Review

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.


    Abbreviations

    DM

    Diabetes mellitus

    COVID-19

    Coronavirus disease 2019

    SARS-CoV

    Severe Acute Respiratory Syndrome Coronavirus

    SARS-CoV-2

    Severe Acute Respiratory Syndrome Coronavirus 2

    CIAD

    Research Center for Food and Development

    WHO

    World Health Organization

    CSSE

    Center for Systems Science and Engineering

    MERS

    Middle East respiratory syndrome

    ICU

    Intensive care unit

    ACE1

    Angiotensin-converting enzyme 1

    ACE2

    Angiotensin-converting enzyme 2

    ACEi

    ACE inhibitors

    RAAS

    Renin-angiotensin-aldosterone system

    ARBs

    Angiotensin-receptor blockers

    HbAc1

    glycosylated hemoglobin

    ROS

    Reactive oxygen species

    CD4+

    Cluster of differentiation 4+

    CD8+

    Cluster of differentiation 8+

    TNF-α

    Tumor necrosis factor-α

    IL

    Interleukin

    CRP

    C-reactive protein

    IFN-ϒ

    Interferon-ϒ

    CT

    Chest computed tomography

    LHD

    Lactate dehydrogenase levels

    RBD

    Receptor-binding domain

    RNA

    Ribonucleic acid

    DNA

    Desoxyribonucleic acid

    SNPs

    Single nucleotide polymorphisms

    CHD

    Coronary heart disease

    BMI

    Body mass index

    DKA

    Diabetic ketoacidosis

    TMPRSS2

    transmembrane serine protease 2

    加载中

    Acknowledgments



    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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