The underlying mechanisms for severe COVID-19 progression in people with diabetes mellitus: a critical review

  • Received: 23 August 2021 Accepted: 20 October 2021 Published: 26 October 2021
  • Diabetes mellitus (DM) has a high incidence of comorbidities among patients with severe coronavirus disease 2019 (COVID-19). The elevated prevalence of DM in the world population makes it a significant risk factor because diabetic individuals appear to be prone to clinical complications and have increased mortality rates. Here, we review the possible underlying mechanisms involved in DM that led to worse outcomes in COVID-19. The impacts of hyperglycemia side effects, secondary comorbidities, weakened innate and adaptive immunity, chronic inflammation, and poor nutritional status, commonly present in DM, are discussed. The role of the SARS-CoV-2 receptor and its polymorphic variations on higher binding affinity to facilitate viral uptake in people with DM were also considered. Clinical differences between individuals with type 1 DM and type 2 DM affected by COVID-19 and the potential diabetogenic effect of SARS-CoV-2 infection were addressed.

    Citation: María D Figueroa-Pizano, Alma C Campa-Mada, Elizabeth Carvajal-Millan, Karla G Martinez-Robinson, Agustin Rascon Chu. The underlying mechanisms for severe COVID-19 progression in people with diabetes mellitus: a critical review[J]. AIMS Public Health, 2021, 8(4): 720-742. doi: 10.3934/publichealth.2021057

    Related Papers:

  • Diabetes mellitus (DM) has a high incidence of comorbidities among patients with severe coronavirus disease 2019 (COVID-19). The elevated prevalence of DM in the world population makes it a significant risk factor because diabetic individuals appear to be prone to clinical complications and have increased mortality rates. Here, we review the possible underlying mechanisms involved in DM that led to worse outcomes in COVID-19. The impacts of hyperglycemia side effects, secondary comorbidities, weakened innate and adaptive immunity, chronic inflammation, and poor nutritional status, commonly present in DM, are discussed. The role of the SARS-CoV-2 receptor and its polymorphic variations on higher binding affinity to facilitate viral uptake in people with DM were also considered. Clinical differences between individuals with type 1 DM and type 2 DM affected by COVID-19 and the potential diabetogenic effect of SARS-CoV-2 infection were addressed.



    Diabetes mellitus


    Coronavirus disease 2019


    Severe Acute Respiratory Syndrome Coronavirus


    Severe Acute Respiratory Syndrome Coronavirus 2


    Research Center for Food and Development


    World Health Organization


    Center for Systems Science and Engineering


    Middle East respiratory syndrome


    Intensive care unit


    Angiotensin-converting enzyme 1


    Angiotensin-converting enzyme 2


    ACE inhibitors


    Renin-angiotensin-aldosterone system


    Angiotensin-receptor blockers


    glycosylated hemoglobin


    Reactive oxygen species


    Cluster of differentiation 4+


    Cluster of differentiation 8+


    Tumor necrosis factor-α




    C-reactive protein




    Chest computed tomography


    Lactate dehydrogenase levels


    Receptor-binding domain


    Ribonucleic acid


    Desoxyribonucleic acid


    Single nucleotide polymorphisms


    Coronary heart disease


    Body mass index


    Diabetic ketoacidosis


    transmembrane serine protease 2



    This research was funded by the program “2do año de continuidad de estancias posdoctorales vinculadas al fortalecimiento de la calidad del posgrado nacional”, granted by Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico. Grant number I1200/94/2020. M. D Figueroa-Pizano acknowledges CONACyT for the support provided for postdoctoral research.

    Conflict of interest

    All authors declare no conflicts of interest in this paper.

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