COVID-19 in People With Diabetes: Urgently Needed Lessons From Early Reports

SPS commentary:

The data reported in these articles were rapidly collected and analysed, thus some of the analyses are understandably limited due to missing data, incomplete follow-up, and inability to identify infected but asymptomatic patients. Despite these limitations, some, some points are clear:

 

• The consistency of findings in these reports is reassuring in terms of scientific validity, but the story unfolding is worrisome. Diabetes has not yet been shown to increase the likelihood of infection, but progression to severe illness is more likely in people with diabetes.

 

• The frequency of diabetes among patients requiring intensive care is two to three times higher than in the overall population, and mortality rates in those with diabetes are also higher. Neither the mechanisms underlying the increased risk nor the best interventions to limit it have yet been defined, but the studies in this collection of articles offer important clues.

 

• Obesity is a major risk factor for diabetes and appears to be an independent risk factor for severe illness in COVID-19. Rates of severe illness are therefore likely to be especially frequent in regions and populations where both obesity and diabetes are common.

 

• Because more severe hyperglycaemia accompanies progression to severe pulmonary and systemic illness, better metabolic control with insulin infusion or other means may be protective.

 

• Complications of diabetes including renal, cardiac, and peripheral vascular disease can be additive risk factors and call for specific attention. Some circulating markers of systemic inflammation are elevated in severe cases, suggesting possible molecular sites for intervention.

 

• Of particular interest is the observation that ACE2 expression is associated with diabetes and may be involved in this viral infection, offering another starting point for research to develop specifically targeted interventions.