Abstract
Covid-19 is a recently-emerged infectious disease caused by the novel severe acute respiratory syndrome coronavirus SARS-CoV2. SARS-CoV2 differs from previous coronavirus infections (SARS and MERS) due to its high infectivity (reproduction value, R0, typically 2–4) and pre- or asymptomatic transmission, properties that have contributed to the current global Covid-19 pandemic. Identified risk factors for disease severity and death from SARS-Cov2 infection include older age, male sex, diabetes, obesity and hypertension. The reasons for these associations are still largely obscure. Evidence is also emerging that SARS-CoV2 infection exacerbates the underlying pathophysiology of hyperglycemia in people with diabetes. Here, we discuss potential mechanisms through which diabetes may affect the risk of more severe outcomes in Covid-19 and, additionally, how diabetic emergencies and longer term pathology may be aggravated by infection with the virus. We consider roles for the immune system, the observed phenomenon of microangiopathy in severe Covid-19 infection and the potential for direct viral toxicity on metabolically-relevant tissues including pancreatic beta cells and targets of insulin action.
Highlights
Reviewed by: Rinke Stienstra, Radboud University Nijmegen Medical Centre, Netherlands Clodoveo Ferri, University of Modena and Reggio
Since its emergence in December 2019 in Wuhan, China, severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2), subsequently called coronavirus disease 19 (Covid-19), has ravaged the world [1] and was declared a pandemic by the World Health Organization (WHO) in March 2020 [2]
In results from Fang et al [18], patients with diabetes and hypertension who had been treated with ACE inhibitors or angiotensin receptor blockers (ARB) had a high number of angiotensin-converting enzyme 2 (ACE2) receptors in the lung, and could be at higher risk of developing severe symptoms, if infected with Covid-19
Summary
Reviewed by: Rinke Stienstra, Radboud University Nijmegen Medical Centre, Netherlands Clodoveo Ferri, University of Modena and Reggio. Identified risk factors for disease severity and death from SARS-Cov2 infection include older age, male sex, diabetes, obesity and hypertension.
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