Diabetes and COVID-19: evidence, current status and unanswered research questions

Abstract

Patients with diabetes who get coronavirus disease 2019 are at risk of a severe disease course and mortality. Several factors especially the impaired immune response, heightened inflammatory response and hypercoagulable state contribute to the increased disease severity. However, there are many contentious issues about which the evidence is rather limited. There are some theoretical concerns about the effects of different anti-hyperglycaemic drugs. Similarly, despite the recognition of angiotensin converting enzyme 2 (ACE2) as the receptor for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), and the role of ACE2 in lung injury; there are conflicting results with the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in these patients. Management of patients with diabetes in times of restrictions on mobility poses some challenges and novel approaches like telemedicine can be useful. There is a need to further study the natural course of COVID-19 in patients with diabetes and to understand the individual, regional and ethnic variations in disease prevalence and course.

Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis

“…As of July 17, 2020, the World Health Organisation (WHO) has declared more than 13 million people as a positive confirmed COVID-19 case that results in more than 580.000 deaths [ 1 ]. Through descriptive observational studies, it is well established that patients with comorbidities are disproportionately affected by COVID-19 and associated with worse clinical outcomes [ [2] , [3] , [4] , [5] ].…”

SARS-CoV-2 receptor Angiotensin I-Converting Enzyme type 2 (ACE2) is expressed in human pancreatic β-cells and in the human pancreas microvasculature

“…Recent studies showed that older adults and those with chronic medical conditions like heart and lung disease and/or diabetes mellitus are at the highest risk for complications from SARS-CoV-2 infection. Of importance, a yet unresolved conundrum relies on the recently hypothesized bidirectional relationship between COVID-19 and diabetes mellitus (12,13). This concept is supported by reports in which impaired glycaemic control is associated with increased risk of severe COVID-19.…”

Allium Flavonols: Health Benefits, Molecular Targets, and Bioavailability

“…We emphasize that the dietary co-administration of the antioxidant-rich foods along with clinical treatments may ameliorate chronic illnesses mediated by heightened free radicals in the body. It has particularly been observed that people with chronic illnesses are more vulnerable to clinical complications and deaths by novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) infections [3][4][5]. The on-going coronavirus disease (CoVID-19) pandemic has forced people across the globe to rethink their nutritional habits, switching to antioxidant-rich foods to avoid chronic illness with stronger immunity [6,7].…”