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Diabetes Mellitus and SARS-CoV-2 Infection: Pathophysiologic Mechanisms and Implications in Management

Author(s):

Natalia G. Vallianou*, Angelos Evangelopoulos, Dimitris Kounatidis, Theodora Stratigou, Gerasimos Socrates Christodoulatos, Irene Karampela and Maria Dalamaga   Pages 1 - 11 ( 11 )

Abstract:


Introduction: Currently, diabetes mellitus (DM) as well as coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are major public health issues worldwide.

Background: It has been suggested that patients with DM are more vulnerable to SARS-CoV-2 infection and suffer from more severe forms of the disease.

Methods: A literature search was performed using PubMed, Scopus and Google search engines.

Results: Angiotensin converting enzyme-2 (ACE2) is the major receptor of SARS-CoV-2 in the human host. The differential expression of ACE2 in the lungs of patients with DM makes them more susceptible to COVID-19. Additionally, acute or chronic hyperglycemia renders individuals in an immune-suppressive state, with impaired innate and adaptive immunity function, contributing also to the severity of COVID-19 infection among patients with DM. Other factors contributing to a more severe course of COVID-19 include the co-existence of obesity in T2DM; the endothelial inflammation induced by the SARS-CoV-2 infection, which aggravates the endothelial dysfunction observed in both T1DM and T2DM; and the hypercoagulability presented in COVID-19 infection that increases the thrombotic tendency in DM.

Conclusion: This review summarizes the pathophysiologic mechanisms underlying the co-existence of both pandemics as well as the current recommendations and future perspectives regarding optimal treatment of inpatients and outpatients with DM in the era of SARS-CoV-2 infection. Notably, the current recommended drugs for the treatment of severe COVID-19, dexamethasone and remdesivir, may cause hyperglycemia, an adverse effect that physicians should bear in mind, when caring for patients with DM and COVID-19.

Keywords:

diabetes mellitus, COVID-19, pandemic, pathogenesis, SARS-CoV-2, treatment

Affiliation:

Department of Endocrinology, 'Evangelismos' General Hospital of Athens, 45-47 Ypsilantou street, 10676 Athens, Roche Diagnostics (Hellas) S.A., 18-20 Amarousiou-Chalandriou str, 15125, Athens, Department of Endocrinology, 'Evangelismos' General Hospital of Athens, 45-47 Ypsilantou street, 10676 Athens, Department of Endocrinology, 'Evangelismos' General Hospital of Athens, 45-47 Ypsilantou street, 10676 Athens, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527 Athens, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527 Athens, Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini street, Haidari, 12462 Athens



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