Dr Mary Pat Gallagher Highlights Unanswered Questions on COVID-19 and Diabetes

Mary Pat Gallagher, MD, of NYU Langone Health, discusses research needed to better understand how COVID-19 impacts individuals with diabetes.

As it is the pandemic of the 21st century, we'll be learning about COVID-19 for a long time, said Mary Pat Gallagher, MD, a pediatric endocrinologist at NYU Langone Health.


What questions remain unanswered about COVID-19 and diabetes?

The questions that still remain are numerous. I think as the pandemic of the 21st century, I think we'll be learning about COVID-19 for a long time. I think we've just begun to do studies on it. So there's much that we need to learn. One of the most important questions, I think, in patients with diabetes is, 'In what way is it affecting the onset and the presentation?' I think from our type 1 diabetes (T1D) Exchange data, as well as other data sets around the country, we have a general sense that age is the most important risk factor for disease severity. Metabolic control is an important risk factor in hospitalization, not necessarily for severe COVID-19 disease, but for being hospitalized. Most of those hospitalizations in young people were for diabetic ketoacidosis (DKA), not for severe COVID-19 disease, per se. So we have some of that data, we'll continue to collect it, of course, and learn more about it. But I think it's really fascinating, and still unanswered: 'Does this particular virus, like some other viruses, rubella, for instance, cause a much stronger inflammatory response than the flu? And does that have a greater impact?' Because when we started, we told people 'Sure, even influenza, you have a higher risk for DKA. Be careful. Check your ketones, make sure that you're aggressively treating high blood sugars, maintain hydration. But this might be orders of magnitude greater risk for DKA. We just don't have that information yet. And even when we do have the epidemiologic data, it'll be really interesting to get a better understanding on the physiology of it. Why is that happening? How is it happening?