COVID-19 and diabetes mellitus: An unholy interaction of two pandemics

Abstract

Background and aims: Diabetes mellitus is associated with poor prognosis in patients with COVID-19. On the other hand, COVID-19 contributes to worsening of dysglycemia in people with diabetes mellitus over and above that contributed by stress hyperglycemia. Herein, we have reviewed the two-way interactions between COVID-19 and diabetes mellitus. Methods: We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till April 25, 2020, with the following keywords: "COVID-19", "SARS-CoV-2", "diabetes", "diabetes mellitus", "SARS", "infection" and "management of diabetes mellitus" with interposition of the Boolean operator "AND". Results: Compromised innate immunity, pro-inflammatory cytokine milieu, reduced expression of ACE2 and use of renin-angiotensin-aldosterone system antagonists in people with diabetes mellitus contribute to poor prognosis in COVID-19. On the contrary, direct b-cell damage, cytokine-induced insulin resistance, hypokalemia and drugs used in the treatment of COVID-19 (like corticosteroids, lopinavir/ritonavir) can contribute to worsening of glucose control in people with diabetes mellitus. Conclusions: The two-way interaction between COVID-19 and diabetes mellitus sets up a vicious cycle wherein COVID-19 leads to worsening of dysglycemia and diabetes mellitus, in turn, exacerbates the severity of COVID-19. Thus, it is imperative that people with diabetes mellitus take all necessary precautions and ensure good glycemic control amid the ongoing pandemic.

Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals

“…It is plausible that there is a lower threshold for admission of diabetic patients with mild COVID-19 symptoms in view of higher complication risk or alternatively diabetic patients may present with metabolic rather than overtly infective complications. 21 The composition of the survey population was similar in age, sex, comorbidities and disease severity to the larger, published UK COVID-19 ISARIC hospital cohort. 22 We did not attempt to estimate false negative SARS-CoV-2 RT-PCR test results although 9.8% of those receiving critical care for COVID-19 were SARS-CoV-2 RT-PCR negative, and chest X-rays were suggestive of or indeterminant for COVID-19 in 14.3% and 23.5% of all surveyed SARS-CoV-2 negative patients, respectively.…”

Is Toll-like receptor 4 involved in the severity of COVID-19 pathology in patients with cardiometabolic comorbidities?

“…In support of this, even mild COVID-19 can present high amounts of IL-6, IL-1β, TNF-α, MCP-1, and IP-10, products of the TLR4 pathway, that can further lead to lowering of insulin sensitivity [ 91 ]. Moreover, obesity, commonly associated with T2DM is likely to further aggravate the cytokine response in a process to be described below, thereby worsening insulin resistance [ 92 ].…”

ACE2: THE DOORWAY TO SARS-CoV-2

“…Alterations of RAS have been associated to complications of diabetes mellitus (DM), including insulin resistance, endothelial damage and diabetic nephropathy due to elevated concentrations of AngII that contribute to increased oxidative stress and inflammation [35,36]. increases the speed of progression to septic shock and multiple organ failure [38][39][40].…”