Interactions between diabetes and COVID-19: A narrative review

Abstract

Diabetes, whether due to pancreatic beta cells insufficiency or peripheral resistance to insulin, has been suggested as a risk factor of developing severe acute respiratory disease coronavirus-2 (SARS-CoV-2) infections. Indeed, diabetes has been associated with a higher risk of infections and higher risk of developing severe forms of coronavirus disease 2019 (COVID-19) related pneumonia. Diabetic patients often present associated comorbidities such as obesity, hypertension and cardiovascular diseases, and complications of diabetes, including chronic kidney disease, vasculopathy and relative immune dysfunction, all of which make them more susceptible to infectious complications. Moreover, they often present low-grade inflammation with increased circulating interleukin levels, endothelial susceptibility to inflammation and dysfunction, and finally, hyperglycemia, which increases this risk. Additionally, corticosteroids, which count among the few medications which showed benefit on survival and mechanical ventilation requirement in COVID-19 pneumonia in large randomized controlled trials, are associated to new onsets of diabetes, and metabolic disorders in patients with previous history of diabetes. Finally, SARS-CoV-2 via the alternate effects of the renin-angiotensin system, mediated by the angiotensin-converting-enzyme 2, was also associated with insulin resistance in key tissues involved in glucose homeostasis, such as liver, skeletal muscles, and adipose tissue; and also, with impaired insulin secretion by pancreatic β-cells. In this work, we reviewed all elements which may help understand how diabetes affects patients with COVID-19, how treatments affect outcomes in patients with COVID-19, how they may cause new onsets of diabetes, and finally review how SARS-CoV-2 may inherently be a risk factor of developing diabetes, through immune-mediated diabetogenic mechanisms.

Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments

“…Numerous studies have shown that new-onset hyperglycemia, ketoacidosis, and diabetes are frequently observed in patients with COVID-19[ 88 , 89 , 92 , 93 ]. Individuals with diabetes often have associated comorbidities, such as obesity, hypertension, and cardiovascular disease, as well as diabetic complications, including chronic kidney disease, vascular disease, and related immune dysfunction, all of which put them at risk for infectious complications[ 94 ]. In a study of 458 patients with COVID-19 and diabetes, those with liver injury and chronic kidney disease had significantly higher mortality rates than other complications[ 95 ].…”

Healthy Immunity on Preventive Medicine for Combating COVID-19

“…Diabetes and obesity (leading to CVDs) are the most common comorbidities of COVID-19-associated complications [ 107 , 108 , 109 ]. It has been reported that the expression of ACE2 receptors is upregulated in diabetes, allowing for higher levels of the COVID virus binding to the host cells and resulting in progressive infections [ 110 , 111 ]. Diabetes also increases circulating levels of furin, which is known to assist host–COVID-19 interactions [ 112 ].…”

Diabetes - a Consequence of COVID-19 Infection

“…One of the proposed mechanisms is that SARS-CoV-2 binds to receptors of the enzyme that converts angiotensin-2 (ACE-2) expressed on adipose tissue, lungs, small intestine, kidneys, and pancreas. After virus endocytosis, ACE-2 decreases, leading to overexpression of angiotensin II, which may interfere with insulin secretion ( 9 - 12 ).…”