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?:abstract
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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.
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