Diabetes being a risk factor for hospitalization and mortality in patients infected with COVID 19 is no longer a conspiracy. In a study of 52 COVID 19 intensive care patients, diabetes was established to be a comorbidity in 22% of the 32 nonsurvivors. Scientific data has shown a two-fold increase in the incidence of COVID 19 patients with diabetes needing intensive care. Mortality has been reported to be about 3 times higher in diabetic patients. Apart from diabetes other common comorbidities reported to be COVID 19 risk factors by CDC include hypertension, liver disease, cancer, cardiovascular disease, and lung disease. COVID 19 has also been established to cause temporary diabetes. Here we explain 3 pathways to the relationship between diabetes and COVID 19.
1.Compromised immune system
Diabetes impairs the immune system compromising its response to infection both with T cell and macrophage activation and cytokine profile. Diabetes is identified as a disturbance of glucose homeostasis and progressive increase of glucose in blood circulation known as hyperglycemia. High glucose concentration is an independent predictor of death and morbidity in other infections which likely to be the case with COVID 19.
2. Obesity and weak metabolic system
While obesity is also a risk factor for severe infection, many people with type 2 diabetes are obese. During the 2009 H1N1 epidemic, It was reported that patients with obesity were twice likely to be treated in intensive care units as compared to the background population. Obesity is associated with abnormal metabolic activity resulting in abnormal secretion of adipokines and cytokines compromising the immune system. Obesity can also cause mechanical respiratory problems and reduced oxygen saturation in the blood.
3. Angiotensin-converting enzyme
Angiotensin-converting enzyme (ACE 2) is a cell surface protein that produces many proteins by breaking down the larger protein angiotensinogen which is significant in regulating cell functions. When one is infected with the SARS COV 2 virus, it binds to ACE 2 in a key and lock fashion prior t entry into the host cell. In short, ACE 2 is the doorway to the SARS COV 2 Virus. ACE 2 is found in many tissues including Lungs, heart, kidney, liver, and the gastrointestinal tract. We do not have the same number of ACE 2 in our cells. Patients undergoing hypertension and diabetes treatment often receive ACE 2 inhibitors resulting in an increased expression of ACE 2. As a result of the increased ACE 2 in patients with diabetes, there is a risk of severe disease and fatality due to multiple doorways of virus entry into cells. Scientists have also acknowledged that people with COVID 19 are likely to get temporary diabetes. This has been associated with the many ACE 2 cells in the islet cells of the pancreas. These cells make insulin which is critical in controlling blood sugar. If the virus infects the islet cell, you then stop producing insulin resulting in an increased sugar level.
Diabetes management in COVID 19 patients poses a great clinical challenge to reduce the risk of complications and death. There is a strong interrelationship between COVID 19 and diabetes and this should trigger advanced research to understand specific mechanisms of the virus.