COVID-19 and Diabetes: A Collision and Collusion of Two Diseases

The coronavirus disease 2019 (COVID-19) pandemic has infected >22.7 million and led to the deaths of 795,000 people worldwide. Patients with diabetes are highly susceptible to COVID-19–induced adverse outcomes and complications. The COVID-19 pandemic is superimposing on the preexisting diabetes pandemic to create large and significantly vulnerable populations of patients with COVID-19 and diabetes. This article provides an overview of the clinical evidence on the poorer clinical outcomes of COVID-19 infection in patients with diabetes versus patients without diabetes, including in specific patient populations, such as children, pregnant women, and racial and ethnic minorities. It also draws parallels between COVID-19 and diabetes pathology and suggests that preexisting complications or pathologies in patients with diabetes might aggravate infection course. Finally, this article outlines the prospects for long-term sequelae after COVID-19 for vulnerable populations of patients with diabetes.

[1]  N. Oliver,et al.  New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter Regional Findings in the U.K. , 2020, Diabetes Care.

[2]  K. Khunti,et al.  Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study , 2020, The Lancet Diabetes & Endocrinology.

[3]  K. Khunti,et al.  Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study , 2020, The Lancet Diabetes & Endocrinology.

[4]  R. Pop-Busui,et al.  Managing Hyperglycemia in the COVID-19 Inflammatory Storm , 2020, Diabetes.

[5]  Feng Wu,et al.  Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study , 2020, Diabetologia.

[6]  Angelo Carfì,et al.  Persistent Symptoms in Patients After Acute COVID-19. , 2020, JAMA.

[7]  K. Bhaskaran,et al.  OpenSAFELY: factors associated with COVID-19 death in 17 million patients , 2020, Nature.

[8]  J. Laukkanen,et al.  Renal complications in COVID-19: a systematic review and meta-analysis , 2020, Annals of medicine.

[9]  K. Bhaskaran,et al.  Factors associated with COVID-19-related death using OpenSAFELY , 2020, Nature.

[10]  Heshui Shi,et al.  Baseline characteristics and risk factors for short-term outcomes in 132 COVID-19 patients with diabetes in Wuhan China: A retrospective study , 2020, Diabetes Research and Clinical Practice.

[11]  R. Muniyappa,et al.  Metabolic Syndrome and COVID 19: Endocrine-Immune-Vascular Interactions Shapes Clinical Course , 2020, Endocrinology.

[12]  J. Gerber,et al.  The Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in a Pediatric Healthcare Network in the United States , 2020, Journal of the Pediatric Infectious Diseases Society.

[13]  J. Gerber,et al.  The Epidemiology of SARS-CoV-2 in a Pediatric Healthcare Network in the United States. , 2020, Journal of the Pediatric Infectious Diseases Society.

[14]  Y. Tie,et al.  Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[15]  P. Munroe,et al.  Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank , 2020, Journal of public health.

[16]  P. Kuhn,et al.  Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth , 2020, American Journal of Obstetrics and Gynecology.

[17]  P. Brocklehurst,et al.  Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study , 2020, BMJ.

[18]  N. Patel.  Pediatric COVID-19: Systematic review of the literature , 2020, American Journal of Otolaryngology.

[19]  Nudrat Noor,et al.  Type 1 Diabetes and COVID-19: Preliminary Findings From a Multicenter Surveillance Study in the U.S. , 2020, Diabetes Care.

[20]  A. Brufsky,et al.  Impaired glucose metabolism in patients with diabetes, prediabetes, and obesity is associated with severe COVID‐19 , 2020, medRxiv.

[21]  M. Heneka,et al.  Immediate and long-term consequences of COVID-19 infections for the development of neurological disease , 2020, Alzheimer's Research & Therapy.

[22]  Adam J. Schweickert,et al.  Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children's Hospital in New York City, New York. , 2020, JAMA pediatrics.

[23]  M. Zervos,et al.  Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit , 2020, JAMA network open.

[24]  C. Gale,et al.  Ethnic disparities in hospitalisation for COVID-19 in England: The role of socioeconomic factors, mental health, and inflammatory and pro-inflammatory factors in a community-based cohort study , 2020, Brain, Behavior, and Immunity.

[25]  S. Szpunar,et al.  Predictors for Severe COVID-19 Infection , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  S. Hadjadj,et al.  Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study , 2020, Diabetologia.

[27]  E. Price-Haywood,et al.  Hospitalization and Mortality among Black Patients and White Patients with Covid-19 , 2020, The New England journal of medicine.

[28]  Leora I. Horwitz,et al.  Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study , 2020, BMJ.

[29]  Kristen M J Azar,et al.  Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California. , 2020, Health affairs.

[30]  Yanjun Zeng,et al.  Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study , 2020, Diabetes Research and Clinical Practice.

[31]  M. Marre,et al.  Prognostic factors in patients with diabetes hospitalized for COVID-19: Findings from the CORONADO study and other recent reports , 2020, Diabetes & Metabolism.

[32]  M. Maiorino,et al.  Type 1 diabetes triggered by covid-19 pandemic: A potential outbreak? , 2020, Diabetes Research and Clinical Practice.

[33]  J. Munson,et al.  Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State , 2020, American Journal of Obstetrics and Gynecology.

[34]  V. Montalvan,et al.  Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review , 2020, Clinical Neurology and Neurosurgery.

[35]  Feng Gao,et al.  Obesity Is a Risk Factor for Greater COVID-19 Severity , 2020, Diabetes Care.

[36]  Xuanzhe Zhang,et al.  Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study , 2020, Diabetes Care.

[37]  Kenar D. Jhaveri,et al.  Acute kidney injury in patients hospitalized with COVID-19 , 2020, Kidney International.

[38]  Victor G. Puelles,et al.  Multiorgan and Renal Tropism of SARS-CoV-2 , 2020, The New England journal of medicine.

[39]  P. Valensi,et al.  Issues of Cardiovascular Risk Management in People With Diabetes in the COVID-19 Era , 2020, Diabetes Care.

[40]  Limin Ou,et al.  Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. , 2020, JAMA internal medicine.

[41]  M. Priestley,et al.  Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. , 2020, JAMA pediatrics.

[42]  M. Cabana,et al.  Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City , 2020, The Journal of Pediatrics.

[43]  M. El Chaar,et al.  Are black and Hispanic persons disproportionately affected by COVID-19 because of higher obesity rates? , 2020, Surgery for Obesity and Related Diseases.

[44]  D. Klonoff,et al.  Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States , 2020, Journal of diabetes science and technology.

[45]  C. Beyrer,et al.  Assessing differential impacts of COVID-19 on black communities , 2020, Annals of Epidemiology.

[46]  James M. Blum,et al.  Characteristics and Clinical Outcomes of Adult Patients Hospitalized with COVID-19 — Georgia, March 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[47]  Fang Lei,et al.  Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes , 2020, Cell Metabolism.

[48]  G. Iacobellis,et al.  Admission hyperglycemia and radiological findings of SARS-CoV2 in patients with and without diabetes , 2020, Diabetes Research and Clinical Practice.

[49]  N. Rovina,et al.  Soluble urokinase plasminogen activator receptor (suPAR) as an early predictor of severe respiratory failure in patients with COVID-19 pneumonia , 2020, Critical Care.

[50]  A. Shah,et al.  A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study , 2020, Journal of Infection.

[51]  Xiaosheng Wang,et al.  Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues , 2020, Infectious Diseases of Poverty.

[52]  C. Hedrich,et al.  COVID-19: Immunology and treatment options , 2020, Clinical Immunology.

[53]  Hangyuan Guo,et al.  Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis , 2020, Journal of Infection.

[54]  Eun Ji Kim,et al.  Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. , 2020, JAMA.

[55]  Hong Zhang,et al.  The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: A single‐centre, retrospective, observational study in Wuhan , 2020, Diabetes, obesity & metabolism.

[56]  D. Brodie,et al.  Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study , 2020, medRxiv.

[57]  Holger Moch,et al.  Endothelial cell infection and endotheliitis in COVID-19 , 2020, The Lancet.

[58]  Xuexian Fang,et al.  Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis , 2020, Research.

[59]  Nathaniel Hupert,et al.  Clinical Characteristics of Covid-19 in New York City , 2020, The New England journal of medicine.

[60]  N. Marx,et al.  The Characteristics of 50 Hospitalized COVID-19 Patients With and Without ARDS. , 2020, Deutsches Arzteblatt international.

[61]  D. Drucker.  Coronavirus infections and type 2 diabetes-shared pathways with therapeutic implications , 2020, Endocrine reviews.

[62]  Stefano Volpi,et al.  On the Alert for Cytokine Storm: Immunopathology in COVID‐19 , 2020, Arthritis & rheumatology.

[63]  D. Mathieu,et al.  High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) Requiring Invasive Mechanical Ventilation , 2020, Obesity.

[64]  D. Luton,et al.  A snapshot of the Covid-19 pandemic among pregnant women in France , 2020, Journal of Gynecology Obstetrics and Human Reproduction.

[65]  Cdc Covid- Response Team.  Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 — United States, February 12–March 28, 2020 , 2020 .

[66]  Emily N. Ussery,et al.  Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[67]  C. Eastin,et al.  Clinical Characteristics of Coronavirus Disease 2019 in China , 2020, The Journal of Emergency Medicine.

[68]  Heng Fan,et al.  Diabetes is a risk factor for the progression and prognosis of COVID‐19 , 2020, Diabetes/metabolism research and reviews.

[69]  Weidong Wu,et al.  Virology, Epidemiology, Pathogenesis, and Control of COVID-19 , 2020, Viruses.

[70]  Mohammad Madjid,et al.  Potential Effects of Coronaviruses on the Cardiovascular System: A Review. , 2020, JAMA cardiology.

[71]  Howard Bauchner,et al.  Editorial Concern-Possible Reporting of the Same Patients With COVID-19 in Different Reports. , 2020, JAMA.

[72]  Xin Zhou,et al.  Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China , 2020, The Journal of Emergency Medicine.

[73]  Qiang Zhou,et al.  Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2 , 2020, Science.

[74]  G. Herrler,et al.  SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor , 2020, Cell.

[75]  J. Xiang,et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study , 2020, The Lancet.

[76]  K. Yuen,et al.  Clinical Characteristics of Coronavirus Disease 2019 in China , 2020, The New England journal of medicine.

[77]  Wei Wang,et al.  Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis , 2020, European Respiratory Journal.

[78]  Zunyou Wu,et al.  Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. , 2020, JAMA.

[79]  M. Chan,et al.  Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis , 2020, Annals of Intensive Care.

[80]  Yan Zhao,et al.  Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. , 2020, JAMA.

[81]  M. Banerjee,et al.  The Prevalence and Determinants of Cognitive Deficits and Traditional Diabetic Complications in the Severely Obese , 2020, Diabetes Care.

[82]  J. Luban.  SARS-CoV-2 , 2020 .

[83]  A. Caspi,et al.  Association of Adverse Experiences and Exposure to Violence in Childhood and Adolescence With Inflammatory Burden in Young People , 2019, JAMA pediatrics.

[84]  T. Uyeki,et al.  Quality of life reported by survivors after hospitalization for Middle East respiratory syndrome (MERS) , 2019, Health and Quality of Life Outcomes.

[85]  G. Biessels,et al.  Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications , 2018, Nature Reviews Endocrinology.

[86]  M. Raad,et al.  Predicting Mortality in African Americans With Type 2 Diabetes Mellitus: Soluble Urokinase Plasminogen Activator Receptor, Coronary Artery Calcium, and High‐Sensitivity C‐Reactive Protein , 2018, Journal of the American Heart Association.

[87]  Eva L. Feldman,et al.  MICROVASCULAR COMPLICATIONS — NEUROPATHY ( R POP-BUSUI , SECTION EDITOR ) Inflammation as a Therapeutic Target for Diabetic Neuropathies , 2016 .

[88]  A. Quyyumi,et al.  Soluble Urokinase Receptor and Chronic Kidney Disease. , 2015, The New England journal of medicine.

[89]  C. Correll,et al.  Outcomes of SARS survivors in China: not only physical and psychiatric co-morbidities. , 2014, East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan.

[90]  K. Borch-Johnsen,et al.  The pro-inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is associated with incident type 2 diabetes among overweight but not obese individuals with impaired glucose regulation: effect modification by smoking and body weight status , 2013, Diabetologia.

[91]  M. Cooper,et al.  Mechanisms of diabetic complications. , 2013, Physiological reviews.

[92]  임재영,et al.  BMI(Body Mass Index)가 소득에 미치는 영향 , 2012 .

[93]  R. Gans,et al.  Plasma procalcitonin and risk of type 2 diabetes in the general population , 2011, Diabetologia.

[94]  S. Shoelson,et al.  Type 2 diabetes as an inflammatory disease , 2011, Nature Reviews Immunology.

[95]  V. Preedy,et al.  Prospective Cohort Study , 2010 .

[96]  M. Tong,et al.  Long-term sequelae of SARS: physical, neuropsychiatric, and quality-of-life assessment. , 2009, Hong Kong medical journal = Xianggang yi xue za zhi.

[97]  Y. Guan,et al.  The role of influenza virus gene constellation and viral morphology on cytokine induction, pathogenesis, and viral virulence. , 2009, Hong Kong medical journal = Xianggang yi xue za zhi.

[98]  Jin-Kui Yang,et al.  Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes , 2009, Acta Diabetologica.