Published online Mar 15, 2021. doi: 10.4239/wjd.v12.i3.215
Peer-review started: November 6, 2020
First decision: December 11, 2020
Revised: December 20, 2020
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: March 15, 2021
Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.
Core Tip: This narrative review hypothesizes that there is a bidirectional link between diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19). The first bidirectional link is from COVID-19 to DM due to pancreatic damage or renin-angiotensin-aldosterone system dysregulation or cytokine storm. This is caused by the endocytosis of severe acute respiratory syndrome coronavirus 2. The second bidirectional link is from DM to COVID-19 and is due to drug-induced or impaired immunity or raised furin levels in DM. The review furthers explores the five pathways leading to cardiovascular diseases.