Abstract
The outbreak of the Coronavirus Disease 2019 (COVID-19) started in December 2019 in Wuhan (China) and has since spread in more than 200 countries. The pandemic was brought about by a novel virus causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among the comorbidities of people suffering from COVID-19, the most prevalent are diabetes, cardiovascular disease, and hypertension, all of which are associated with worse outcomes (1). People with diabetes are at increased risk of severe viral respiratory tract infections, including the SARS-CoV, H1N1 influenza, and Middle East Respiratory Syndrome (MERS-CoV). The prevalence of diabetes in individuals with COVID-19 has been reported to range between nearly 10% and up to 30%, depending on the location of the study, population, age of participants in the studies, severity of illness, and method of testing (2). Moreover, diabetes has emerged as an important predictor of severity of the SARS-CoV-2, as the risk of fatal outcomes has been reported to be 50% higher in individuals with diabetes than in those without (3). Given the high transmission rate of SARS-CoV-2 and the global prevalence of diabetes, which affects nearly half a billion people worldwide, the coexistence of both COVID-19 and diabetes should be considered alarming, as it represents the combination of two pandemics.
Highlights
The outbreak of the Coronavirus Disease 2019 (COVID-19) started in December 2019 in Wuhan (China) and has since spread in more than 200 countries
There are no studies confirming that, in diabetic people, the improvement of glycemic control associated with a high adherence to the Mediterranean dietary pattern may protect from lung infections or blunt the severity of the disease
There is evidence from a large retrospective study of individuals affected by COVID-19, including nearly 1,000 participants with type 2 diabetes, that wellcontrolled blood glucose was associated with lower mortality compared with individuals with poor glycemic control during hospitalization, supporting the correlation between improved glucose control and better outcomes in SARS-CoV-2 affectedpatients with pre-existing diabetes [21]
Summary
The outbreak of the Coronavirus Disease 2019 (COVID-19) started in December 2019 in Wuhan (China) and has since spread in more than 200 countries. An imbalance between coagulation and fibrinolysis takes place in diabetes, with enhanced platelet aggregation and activation, favoring the development of a hypercoagulable pro-thrombotic state All these alterations may represent the underlying conditions linking diabetes to other chronic conditions, including hypertension and cardiovascular diseases [5]. Evidence from randomized controlled trials evaluating the effect of anti-inflammatory drugs on glycemic control or cardiovascular events in people with type 2 diabetes suggest only a modest effect on HbA1c reduction [5]; whether patients with cardiovascular diseases and/or type 2 diabetes may have clinical benefit from marked reductions in circulating inflammatory markers remains controversial Both the maintenance and intensification of the glycometabolic control in individuals with diabetes who have not been infected with the SARS-CoV-2 virus has suggested to be a means of primary prevention of COVID-19 disease [3]
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