An Overview of Systematic Reviews of the Role of Vitamin D on Inflammation in Patients with Diabetes and the Potentiality of Its Application on Diabetic Patients with COVID-19.

Christiano Argano,Marika Lo Monaco,Raffaella Mallaci Bocchio,Attilio Cavezzi,Emidio Troiani,Salvatore Corrao,Salvatore Scibetta,Giuseppe Natoli

doi:10.3390/ijms23052873

Christiano Argano, Marika Lo Monaco + Show 6 more

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https://doi.org/10.3390/ijms23052873

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Abstract

Almost two years have passed since the outbreak reported for the first time in Wuhan of coronavirus disease 2019 (COVID-19), due to severe acute respiratory syndrome (SARS)-CoV-2 coronavirus, rapidly evolved into a pandemic. This infectious disease has stressed global health care systems. The mortality rate is higher, particularly in elderly population and in patients with comorbidities such as hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, chronic renal disease, and malignancy. Among them, subjects with diabetes have a high risk of developing severe form of COVID-19 and show increased mortality. How diabetes contributes to COVID-19 severity remains unclear. It has been hypothesized that it may be correlated with the effects of hyperglycemia on systemic inflammatory responses and immune system dysfunction. Vitamin D (VD) is a modulator of immune-response. Data from literature showed that vitamin D deficiency in COVID-19 patients increases COVID-19 severity, likely because of its negative impact on immune and inflammatory responses. Therefore, the use of vitamin D might play a role in some aspects of the infection, particularly the inflammatory state and the immune system function of patients. Moreover, a piece of evidence highlighted a link among vitamin D deficiency, obesity and diabetes, all factors associated with COVID-19 severity. Given this background, we performed an overview of the systematic reviews to assess the association between vitamin D supplementation and inflammatory markers in patients with diabetes; furthermore, vitamin D’s possible role in COVID-19 patients was assessed as well. Three databases, namely MEDLINE, PubMed Central and the Cochrane Library of Systematic Reviews, were reviewed to retrieve the pertinent data. The aim of this review is to provide insight into the recent advances about the molecular basis of the relationship between vitamin D, immune response, inflammation, diabetes and COVID-19.

Highlights

In late December 2019, the first pneumonia cases caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred [1]
Subjects and patients with comorbidities, such as diabetes mellitus (DM), hypertension, cardiovascular disease, chronic obstructive pulmonary disease and chronic renal insufficiency, are more likely to suffer from severe COVID-19, showing a higher mortality rate [6–10]
Systemic inflammatory response, increased coagulation activity, immune response impairment and direct pancreatic damage by SARS-CoV-2 might underpin the association between diabetes and COVID-19 [13,16,17]

Summary

Introduction

In late December 2019, the first pneumonia cases caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred [1]. Subjects and patients with comorbidities, such as diabetes mellitus (DM), hypertension, cardiovascular disease, chronic obstructive pulmonary disease and chronic renal insufficiency, are more likely to suffer from severe COVID-19, showing a higher mortality rate [6–10]. DM represents one of the most relevant chronic diseases that impacts hospitalization and mortality rates, with relevant economic repercussions on health care systems. It has been estimated that, in 2019, the prevalence of DM among adults was 463 million worldwide [11] This disease represents the second most-frequent comorbidity in subjects affected by severe COVID-19 infection, after hypertension [12]. Different studies highlighted that DM is associated with disease severity, poor prognosis and mortality among COVID-19 patients [13–15]. Systemic inflammatory response, increased coagulation activity, immune response impairment and direct pancreatic damage by SARS-CoV-2 might underpin the association between diabetes and COVID-19 [13,16,17]. It could be hypothesized that the combination of SARS-CoV-2 infection and DM might represent a negative condition that tends to complicate the course of the disease [21]

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