Sars-Cov-2 infection and diabetic patient
In light of currently available data, people with diabetes appear to be
more susceptible to Sars-CoV-2 infection. Predisposing risk factors are
mainly secondary diseases caused by diabetes, such as coagulation
dysfunction, inflammatory tissue status, nephropathy, cardiovascular
diseases, immunodepressed status. An extensive epidemiological study of
72,314 patients with COVID-19 in China indicated that patients with
diabetes have a mortality rate three times higher than all patients with
COVID-19 (8). Diabetes is known to cause homeostasis dysfunction of the
coagulation system and fibrinolytic cascade and hyperactive
inflammation. These two components also manifest themselves in the more
severe stages of Sars-Cov-2 infection. In the most severe stages of
infection, the major complications are caused by a generalized
hyperactive inflammatory state and coagulative dysfunction with risk of
thrombosis and lung injury. In a study conducted on 174 patients with
COVID-19 in Wuhan, China, people with diabetes had a higher
concentration of inflammatory markers and a higher incidence of
coagulopathy associated with higher mortality than those without
diabetes (9). Another key aspect to highlight is that during the
Sars-Cov epidemic it was noted that patients with viral infection had
higher blood sugar levels than patients with infections caused by other
viral agents. (10) Today it is known that Sars-Cov and Sars-Cov-2 use
ACE-2 membrane glycoprotein to penetrate cells. In vitro and animal
studies have shown that Sars-Cov binds ACE-2 also on pancreatic islands,
damaging their function and causing a lack of adequate insulin
production, (11) this biological mechanism is probably the cause of the
hypeglycemia noticed in patients with Sars-Cov. Considering that
sars-cov and Sars-Cov-2 share a high percentage of genomic similarity,
and that Sars-Cov-2 also binds ACE-2, a risk of hyperglycemia could be
hypothesized also in patients with COVID-19, as happened in the Sars-Cov
epidemic. At the moment there are no data from epidemiological studies
in this respect.