Impact of Diabetes Among People Infected with COVID-19

Abstract

This is a brief review aimed to characterize the novel coronavirus (SARS-CoV-2) for a better understanding of the COVID-19 in people with diabetes, and its management. We searched for articles in PubMed and Google Scholar databases for articles related to this subject. The clinical spectrum of COVID-19 is heterogeneous. Older age, diabetes, and other comorbidities are reported as significant predictors of morbidity and mortality. Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying mechanisms of the association between diabetes and COVID-19. Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus (SARS-CoV and SARSCoV-2) were bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs). These data suggest that ACE2 expression is increased in diabetes with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesize that diabetes treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19. Caution should be taken to potential hypoglycemic events with the use of chloroquine in diabetic patients. In conclusion: It is difficult to extract specific conclusions based on currently limited evidence. Therefore, further researches are needed to identify the real relationship between diabetic patients and COVID-19.