SARS-CoV-2 induced exacerbation of HbA1c in Type 2 Diabetics

Background: The Covid-19 pandemic started when severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was discovered in Wuhan, China. Although the majority of those infected suffer mild symptoms and recover, it is estimated that about 20% of infected patients can develop pneumonia, and some of these patients can develop acute respiratory distress syndrome (ARDS). Diabetes mellitus is a complex disease that affects millions of people worldwide. When it comes to type 2 diabetes mellitus the CDC reports that about 11.3% of the United States population is affected by diabetes. Case Presentation: A 56-year-old Hispanic male presented to the clinic for his routine 6-month diabetes follow-up. He had a medical history of type 2 diabetes mellitus, morbid obesity, benign hypertension, BPH without urinary obstruction, and unspecified hyperlipidemia. For his diabetes, the patient took 500 mg metformin, 4 mg glimepiride, and 2 mg/dose semaglutide. The patient had been compliant with his medication. His only relevant family history included his mother with a diagnosis of diabetes mellitus. The patient denied constitutional, cardiovascular, respiratory, and neurological ROS questions. There was no change in the patient’s medical history except that he had contracted SARS-CoV-2 three months before the visit. The patient described his symptoms, and his infection was classified as a mild version of the disease. The patient’s vitals were within normal limits, and he had a BMI of 37.3. His general, cardio, respiratory, and skin PE findings were all normal as well. HbA1c was recorded at 10.2% and his estimated average blood glucose was 242 mg/dl. Both values had increased from 7.1% and 157 mg/dl respectively since his previous visit on July 22, 2022. At this current visit, his (nonfasting) glucose was 324 mg/dl. The patient’s semaglutide was stopped and replaced with tirzepatide in hopes of reducing his HbA1c along with helping him lose weight. Unfortunately, the patient could not tolerate a higher dose of metformin. Discussion: The question remains whether this patient’s sudden increase in HbA1c of 3.1% from 7.1% to 10.2% could be attributed to the patient’s mild infection of COVID-19. A study published by Joshi & Pozzilli in 2022 in the Diabetes Research and Clinical Practice journal found that SARS-CoV-2 can dysregulate glucose homeostasis even in patients with no previous risk factors for diabetes mellitus. One report that studied the relationship between these two variables found that there was an association between severe COVID-19 and increased blood glucose. They also found that HbA1c was slightly elevated in those with severe COVID-19 compared to mild COVID-19 however, this finding did not reach significance. Physicians taking care of type 2 diabetic patients can caution their patients on the possibility of being infected with COVID-19 and worsening their A1c levels. For those patients battling a severe form of COVID-19, their A1c levels could also be measured after the infection to rule out COVID-19-induced diabetes mellitus. This case report also expands the list of long-term complications from COVID-19.