Diabetes and Novel Coronavirus Infection: Implications for Treatment

Abstract

The novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) outbreak originating in December 2019 has resulted in a worldwide pandemic affecting millions across almost 200 countries. People with diabetes appear to develop more severe forms of the disease and to require intensive care unit support and/or mechanical ventilation more frequently than those with other underlying medical conditions. The mortality rate among people with diabetes is also significantly higher than that among people without diabetes. A diagnosis of diabetes is often an indicator of poor underlying metabolic health, and frequently people with diabetes have multiple risk factors for severe coronavirus disease 2019 (COVID-19), including cardiovascular and renal disease. In this review, we discuss the potential biological mechanisms by which SARS-CoV-2 may interact with disease processes implicated in diabetes and discuss how treatments commonly used for people with diabetes may affect COVID-19 severity and progression. There is currently a lack of evidence from human studies, and further trials in this area will prove useful to further expand our understanding of this rapidly developing disease process to improve outcomes for this high-risk group of patients.

Impact of COVID-19 on primary care visits: lesson learnt from the early pandemic period

“…Moreover, both are significant comorbidities for many other diseases including COVID-19. [23][24][25] In this study, we found that the number of diabetes mellitus visits had shown minimal decrease in the four week average, yet the prevalence ratio surged 1.54 times higher than the comparison period. This was desirable as it indicated that the patients were still willing to come for follow-ups.…”

Proportion and mortality of Iranian diabetes mellitus, chronic kidney disease, hypertension and cardiovascular disease patients with COVID-19: a meta-analysis

“…To date, several clinical and epidemiological studies have indicated higher risk of SARS-COV-2 infection in DM patients [19,20]. However, it is not yet known whether patients with underlying DM are more susceptible to SARS-COV-2 infection [21][22][23]. Some studies postulated that the angiotensin converting enzyme 2 (ACE2) may be the plausible explanation of the association between risk of SARS-COV-2 infection in DM, CKD and CVDs patients and COVID-19 severity [24][25][26].…”

Managing diabetes in ageing patients during the COVID-19 pandemic

“…Sodium-glucose transport inhibitors (SGLT-2i) precipitate towards a reverse insulin/glucagon ratio, and thus higher rates of ketosis, likely to complicate clinical manifestations of COVID-19 infection [10]; therefore their administration should be kept to a minimum. Treatment with glucagon like peptide 1 receptor agonists (GLP-1RA), a safe and effective anti-diabetic option in general, has been associated with an upregulation of ACE-2 inhibitors, which implies a possible adverse effect on the severity of immune reaction related with the disease [10]. Thiazolidinediones (TZDs) regulate not only glucose levels but also immune system response, through activation of the peroxisome proliferator activated J o u r n a l P r e -p r o o f receptor-γ (PPARγ) [11].…”

“…Although metformin is the gold standard first choice of treatment in DM, it has to be withheld as soon as suspicious symptoms arise, aiming to minimize the risk of lactic acidosis. Sodium-glucose transport inhibitors (SGLT-2i) precipitate towards a reverse insulin/glucagon ratio, and thus higher rates of ketosis, likely to complicate clinical manifestations of COVID-19 infection [ 10 ]; therefore their administration should be kept to a minimum. Treatment with glucagon like peptide 1 receptor agonists (GLP-1RA), a safe and effective anti-diabetic option in general, has been associated with an upregulation of ACE-2 inhibitors, which implies a possible adverse effect on the severity of immune reaction related with the disease [ 10 ].…”

“…Such a treatment should be readjusted after a confirmed infection, due to the possible viral damage on pancreatic islet cells and possible insulin deficiency observed in patients with COVID-19 [ 4 , 5 ]. Dipeptidyl peptidase 4 inhibitors (DPP-4i) might have a potential positive effect in regulation of the infectious process [ 10 ], so the use of these agents appears as a rather efficient and safe choice.…”