Individuals with diabetes are at increased risk for bacterial, parasitic and viral infections. New research published in Endocrine Reviews, a journal of the Endocrine Society, illuminates how intersections of the coronavirus infection (COVID-19) and type 2 diabetes may require new approaches in treatment for hospitalized patients.
Not only does the global COVID-19 pandemic have immediate implications for the therapy of type 2 diabetes, individuals with obesity are known to be at increased risk for complications arising from influenza, and obesity is emerging as an important comorbidity for disease severity in the context of COVID-19.
Coronavirus Infections and Type 2 Diabetes—Shared Pathways with Therapeutic Implications
Abstract Individuals with diabetes are at increased risk for bacterial, mycotic, parasitic, and viral infections. The severe acute respiratory syndrome (SARS)-CoV-2 (also referred to as COVID-19) coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with type 2 diabetes (T2D). Two coronavirus receptor proteins, angiotensin-converting enzyme 2 (ACE2) and dipeptidyl peptidase-4 (DPP4) are also established transducers of metabolic signals and pathways regulating inflammation, renal and cardiovascular physiology, and glucose homeostasis. Moreover, glucose-lowering agents such as the DPP4 inhibitors, widely used in subjects with T2D, are known to modify the biological activities of multiple immunomodulatory substrates. Here, we review the basic and clinical science spanning the intersections of diabetes, coronavirus infections, ACE2, and DPP4 biology, highlighting clinical relevance and evolving areas of uncertainty underlying the pathophysiology and treatment of T2D in the context of coronavirus infection.
“We reviewed how the pathophysiology of diabetes and obesity might intersect with COVID-19 biology and found key shared pathways and mechanisms linked to the development and treatment of type 2 diabetes,” said the study’s author Daniel J. Drucker, M.D., of Mount Sinai Hospital in Toronto. “Cells within the lung and gut are major sites for coronavirus entry and inflammation. These cells express key proteins like Angiotensin Converting Enzyme 2 (ACE2) and Dipeptidyl Peptidase-4 (DPP4) that are also present in the development of type 2 diabetes.”
More studies need to be done to understand the risks and benefits of commonly used diabetes medications in patients with severe coronavirus infections. The pandemic highlights the importance of expanding innovative delivery of diabetes care and regular communication between people with diabetes and their health care providers.
The study, “Coronavirus infections and type 2 diabetes-shared pathways with therapeutic implications,” was published online, ahead of print.
Rates of Diabetes and Obesity in Subjects with Coronavirus Infections
Diabetes is associated with an increased risk of severe bacterial and viral respiratory tract infections, including H1N1 influenza . Analysis of more than 500 subjects hospitalized with SARS-CoV in China revealed that elevations in fasting glucose were associated with increased rates of death; however, hyperglycemia was often transient, and generally resolved after discharge from hospital in the majority of subjects. A diagnosis of diabetes was associated with a 3-fold increased risk of mortality in a retrospective analysis of 114 adults hospitalized with SARS-CoV in Toronto in 2003.
Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org.
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