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To the Editor, The article by Papadokostaki et al. in the recent issue of Primary Care Diabetes has highlighted several critical issues related to the bi-directional relationship between coronavirus disease-19 (COVID-19) and diabetes [1]. These are highly relevant for clinicians to optimize care for patients with diabetes that are inflicted with COVID-19. The authors briefly pointed out the possibility of COVID-19-induced new-onset diabetes. With respect to this, we would like to add that in addition to precipitating new-onset diabetes, COVID-19 may also unmask previously undiagnosed diabetes by causing pleiotropic alterations in glucose metabolism [2]. Further, patients with newly diagnosed diabetes, whether it is new-onset diabetes or previously undiagnosed diabetes, tend to have increased levels of inflammatory markers (eg, interleukin-6) and indicators of multi-organ injury (eg, high alanine transaminase for liver damage), thereby experiencing severe or critical illness of COVID-19 [2]. They are also more susceptible to develop acute hyperglycemic crisis including, diabetic ketoacidosis and hyperosmolar hyperglycemic state [3, 4], requiring exceptionally high doses of insulin. Most importantly, compared