The interaction between COVID-19 and diabetes

People with diabetes have worse prognosis with COVID-19 infections. This review explores the potential prognostic factors underlying this clinical observation.

The syndromic nature of diabetes, multiple associated conditions (hypertension, cardiovascular diseases, obesity, a pro-inflammatory and pro-coagulative state), age, sex and ethnicity of the patients are probable multi-factorial drivers of the poor prognosis.

Further studying the reasons for worse outcomes in COVID-19 patients with diabetes, the researchers found that COVID-19 infection can precipitate acute metabolic complications through direct negative effects on the β-cell function. This review also highlights a potential mechanism for worsening outcomes in that a negative impact of COVID-19 infection on β-cell function may precipitate diabetic ketoacidosis in dysglycaemic individuals (overt diabetes, hyperglycaemia at hospital admission in patients with unknown history of diabetes, and potentially new-onset diabetes).

The biunivocal relationship between diabetes and COVID-19 might cause new onset of diabetes or sustained hyperglycaemia at hospital admission in patients infected with the COVID-19 virus. The SARS-CoV-2 (virus responsible for COVID-19) tropism for the β-cells leading to impairment of the insulin secretion could be the underlying mechanism behind the development of new onset of diabetes in the COVID-19 patients. New-onset diabetes, hyperglycaemia at admission and acute metabolic deterioration, in turn, can further worsen COVID-19 outcomes. The collective impairment of β-cell function and the inflammatory cytokine storm may further cause the worsening of the metabolic controls in patients with diabetes. Thus, to reduce the risk of metabolic complications, glycaemic control should be ensured in patients with hyperglycaemia during the hospital stay (see figure below, adapted from Apicella et al).

"The potential negative impact of diabetes and its chronic complications indicates once more to optimize glucose control in subjects with diabetes."

Dr. De Cosmo