Impact of Diabetes in Patients Diagnosed With COVID-19

Abstract

COVID-19 is a disease caused by the coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2), known as a highly contagious disease, currently affecting more than 200 countries worldwide. The main feature of SARS-CoV-2 that distinguishes it from other viruses is the speed of transmission combined with higher risk of mortality from acute respiratory distress syndrome (ARDS). People with diabetes mellitus (DM), severe obesity, cardiovascular disease, and hypertension are more likely to get infected and are at a higher risk of mortality from COVID-19. Among elderly patients who are at higher risk of death from COVID-19, 26.8% have DM. Although the reasons for this increased risk are yet to be determined, several factors may contribute to type-2 DM patients’ increased susceptibility to infections. A possible factor that may play a role in increasing the risk in people affected by diabetes and/or obesity is the impaired innate and adaptive immune response, characterized by a state of chronic and low-grade inflammation that can lead to abrupt systemic metabolic alteration. SARS patients previously diagnosed with diabetes or hyperglycemia had higher mortality and morbidity rates when compared with patients who were under metabolic control. Similarly, obese individuals are at higher risk of developing complications from SARS-CoV-2. In this review, we will explore the current and evolving insights pertinent to the metabolic impact of coronavirus infections with special attention to the main pathways and mechanisms that are linked to the pathophysiology and treatment of diabetes.

Clinical characteristics and outcomes of COVID-19 patients with diabetes mellitus in Kuwait

“…ACE2 is also found lining the cells of the pancreatic islets, hence patients with diabetes and hypertension can be treated with ACE inhibitors (ACEi) [ 38 ]. It has been established that SARs-CoV-2 enters the cell via the ACE2 receptor, hence the administration of ACEi to these patients can potentially exacerbate the progression of COVID-19 [ 23 ]. However, studies have shown that anti-hypertensive medications appear to have no impact on the prognosis of COVID-19 [ 34 ].…”

“…Several studies have shown that type 2 diabetes, which is the most prevalent type of the disease, is associated with low-grade chronic inflammation that affects the homeostatic glucose regulation and insulin sensitivity [ 23 , 24 ]. Studies have indicated that hyperglycemia may be a major pushing factor for a poorer prognosis of COVID-19, and has been a suggested risk factor for predicting ICU admission and negative outcomes in patients [ 17 ].…”

Vitamin D and COVID‐19 in an immunocompromised patient with multiple comorbidities—A Case Report

“…Almost immediately after the pandemic outbreak in China, greater vulnerability and higher incidence of severe clinical presentation and fatal outcome were observed in patients with particular preexisting conditions, especially in persons aged >65 1,2 . Numerous studies have shown that the greatest risk of severe COVID‐19 course/manifestation is posed by the presence of either diabetes mellitus, obesity, arterial hypertension, or immunosuppression / immunodeficiency 3‐8 . Severe COVID‐19 manifestations include development of extensive bilateral pneumonia, ARDS, and endothelial damage accompanied with accelerated thrombogenesis, which can all lead to the respiratory and multiorgan failure, being major clinical concern due to intensive care units overcrowding and high mortality rate 4,6 …”

“…Inappropriately excessive and uncontrolled inflammation more likely can result with the development of autodestrucitive cytokine storm, which is considered to be the final effector mechanism of tissue damage 4,6,10,11 . Obesity, insulin resistance and diabetes mellitus, as well as hypertension, are characterized by the presence of persistent low‐intensity inflammation, which may be decisive underlying factor amplifying and perpetuating viral‐induced inflammatory response 4‐11 . Some authors also suggest pathogenetic involvement of immunogenic damage‐associated molecular patterns (DAMPs), released as a consequence of preexisting disease 29 .…”

“…In most groups of risk patients, common mechanism favoring development of excessive inflammation and cytokine storm is persistently present proinflammatory milieu 7 . Such chronic proinflammatory state can arise either due to hypersecretion of proinflammatory adipokines in obese patients, 7 lack of anti‐inflammatory signaling in diabetic, and insulin‐resistant patients 7,8 or dysregulation of renin‐angiotensin system (RAS) with increased proinflammatory angiotensin II (Ang II) production in hypertensive patients 6,9,10 . Patients on immunosuppressive therapy are considered to be at risk due to the facilitated viral multiplication and dissemination during the initial phase, enabling in turn more vigorous ignition of hyperinflammatory phase 6,10,11 .…”