Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2021; 12(10): 1674-1692
Published online Oct 15, 2021. doi: 10.4239/wjd.v12.i10.1674
Interactions between diabetes and COVID-19: A narrative review
Sophia Sabri, Olivier Bourron, Franck Phan, Lee S Nguyen
Sophia Sabri, Intensive Care Medicine, CMC Ambroise Paré, Neuilly-Sur-Seine 92200, France
Olivier Bourron, Franck Phan, Sorbonne Université Médecine; Assistance publique Hôpitaux de Paris (APHP), Service de Diabétologie, Hôpital Pitié-Salpêtrière; INSERM UMRS_1138, Centre de recherche des Cordeliers; Institute of CArdiometabolisme and Nutrition (ICAN), Paris 75013, France
Lee S Nguyen, Research and Innovation, RICAP, CMC Ambroise Paré, Neuilly-Sur-Seine 92200, France
Author contributions: Sabri S wrote the manuscript; Bourron O and Phan F cowrote the manuscript; Bourron O, Phan F and Nguyen LS provided expertise; and Nguyen LS supervised this work.
Conflict-of-interest statement: All other authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lee S Nguyen, MD, PhD, Doctor, Senior Researcher, Research and Innovation, RICAP, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, Neuilly-Sur-Seine 92200, France. nguyen.lee@icloud.com
Received: May 21, 2021
Peer-review started: May 21, 2021
First decision: June 16, 2021
Revised: June 29, 2021
Accepted: August 31, 2021
Article in press: August 31, 2021
Published online: October 15, 2021
Abstract

Diabetes, whether due to pancreatic beta cells insufficiency or peripheral resistance to insulin, has been suggested as a risk factor of developing severe acute respiratory disease coronavirus-2 (SARS-CoV-2) infections. Indeed, diabetes has been associated with a higher risk of infections and higher risk of developing severe forms of coronavirus disease 2019 (COVID-19) related pneumonia. Diabetic patients often present associated comorbidities such as obesity, hypertension and cardiovascular diseases, and complications of diabetes, including chronic kidney disease, vasculopathy and relative immune dysfunction, all of which make them more susceptible to infectious complications. Moreover, they often present low-grade inflammation with increased circulating interleukin levels, endothelial susceptibility to inflammation and dysfunction, and finally, hyperglycemia, which increases this risk. Additionally, corticosteroids, which count among the few medications which showed benefit on survival and mechanical ventilation requirement in COVID-19 pneumonia in large randomized controlled trials, are associated to new onsets of diabetes, and metabolic disorders in patients with previous history of diabetes. Finally, SARS-CoV-2 via the alternate effects of the renin-angiotensin system, mediated by the angiotensin-converting-enzyme 2, was also associated with insulin resistance in key tissues involved in glucose homeostasis, such as liver, skeletal muscles, and adipose tissue; and also, with impaired insulin secretion by pancreatic β-cells. In this work, we reviewed all elements which may help understand how diabetes affects patients with COVID-19, how treatments affect outcomes in patients with COVID-19, how they may cause new onsets of diabetes, and finally review how SARS-CoV-2 may inherently be a risk factor of developing diabetes, through immune-mediated diabetogenic mechanisms.

Keywords: COVID-19, Corticosteroids, Steroid-induced diabetes, Renin-angiotensin system, Prognosis

Core Tip: Diabetes features complex interactions with the severe acute respiratory disease coronavirus-2 (SARS-CoV-2). Diabetic patients are at higher risk of severe infections. They often present associated comorbidities such as obesity, hypertension and cardiovascular diseases, and complications of diabetes, including chronic kidney disease, vasculopathy and relative immune dysfunction. Additionally, corticosteroids, which count among the few medications which showed benefit on survival are associated to new onsets of diabetes, and metabolic disorders in patients with previous history of diabetes. Finally, SARS-CoV-2 via the alternate effects of the renin-angiotensin system, mediated by the angiotensin-converting-enzyme 2, was also associated with insulin resistance.