Chest radiological finding of COVID-19 in patients with and without diabetes mellitus: Differences in imaging finding

Abstract

The pandemic of novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus is a risk factor for developing severe illness and a leading cause of death in patients with COVID-19. Diabetes can precipitate hyperglycaemic emergencies and cause prolonged hospital admissions. Insulin resistance is thought to cause endothelial dysfunction, alveolar capillary micro-angiopathy and interstitial lung fibrosis through pro-inflammatory pathways. Autopsy studies have also demonstrated the presence of microvascular thrombi in affected sections of lung, which may be associated with diabetes. Chest imaging using x-ray (CXR) and computed tomography (CT) of chest is used to diagnose, assess disease progression and severity in COVID-19. This article reviews current literature regarding chest imaging findings in patients with diabetes affected by COVID-19. A literature search was performed on PubMed. Patients with diabetes infected with SARS-CoV-2 are likely to have more severe infective changes on CXR and CT chest imaging. Severity of airspace consolidation on CXR is associated with higher mortality, particularly in the presence of co-morbidities such as ischaemic heart disease. Poorly controlled diabetes is associated with more severe acute lung injury on CT. However, no association has been identified between poorly-controlled diabetes and the incidence of pulmonary thromboembolism in patients with COVID-19.

Topical Reappraisal of Molecular Pharmacological Approaches to Endothelial Dysfunction in Diabetes Mellitus Angiopathy

“…Insulin resistance and impaired glucose homeostasis have been shown to cause alveolar capillary microangiopathy and interstitial fibrosis due to super inflammation [ 72 ]. In addition, elevated HbA1c levels have been associated with inflammation and hypercoagulability, leading to an increased mortality rate in patients with diabetes with COVID-19 [ 73 ].…”

“…In situ microvascular thrombosis or immunothrombosis occurs due to alveolar injury, inflammatory storm, and disruption in the thromboprotective pulmonary vascular endothelium. The clinical results of COVID-19 are worse in patients with diseases associated with endothelial dysfunction, such as systemic hypertension, diabetes, and obesity [ 73 ].…”

Lenfopenik Olan Hafif COVID-19 Vakalarında İmmun Plazma Tedavisi Ne Kadar Güvenliydi?

“…Remarkably, patients with the involvement of 50% of their parenchyma had higher fibrous scores than those with single lobe involvement. This may indicate that, in addition to detecting more airspace consolidation in diabetics, [32] vascular microemboli are highly involved in the pathogenesis. [33] One criticism of this work on COVID-19-related pulmonary fibrosis is the sample size.…”

Severity of COVID-19 infection in patients with COVID-19 combined with diabetes

“…Previous research has shown that, compared with normal infected individuals, patients with diabetes exhibit more severe conditions in terms of clinical course and chest imaging and are more likely to develop critical COVID-19 [ 5 , 7 , 8 ]. In addition, those with poor blood glucose control have a worse prognosis [ 9 ].…”