Abstract
Coronavirus disease 2019 (COVID-19) is a recently emerged disease with formidable infectivity and high mortality. Emerging data suggest that diabetes is one of the most prevalent comorbidities in patients with COVID-19. Although their causal relationship has not yet been investigated, preexisting diabetes can be considered as a risk factor for the adverse outcomes of COVID-19. Proinflammatory state, attenuation of the innate immune response, possibly increased level of ACE2, along with vascular dysfunction, and prothrombotic state in people with diabetes probably contribute to higher susceptibility for SARS-CoV-2 infection and worsened prognosis. On the other hand, activated inflammation, islet damage induced by virus infection, and treatment with glucocorticoids could, in turn, result in impaired glucose regulation in people with diabetes, thus working as an amplification loop to aggravate the disease. Therefore, glycemic management in people with COVID-19, especially in those with severe illness, is of considerable importance. The insights may help to reduce the fatality in the effort against COVID-19.
Highlights
Emerging information suggests that comorbid diabetes in patients with COVID-19 is associated with disease deterioration and even death
A recent study [8] pointed out that the increased baseline glycemic level was significantly associated with a higher rate of developing acute respiratory distress syndrome (ARDS) in patients with COVID-19, the data were not fully adjusted for confounders. e study by Zhu et al [16] showed that well-controlled blood glucose was associated with significantly lower mortality compared to patients with poorly controlled blood glucose during hospitalization. ese results provide clinical evidence linking improved glycemic control to better outcomes in COVID-19 patients who have preexisting type 2 diabetes, the causal relationship warrants further validation in well-designed randomized controlled trials (RCTs)
Emerging data suggest that preexisting diabetes is associated with the progression and poor outcomes of COVID-19. e underlying mechanisms of this association remain unclear
Summary
Emerging information suggests that comorbid diabetes in patients with COVID-19 is associated with disease deterioration and even death. A recent clinical study reported that compared to COVID-19 patients without diabetes, people with diabetes had activated inflammatory response (manifested as elevated levels of neutrophils, serum ferritin, IL-6, C-reactive protein (CRP), and erythrocyte sedimentation. Data from a number of observational studies did not show a significant association between ACEIs/ARBs’ use and the risk of SARS-CoV-2 infection or poor COVID-19 outcomes, which supports the statement by several societies that ACEIs and ARBs should be continued in the setting of COVID-19 pandemic [34,35,36]. Hyperglycemia and insulin resistance, together with other metabolic abnormalities in type 2 diabetes, impair the vascular wall through a number of events, including oxidative stress, endothelial dysfunction, platelet hyperactivity, and low-grade inflammation Activation of these events promotes vasoconstriction and thrombus formation, increasing the vascular risk as well as mortality and morbidity rate in diabetic patients [59, 60]. There remains much interest, and an urgent clinical need, to compare the prevalence and incidence of thrombotic complications between COVID-19 patients with and without diabetes, to delineate the underlying mechanisms, and to investigate whether good glycemic control could reduce the incidence of thrombotic complications in patients with COVID-19
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