Implications of COVID-19 Pandemic on Evolution of Diabetes in Malaria-Endemic African Region

Abstract

The coronavirus disease 2019 (COVID-19) pandemic continues to cause havoc to many countries of the globe, with no end in sight, due to nonavailability of a given vaccine or treatment regimen. The pandemic has so far had a relatively limited impact on the African continent, which contributes more than 93% of global malaria burden. However, the limited burden of COVID-19 pandemic on the African region could have long-term implications on the health and wellbeing of affected inhabitants due to its malaria-endemic status. Malaria causes recurrent insulin resistance with episodes of infection at relatively low parasitaemia. Angiotensin-converting enzyme 2 (ACE2) which is widely distributed in the human body is implicated in the pathogenesis of malaria, type 2 diabetes mellitus (T2DM), and COVID-19. Use of ACE2 by the COVID-19 virus induces inflammation and oxidative stress, which can lead to insulin resistance. Although COVID-19 patients in malaria-endemic African region may not exhibit severe signs and symptoms of the disease, their risk of exhibiting heightened insulin resistance and possible future development of T2DM is high due to their prior exposure to malaria. African governments must double efforts at containing the continued spread of the virus without neglecting existing malarial control measures if the region is to avert the plausible long-term impact of the pandemic in terms of future development of T2DM.

Genetic Variants within SARS-CoV-2 Human Receptor Genes May Contribute to Variable Disease Outcomes in Different Ethnicities

“…Therefore, the hypothesis that links malaria-hypertension-COVID-19 is rational, further warranting the need to identify ACE2 polymorphisms, such as rs2106809 (A>G), rs2285666 (C>T), and others, which control the expression of ACE2 [90]. Since the COVID-19 pandemic, various studies have outlined the relationship between malaria-ACE2 and COVID-19 severity and susceptibility [90][91][92][93].…”

Diabetes como um fator associado ao óbito hospitalar por COVID-19 no Brasil, 2020

“…21 Nesse sentido, ressalta-se que o controle glicêmico é fundamental para a prevenção dessas condições. 22,23 Outro ponto relevante encontra-se no fato de os diversos níveis de isolamento social, adotados durante os meses de pandemia, terem alterado o estilo de vida das pessoas, sua maior presença em casa, aumentando a ansiedade e o consumo alimentar. 24 Isto pode ter implicado maior consumo de calorias, menor gasto energético e instabilidade metabólica, 25,26 justamente fatores de forte impacto em diabéticos por conta das alterações glicêmicas que a doença causa.…”