SARS-CoV-2 disease severity and diabetes: why the connection and what is to be done?

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus responsible for the current coronavirus disease 2019 (COVID-19) pandemic, has infected over 3.5 million people all over the world since the first case was reported from Wuhan, China 5 months ago. As more epidemiological data regarding COVID-19 patients is acquired, factors that increase the severity of the infection are being identified and reported. One of the most consistent comorbidities associated with worse outcome in COVID-19 patients is diabetes, along with age and cardiovascular disease. Studies on the association of diabetes with other acute respiratory infections, namely SARS, MERS, and Influenza, outline what seems to be an underlying factor in diabetic patients that makes them more susceptible to complications. In this review we summarize what we think may be the factors driving this pattern between diabetes, aging and poor outcomes in respiratory infections. We also review therapeutic considerations and strategies for treatment of COVID-19 in diabetic patients, and how the additional challenge of this co-morbidity requires attention to glucose homeostasis so as to achieve the best outcomes possible for patients.

Mortality Rate and Predictors of Mortality in Hospitalized COVID-19 Patients with Diabetes

“…For example, a recent modeling study estimated that 20% of those aged 70 years or older patients with COIVD-19 were severe requiring hospitalization whereas only <1% of those younger than 20 years needed so [23], while a Korean study reported that the age-specific death rate was the highest among patients over 70 years of age, with underlying diseases in their circulatory system [27]. Older individuals with diabetes mellitus and an acute respiratory illness are usually susceptible to develop complications such as severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), influenza (including COVID-19), and thus, to be at higher risk of mortality [10]. Furthermore, it has been suggested that diabetic COVID-19 patients are more susceptible to an 'inflammatory storm', which is associated with rapid deterioration and high mortality risk [18].…”

“…Comorbid conditions such as diabetes mellitus, respiratory, cardiovascular and renal illnesses, and obesity, and an older age group are known to be positively associated with poor outcomes among COVID-19 patients [10][11][12][13]. Furthermore, research studies have demonstrated that COVID-19 patients with diabetes have poorer clinical prognoses, are at higher risks of complications, such as respiratory failure and acute cardiac injury, and have shorter overall survival times than their non-diabetic counterparts [14].…”

Strategies for infection control and prevalence of anti-SARS-CoV-2 IgG in 4,554 employees of a university hospital in Munich, Germany

“…Previously, diabetes mellitus reportedly correlates with the severity of COVID-19 and associated mortality, but no increase in susceptibility to SARS-CoV-2 infection have been reported to date[23].The serological assessment confirmed infection in most individuals who reported positive testing for SARS-CoV-2 by PCR. However, repeated testing over >4 weeks with at least two separate assays each did not detect antibodies in six individuals (two with positive in-house PCR results and four with reported positive external PCR results)(S8 Fig,No.…”

A Bioelectromagnetic Proposal Approaching the Complex Challenges of COVID-19

“…Current statistics show a correlation of COVID-19 with gender [123] [124], and age [125] of infected patients. Comorbidities, such as hypertension [126], diabetes [127], cardiovascular disease [128], asthma, chronic obstructive pulmonary disease (COPD) [129] can lead to serious difficulties. Triggering of comorbidities was also detected in SARS-CoV-1 infection in patients who did not have such damage before [130].…”