Diabetes and COVID19: a bidirectional relationship

Abstract

The advent and rapid spread of the coronavirus disease-2019 (COVID19) pandemic across the world has focused attention on the relationship of commonly occurring comorbidities such as diabetes on the course and outcomes of this infection. While diabetes does not seem to be associated with an increased risk of COVID19 infection per se, it has been clearly demonstrated that the presence of hyperglycemia of any degree predisposes to worse outcomes, such as more severe respiratory involvement, ICU admissions, need for mechanical ventilation and mortality. Further, COVID19 infection has been associated with the development of new-onset hyperglycemia and diabetes, and worsening of glycemic control in pre-existing diabetes, due to direct pancreatic damage by the virus, body’s stress response to infection (including cytokine storm) and use of diabetogenic drugs such as corticosteroids in the treatment of severe COVID19. In addition, public health measures taken to flatten the pandemic curve (such as lockdowns) can also adversely impact persons with diabetes by limiting their access to clinical care, healthy diet, and opportunities to exercise. Most antidiabetic medications can continue to be used in patients with mild COVID19 but switching over to insulin is preferred in severe disease.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

“…Acute organ injury caused by COVID-19 can cause long-term cardiovascular [ 1083 , 1084 ], pulmonary [ 1085 ], metabolic [ 1086 ], renal [ 1086 ] and neurological [ 1087 ] damage, potentially contributing to chronic conditions that can themselves be risk factors for severe COVID-19 in subsequent infections. COVID-19 can lead to the exacerbation of asthma [ 1088 ] and neurodegenerative disorders (both Parkinson’s and Alzheimer’s disease) [ 1088 ], and increase the risk of developing mental disorders [ 1088 , 1089 ], diabetes [ 1090 , 1091 ], CKD [ 1092 ], hypertension [ 1093 ] and CVD [ 1094 ]. COVID-19 also disturbs metabolic homeostasis, and can result in a low intake of calories and greatly reduced physical activity during hospitalization, which can exacerbate frailty and biological aging [ 586 ].…”

Impact of COVID-19 therapy on hyperglycemia

“…Studies have shown DM is an independent predictor of admission to the intensive care unit (ICU), requiring ventilation or mortality in COVID-19. 1 Hyperglycemia is common in the ICU resulting from stress-induced insulin resistance and increased glucose production. Viral-induced hyperglycemia usually persists because of inflammation and activation of the immune system.…”

Clinical Characteristics and Predictors of Mortality in Elderly Patients Hospitalized with COVID-19 in Bangladesh: A Multicenter, Retrospective Study

“…On the other hand, COVID-19 is associated with new-onset hyperglycemia or diabetes as well as worsening of preexisting diabetes [ 55 , 56 ]. Possible mechanisms of hyperglycemia in COVID-19 are direct virus-mediated beta-cell damage, triggering of beta-cell autoimmunity by the virus, disorganized and exuberant immune response against the virus, which leads to perturbations in glycemic status, and iatrogenic hyperglycemia caused by corticosteroids [ 57 ]. Our study finding is also consistent with these and we found, compared to survivors, nonsurvivor had a higher blood glucose levels at admission.…”