Factors Behind the Higher COVID-19 Risk in Diabetes: A Critical Review

Abstract

Diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19) are public health issues worldwide, and their comorbidities trigger the progress to severe disease and even death in such patients. Globally, DM has affected an estimated 9.3% adults, and as of April 18, 2021, the World Health Organization (WHO) has confirmed 141,727,940 COVID-19 confirmed cases. The virus is spread via droplets, aerosols, and direct touch with others. Numerous predictive factors have been linked to COVID-19 severity, including impaired immune response and increased inflammatory response, among others. Angiotensin receptor blockers and angiotensin converting enzyme 2 have also been identified as playing a boosting role in both susceptibility and severity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Specifically, in DM patients, both their control and management during this pandemic is herculean as the restriction periods have markedly hampered the maintenance of means to control glycemia, hypertension, and neuroendocrine and kidney diseases. In addition, as a result of the underlyin cardio-metabolic and immunological disorders, DM patients are at a higher risk of developing the severe form of COVID-19 despite other comorbidities, such as hypertension, also potentially boosting the development of higher COVID-19 severity. However, even in non-DM patients, SARS-CoV-2 may also cause transient hyperglycemia through induction of insulin resistance and/or pancreatic β-cell injury. Therefore, a strict glucose monitoring of DM patients with COVID-19 is mandatory to prevent life-threatening complications.

Effectiveness of COVID-19 Vaccines in Patients Under Maintenance Hemodialysis

“… 28 Several predictive factors have been associated with COVID-19 severity, such as weakened immune response and raised inflammatory response. 29 Unfortunately, 8% of the vaccinated patients involved in our study were non-responders and had undetectable antibodies. Therefore, we suggest that more boosting or a higher dose could be investigated in those non-responders; alternatively, other administration routes for vaccinations could be considered, such as an intranasal vaccine.…”

Challenges and Opportunities in Using Telehealth for Diabetes Care

“…The social distancing policies and economic hardships imposed by the pandemic augmented barriers to accessing in-person care for people with diabetes. Furthermore, observational studies raised concerns very early in the pandemic regarding increased COVID-19-related morbidity and mortality among people with diabetes (38)(39)(40), making diabetes care providers and individuals with diabetes hesitant to choose in-person care even when it was available. Simultaneously, new health care policies enacted during the pandemic circumnavigated many preexisting barriers to telehealth use.…”

Mortality and Clinical Outcomes among Patients with COVID-19 and Diabetes

“…There is a higher risk of mortality and severe disease if individuals with DM develop COVID-19 [ 12 , 13 ]. The pathophysiologic link between DM and adverse outcomes in COVID-19 has been closely studied [ 14 ]. The possible mechanisms leading to complicated disease could be due to differential expression of angiotensin-converting enzyme 2 (ACE2) in the lungs, and suppression of innate and adaptative immunity in DM [ 15 ].…”

“…Additionally, DM often coexists with other comorbidities such as obesity, hypertension, cardiovascular disease (CVD), and chronic kidney disease (CKD), which can adversely impact the outcome [ 11 , 14 , 22 , 23 , 24 ]. The low-grade chronic inflammation in DM also has been presumed to increase the susceptibility to a cytokine storm, a critical and fulminant event associated with rapid deterioration during the second week [ 25 ].…”