The authors suggest the high frequency of diabetes in serious cases of COVID-19 could potentially reflect the higher prevalence of type 2 diabetes in older people.

Furthermore, they write, “diabetes in older age is associated with cardiovascular disease, which in itself could help to explain the association with fatal outcomes of COVID-19”.