COVID-19 as a trigger for type 1 diabetes
Abstract
Type 1 diabetes (T1D) is usually caused by immune-mediated destruction of islet β cells, and genetic and environmental factors are thought to trigger autoimmunity. Convincing evidence indicates that viruses are associated with T1D development and progression. During the COVID-19 pandemic, cases of hyperglycemia, diabetic ketoacidosis, and new diabetes increased, suggesting that SARS-CoV-2 may be a trigger for or unmask T1D. Possible mechanisms of β-cell damage include virus-triggered cell death, immune-mediated loss of pancreatic β cells, and damage to β cells because of infection of surrounding cells. This article examines the potential pathways by which SARS-CoV-2 affects islet β cells in these 3 aspects. Specifically, we emphasize that T1D can be triggered by SARS-CoV-2 through several autoimmune mechanisms, including epitope spread, molecular mimicry, and bystander activation. Given that the development of T1D is often a chronic, long-term process, it is difficult to currently draw firm conclusions as to whether SARS-CoV-2 causes T1D. This area needs to be focused on in terms of the long-term outcomes. More in-depth and comprehensive studies with larger cohorts of patients and long-term clinical follow-ups are required.
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During the COVID-19 pandemic, cases of hyperglycemia, DKA, and new diabetes increased, suggesting that SARS-CoV-2 is a trigger for or can unmask type 1 diabetes.
“During the coronavirus disease 2019 (COVID-19) pandemic, cases of hyperglycemia, DKA, and new diabetes increased, suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a trigger for or can unmask type 1 diabetes (68).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [68]
During the COVID-19 pandemic, numbers of cases of hyperglycemia, DKA, and new diabetes increased, suggesting that SARS-CoV-2 is a trigger for or can unmask type 1 diabetes.
“During the coronavirus disease 2019 (COVID-19) pandemic, numbers of cases of hyperglycemia, DKA, and new diabetes increased, suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a trigger for or can unmask type 1 diabetes (68).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [68]
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Newly diagnosed diabetes and diabetic ketoacidosis precipitated by COVID-19 infection
Heaney, A., Griffin, G. D., & Simon, E. L. (2020) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2020.05.114 · Cited by 85 · see citing works
Barnett, R. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30024-2 · Cited by 82 · see citing works
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Protracted ketonaemia in hyperglycaemic emergencies in COVID-19: a retrospective case series
Armeni, E., Aziz, U., Qamar, S., Nasir, S., Nethaji, C., Negus, R. P. M., Murch, N., Beynon, H. C., Bouloux, P. M., Rosenthal, M. J., et al. (2020) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30221-7 · Cited by 77 · see citing works
Increased Incidence of Type 1 Diabetes during the COVID-19 Pandemic in Romanian Children
Vlad, A., Șerban, V., Timar, R. Z., Sima, A. C., Botea, V., Albai, O., Timar, B., & Vlad, M. (2021) · Medicina · doi:10.3390/medicina57090973 · Cited by 71 · see citing works
Marroquí, L., Lopes, M., dos Santos, R. S., Grieco, F. A., Roivainen, M., Richardson, S. J., Morgan, N. G., Beeck, A. O. D., & Eizirik, D. L. (2015) · eLife · doi:10.7554/elife.06990 · Cited by 70 · see citing works
Role of Viruses and Other Microbes in the Pathogenesis of Type 1 Diabetes
Kondrashova, A., & Hyöty, H. (2014) · International Reviews of Immunology · doi:10.3109/08830185.2014.889130 · Cited by 64 · see citing works
Qadir, M. M. F., Bhondeley, M., Beatty, W. L., Gaupp, D., Doyle‐Meyers, L. A., Fischer, T., Bandyopadhyay, I., Blair, R. V., Bohm, R. P., Rappaport, J., et al. (2021) · JCI Insight · doi:10.1172/jci.insight.151551 · Cited by 64 · see citing works
Pandemic influenza and subsequent risk of type 1 diabetes: a nationwide cohort study
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Enteroviruses and Type 1 Diabetes: Multiple Mechanisms and Factors?
Lloyd, R. E., Tamhankar, M. A., & Lernmark, Å. (2021) · Annual Review of Medicine · doi:10.1146/annurev-med-042320-015952 · Cited by 62 · see citing works
COVID-19 as a Trigger of Brain Autoimmunity
Gupta, M., & Weaver, D. F. (2021) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.1c00403 · Cited by 57 · see citing works
Deleterious Effects of SARS-CoV-2 Infection on Human Pancreatic Cells
Shaharuddin, S. H., Wang, V., Santos, R. D. S., Gross, A. R., Wang, Y., Jawanda, H., Zhang, Y., Hasan, W., Garcia, G., Arumugaswami, V., et al. (2021) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2021.678482 · Cited by 57 · see citing works
Self-citationVenkatakrishnan, A., Kayal, N., Anand, P., Badley, A. D., Church, G. M., & Soundararajan, V. (2020) · Cell Death Discovery · doi:10.1038/s41420-020-00321-y · Cited by 49 · see citing works
Neil, J. A., & Coulson, B. S. (2015) · Diabetologia · doi:10.1007/s00125-015-3562-3 · Cited by 47 · see citing works
COVID-19 and diabetes: a co-conspiracy?
Endocrinology, T. L. D. (2020) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30315-6 · Cited by 44 · see citing works
Pancreatic injury in the course of coronavirus disease 2019: A not‐so‐rare occurrence
Bruno, G., Fabrizio, C., Santoro, C. R., & Buccoliero, G. B. (2020) · Journal of Medical Virology · doi:10.1002/jmv.26134 · Cited by 43 · see citing works
Diabetic Ketoacidosis and Mortality in COVID-19 Infection
Stevens, J. S., Bogun, M. M., McMahon, D. J., Zucker, J. E., Kurlansky, P. A., Mohan, S., Yin, M. T., Nickolas, T. L., & Pajvani, U. B. (2021) · Diabetes & Metabolism · doi:10.1016/j.diabet.2021.101267 · Cited by 43 · see citing works
Newly diagnosed diabetes in patients with mild to moderate COVID-19
Sathish, T., & Anton, M. C. (2021) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2021.02.034 · Cited by 41 · see citing works
Prevention or acceleration of type 1 diabetes by viruses
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Acute pancreatitis in children hospitalized with COVID-19
Suchman, K. I., Raphael, K. L., Liu, Y., Wee, D., & Trindade, A. J. (2020) · Pancreatology · doi:10.1016/j.pan.2020.12.005 · Cited by 36 · see citing works
SARS-CoV-2 and pancreas: a potential pathological interaction?
Geravandi, S., Mahmoudi-Aznaveh, A., Azizi, Z., Maedler, K., & Ardestani, A. D. (2021) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2021.07.004 · Cited by 36 · see citing works
Enteroviruses, hygiene and type 1 diabetes: toward a preventive vaccine
Drescher, K. M., von Herrath, M., & Tracy, S. (2014) · Reviews in Medical Virology · doi:10.1002/rmv.1815 · Cited by 32 · see citing works
Enteroviral Infections as a Trigger for Type 1 Diabetes
Calvo, T. R. (2018) · Current Diabetes Reports · doi:10.1007/s11892-018-1077-2 · Cited by 20 · see citing works
Catriona, C., & Paolo, P. (2022) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3508 · Cited by 18 · see citing works
Non autoimmune type 1B diabetes after mild COVID‐19: Report of three cases
Seow, C. J., Koh, A. W. C., Lian, J. X., Dalan, R., & Boehm, B. O. (2021) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3438 · Cited by 12 · see citing works
New-Onset Type 1 Diabetes in Children With SARS-CoV-2 Infection
Ambati, S. R., Mihic, M., Rosario, D. C., Sánchez, J. C., & Bakar, A. M. (2022) · Cureus · doi:10.7759/cureus.22790 · Cited by 10 · see citing works
Letter to the Editor on Type 1 diabetes onset triggered by COVID-19
Sholihah, M. M., Kusuma, T. R. H., Hanif, M. I., & Prabowo, N. A. (2021) · Acta Diabetologica · doi:10.1007/s00592-021-01761-3 · Cited by 3 · see citing works
Flagged first, then by citations
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2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Gaglia, J. L., Hilliard, M. E., Johnson, E. L., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s002 · Cited by 2,086 · see citing works
2. Diagnosis and classification of diabetes: standards of care in diabetes-2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Ebekozien, O., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s002 · Cited by 1,393 · see citing works
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2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s002 · Cited by 473 · see citing works
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Self-citationAdvances in the Pathogenesis and Treatment Strategies for Type 1 Diabetes Mellitus
Du, M., Li, S., Jiang, J., Ma, X., Liu, L., Wang, T., Zhang, J., & Niu, D. (2025) · International Immunopharmacology · doi:10.1016/j.intimp.2025.114185 · Cited by 15 · see citing works
A prospective study on endocrine function in patients with long-COVID symptoms
Mourelatos, P., Vrettou, C. S., Diamantopoulos, A., Vassiliou, A. G., Jahaj, E., Angelousi, A. G., Pratikaki, M. E., Katsaounou, P. A., Kotanidou, Α., Vassiliadi, D. A., et al. (2023) · HORMONES · doi:10.1007/s42000-023-00511-0 · Cited by 11 · see citing works
Type 1 Diabetes and COVID-19: A Literature Review and Possible Management
Kashfi, K., Anbardar, N., Asadipooya, A., & Asadipooya, K. (2023) · Intern J Endocrinol Metab · doi:10.5812/ijem-139768 · Cited by 10 · see citing works
Rosenbauer, J., Stahl‐Pehe, A., Bächle, C., Lanzinger, S., Kamrath, C., Kuß, O., & Holl, R. W. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1287354 · Cited by 10 · see citing works
Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review
Calcaterra, V., Tagi, V. M., Santis, R. D., Biuso, A., Taranto, S., D’Auria, E., & Zuccotti, G. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165248 · Cited by 9 · see citing works
Autoimmunity, epitope analysis, and molecular mimicry
Rojas, M., Acosta‐Ampudia, Y., Monsalve, D. M., Ramı́rez-Santana, C., Heuer, L. S., Ridgway, W. M., Anaya, J., Lian, Z.-X., & Gershwin, M. E. (2025) · Current Opinion in Immunology · doi:10.1016/j.coi.2025.102681 · Cited by 8 · see citing works
The COVID-19 Pandemic Increased the Incidence of New-Onset Type One Diabetes in Children
Blumenfeld, O., Rozenshmidt, M., Eini, I., & Laron, Z. (2024) · Children · doi:10.3390/children11020142 · Cited by 7 · see citing works
Liu, H., Xu, Z., Karsidag, I., Wang, P., & Weng, J. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1689507 · Cited by 6 · see citing works
Gupte, A., Sriram, S., Gunasekaran, V., Chaudhari, K., & Kamat, D. (2025) · Pediatric Annals · doi:10.3928/19382359-20241106-01 · Cited by 6 · see citing works
Review Article: Overview of Clinical Genetics of Diabetes Mellitus
Asamoah, A., & Ahima, R. S. (2026) · Genes · doi:10.3390/genes17020215 · Cited by 5 · see citing works
Papapetrou, I., & Święcicka, A. (2025) · HORMONES · doi:10.1007/s42000-025-00662-2 · Cited by 5 · see citing works
Environmental Mechanisms Influencing the Pathogenesis and Progression of Type 1 Diabetes
Tang, Y., Wang, W., Huang, Z., Zhang, C., Zhang, J., Pang, Y., & Li, S. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms262311613 · Cited by 5 · see citing works
The Roles of Glutathione and Oxidative Stress in Diabetes and COVID-19
LOS, E. A., Ford, G., Tuell, D. S., Macariola, D., & Stone, W. L. (2024) · Oxygen · doi:10.3390/oxygen4030021 · Cited by 5 · see citing works
Ma, X.-L., Shi, Q.-Y., Zhao, Q., Xu, Q., Yan, S., Han, B., Fang, C., Zhang, L., & Pei, Y. (2023) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2022-003167 · Cited by 4 · see citing works
Bélteky, M., Wahlberg, J., & Ludvigsson, J. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1529447 · Cited by 3 · see citing works
Abdullatypov, A. V., Glushkova, O. V., Petriaikina, E. S., Bogdanov, V. P., Tabakov, D., Akimov, V. E., Yudin, V. S., Keskinov, A. A., Yudin, S. M., Volchkov, P., et al. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1663728 · Cited by 3 · see citing works
Carmon, L., Bachar, Y., Babyev, A. S., Hazn, I., Hershkovitz, E., Shaki, D., Loewenthal, N., Haim, A., & Hazan, G. (2025) · World Journal of Diabetes · doi:10.4239/wjd.v16.i8.108724 · Cited by 3 · see citing works
Environmental Factors in Type 1 DiabetesPreprint
Hyöty, H., Laiho, J. E., & Virtanen, S. M. (2024) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a041590 · Cited by 3 · see citing works
Shitaye, G., Yizengaw, M. G., Mekonnen, Z., D’Abrosca, G., Fattorusso, R., Isernia, C., Amuamuta, A., & Malgieri, G. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1737894 · Cited by 2 · see citing works
Transcriptional changes in multiple endocrine organs from lethal cases of COVID-19
Poma, A. M., Bonuccelli, D., Macerola, E., Niballi, S., Basolo, A., Santini, F., Basolo, F., & Toniolo, A. (2023) · Journal of Molecular Medicine · doi:10.1007/s00109-023-02334-3 · Cited by 2 · see citing works
Polega, J. R. (2024) · Pediatric Annals · doi:10.3928/19382359-20240502-05 · Cited by 1 · see citing works
New Onset of Type 1 Diabetes Mellitus Post-COVID-19 Vaccine
Aburisheh, K. H., Enabi, H. M. K., Alodah, N. A., Alotary, B. H., Algheryafi, L. A., Almairi, A. M., & Aldhewaila, A. A. (2024) · Journal of Medical Cases · doi:10.14740/jmc4307 · Cited by 1 · see citing works
Xu, Z., Xi, L., Wu, J., Ni, J., Luo, F.-H., & Zhang, M. (2024) · World Journal of Diabetes · doi:10.4239/wjd.v15.i12.2276 · Cited by 1 · see citing works
Chu, S., Liu, D., Zhao, H., Liu, L., Li, J., Wang, G., Liu, X., & Li, H.-L. (2024) · Genes & Genomics · doi:10.1007/s13258-024-01607-6 · Cited by 1 · see citing works
Self-citationThe type 1 diabetes mellitus treatment
Morozov, A. M., Tsvetkova, A., Penyaz', E. V., Sitnova, V. A., & Smyslova, A. Y. (2025) · Russian Journal of Preventive Medicine · doi:10.17116/profmed202528081131 · Cited by 1 · see citing works
Incidence and Severity of Type 1 Diabetes in Children Through the COVID-19 Pandemic in Chile
Kutz, C., Alarcón, G. M., Aguilera, E., Garfias, C., & Rumié, H. (2026) · PEDIATRICS · doi:10.1542/peds.2025-072191 · Cited by 1 · see citing works
Wang, T., Zhang, Y., Wu, C., Huang, Z., Liang, X., & Luo, Z. (2024) · Medicine · doi:10.1097/md.0000000000040128 · Cited by 1 · see citing works
Type1 Diabetes and COVID-19: A Systematic Review and Possible ManagementPreprint
Kashfi, K., Anbardar, N., Asadipooya, A., & Asadipooya, K. (2023) · Preprints.org · doi:10.20944/preprints202306.2265.v1 · Cited by 1 · see citing works
Editorial: Developing strategies to improve diabetes management in college-going young adults
Saikia, M., Lassi, Z. S., & McCall, A. L. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1402133 · Cited by 1 · see citing works
Koca, S. B., Takcı, M. Z., Deniz, R., Özcan, S., Çeleğen, M., & Dursun, A. (2024) · Turkish Archives of Pediatrics · doi:10.5152/turkarchpediatr.2024.246202 · Cited by 1 · see citing works
Developing Strategies to Improve Diabetes Management in College-Going Young Adults
(2024) · Frontiers research topics · doi:10.3389/978-2-8325-4815-8
Malikova, Y. V., Valishin, D. A., Мурзабаева, Р. Т., & Yаpparov, R. G. (2024) · Journal Infectology · doi:10.22625/2072-6732-2024-16-2-75-80
Burlaka, I. A., Mityuryayeva-Kornijko, I. O., Sevastiian, O., & Kachula, I. (2024) · Global Pediatric Health · doi:10.1177/2333794x241276356
The influence of the COVID-19 pandemic on pediatric hospitalizations for type 1 diabetes mellitus
Mănescu, M., Mănescu, I. B., & Grama, A. C. (2024) · Acta Marisiensis. Seria Medica · doi:10.2478/amma-2024-0021
Etiopatogenia y situación epidemiológica de la diabetes mellitus tipo 1
Cebada, A. B., Silva, J. B. Q., Escobar-Morreale, H. F., & Chávez, L. N. (2024) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2024.10.001
Post-COVID Metabolic Diseases and their Molecular Pathogenesis: A Comprehensive Review
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Hormonal, metabolic and metabolomic biomarkers in long COVID
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Can Vaccines Cause Chronic Diseases?
Prasad‐Reddy, L., Dahal, A., & Srivastava, S. (2026) · Springer eBooks · doi:10.1007/978-1-0716-5464-4_18
- Authors
- Wang, Y., Guo, H., Wang, G., Zhai, J., & Du, B.
- Affiliations
- First Hospital of Jilin University (CN)
- Corresponding author
- Du, Bing
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2023-03-23
- Volume
- 108
- Issue
- 9
- Pages
- 2176-2183
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W4360600872
- Cited by
- 50
- References
- 109
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 19 · 2023: 7
- FWCI
- 8.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81900384, 81900701)
- Natural Science Foundation of Jilin Province (YDZJ202201ZYTS036)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- type 1 diabetes, COVID-19 pandemic, SARS-CoV-2, islet autoimmunity, viral triggers of autoimmunity, molecular mimicry, bystander activation, beta cell destruction, diabetic ketoacidosis, hyperglycemia, new-onset diabetes
- MeSH terms
- COVID-19, SARS-CoV-2, Diabetes Mellitus, Type 1, Humans, Islets of Langerhans, Pandemics
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