Manuscript Topics

● 2020 is seeing a continued global spread of COVID-19 with many uncertainties on transmission and the prospects for dual COVID-19 and influenza outbreaks heading into colder months.
● It is currently undetermined why people with diabetes, hypertension, or other chronic diseases are more severely affected by COVID-19.
● Diabetes mellitus is an independent predictor of admission to the intensive care unit or invasive ventilation or death in COVID-19 [1].
● The risk of developing pneumonia was 2.98 higher for Type 1 diabetes and 1.58 for Type 2 diabetes compared to the general population [2].
●  Type 1 diabetes was at three and a half times the risk of in-hospital death with COVID-19, while people with Type 2 diabetes were at twice the risk than people without a diagnosis of diabetes [3].
● There are two hypotheses to explain the increased incidence and severity of COVID-19 infection in people with diabetes. 1. Increased risk of infection because of defects in innate immunity, 2. The increased expression of ACE: Acute hyperglycemia has been shown to upregulate ACE2 expression on cells, facilitating viral entry [4,5].
● However, chronic hyperglycemia is known to downregulate ACE2 expression, making the cells vulnerable to the virus's inflammatory and damaging effect [6].
● Yet we are still in uncertain territory, and day by day, we are getting more and more depths in terms of vulnerability.
● There are several unanswered questions like a patient with controlled diabetes are they at risk of getting infected with covid-19? Is there any specific diet or supplement which could help patients with diabetes and COVID-19? Many more doubts yet to be resolved due to limited data regarding diabetes associated with covid-19.
● Overall, the COVID-19 pandemic crisis should establish innovative management strategies for patients with diabetes.
● Early isolation, diagnosis, and management might collectively contribute to better control of the disease and outcomes.

References:
1. Guan WJ, Liang WH, Zhao Y, et al. (2020) Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J 55: 2000547.
2. Carey IM, Critchley JA, DeWilde S, et al. (2018) Risk of infection in Type 1 and Type 2 diabetes compared with the general population: A matched cohort study. Diabetes Care 41: 513–521.
3. Barron E, Bakhai C, Kar P, et al. (2020) Type 1 and Type 2 diabetes and COVID-19 related mortality in England: a whole population study.
4. Rao S, Lau A, So H. Exploring diseases/traits and blood proteins causally related to expression of ACE2, the putative receptor of SARS-CoV-2: A Mendelian Randomization analysis highlights tentative relevance of diabetes-related traits. medRxiv (2020), 20031237.
5. Singh AK, Gupta R, Ghosh A, et al. (2020) Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr 14: 303–310.
6. Bindom SM, Lazartigues E (2009) The sweeter side of ACE2: physiological evidence for a role in diabetes. Mol Cell Endocrinol 302: 193–202.

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