Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2021; 12(3): 215-237
Published online Mar 15, 2021. doi: 10.4239/wjd.v12.i3.215
Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review
Vijay Viswanathan, Anudeep Puvvula, Ankush D Jamthikar, Luca Saba, Amer M Johri, Vasilios Kotsis, Narendra N Khanna, Surinder K Dhanjil, Misha Majhail, Durga Prasanna Misra, Vikas Agarwal, George D Kitas, Aditya M Sharma, Raghu Kolluri, Subbaram Naidu, Jasjit S Suri
Vijay Viswanathan, M Viswanathan Hospital for Diabetes, M Viswanathan Diabetes Research Centre, Chennai 600013, India
Anudeep Puvvula, Annu’s Hospitals for Skin and Diabetes, Nellore 524101, Andhra Pradesh, India
Ankush D Jamthikar, Department of Electronics and Communications, Visvesvaraya National Institute of Technology, Nagpur 440010, Maharashtra, India
Luca Saba, Department of Radiology, University of Cagliari, Monserrato 09045, Cagliari, Italy
Amer M Johri, Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
Vasilios Kotsis, 3rd Department of Internal Medicine, Hypertension Center, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki 541-24, Greece
Narendra N Khanna, Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110020, India
Surinder K Dhanjil, Stroke Diagnosis and Monitoring Division, AtheroPoint™ LLC, CA 95661, United States
Misha Majhail, Jasjit S Suri, Stroke Diagnosis and Monitoring Division, AtheroPoint™, Roseville, CA 95661, United States
Durga Prasanna Misra, Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Vikas Agarwal, Departments of Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
George D Kitas, Academic Affairs, Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, United Kingdom
George D Kitas, Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, United Kingdom
Aditya M Sharma, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22908, United States
Raghu Kolluri, OhioHealth Heart and Vascular, Ohio, OH 43082, United States
Subbaram Naidu, Electrical Engineering Department, University of Minnesota, Duluth, MN 55812, United States
Author contributions: Viswanathan V, Suri JS, Puvvala A, and Jamthikar A contributed conception and design; Dhanjil SK and Khanna NN contributed administrative support; Suri JS, Puvvala A, and Jamthikar A contributed manuscript writing; Johri AM, Kitas GD, Agarwal V, Misra DP, and Dhanjil SK contributed critical evaluation; Sharma A, Kolluri R, Dhanjil SK, Khanna NN, Jamthikar A, and Suri JS contributed vascular inputs; All authors have read and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest among the authors. Dr. Jasjit Suri is affiliated with AtheroPoint™, focused in the area of stroke and cardiovascular imaging.
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:
Corresponding author: Jasjit S Suri, PhD, Professor, Stroke Diagnosis and Monitoring Division, AtheroPoint™, 208 Otter Glen Ct., Roseville, CA 95661, United States.
Received: November 6, 2020
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
Core Tip

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.