Two Cases of Insulinopenic Diabetes After SARS-CoV-2 Infection

What is it about?

Two cases of insulinopenic diabetes are reported after SARS-CoV-2 infection, where both patients were of Caucasian origin, physically fit, and had no other medical conditions. The first patient had a positive SARS-CoV-2 IgG antibody test and required cumulative daily insulin dose of 50-70 units to achieve sufficient blood glucose control. After 4 weeks, the patient stopped taking basal insulin and injected rapid-acting insulin only occasionally. The second patient had a history of COVID-19 in March 2020 and was diagnosed with fasting glucose levels in May 2020. The patient had ongoing fatigue and laboratory testing revealed a fasting glucose of 116 mg/dL and an A1C of 6.1% (43 mmol/mol). The patient had autoantibodies against GAD65 (GAD65-Ab), tyrosine phosphatase (IA-2-Ab), zinc transporter 8 (ZnT8-Ab), and insulin (IA-Ab) were absent. Both patients had insulin requirement reduced and eventually stopped using insulin, with improved glycemic control. The underlying mechanism and susceptibility factors remain elusive, and long-term follow-up of these cases will provide more insight into the phenotype and the potential of remission.

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Why is it important?

The research is important because it reports two cases of insulinopenic diabetes after SARS-CoV-2 infection, suggesting a possible link between the virus and diabetes. This highlights the need for clinicians to be aware of a possible deterioration in blood glucose control after COVID-19. Key Takeaways: 1. SARS-CoV-2 infection may work to deteriorate glycemic control in patients with diabetes or cause increased glucose values in patients without known diabetes. 2. COVID-19 may precede the manifestation of insulinopenic diabetes. 3. The underlying mechanism and susceptibility factors remain elusive, and long-term follow-up of cases with autoantibody-negative insulinopenic diabetes associated with SARS-CoV-2 will provide more insight into the phenotype and the potential of remission.