Diabetes was considered a comorbidity during SARS-CoV-1. Similarly, having diabetes tripled the risk of hospitalization and quadrupled the risk of ICU admission during the Influenza A (H1N1) outbreak in 2009. During the 2012 outbreak of MERS-CoV, the mortality rate for patients with diabetes was a staggering 35%. Patients with diabetes who test positive for COVID-19 are more likely to experience severe disease. 

Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations

Diabetes in elderly patients is a factor in the high rates of mortality for COVID-19 victims. Patients with diabetes or hypertension have an increased risk of having a severe case of COVID-19 or needing an ICU admission immediately. Infection of SARS-CoV-2 in diabetic patients triggers higher stress conditions which can increase blood glucose levels and cause unusual glucose fluctuation. Many of the elderly patients in Wuhan with diabetes are hypoglycemic. 

COVID-19 and diabetes: Knowledge in progress


The Link Between Diabetes and ACE2

- Wuhan, China
- Mexico
- Italy
- England
- Saudi Arabia

Diabetes in COVID-19 Patients by Geographic Location

- It was found that those with diabetes mellitus were at a higher risk of death if diagnosed with COVID-19
- The overall odds ratio of mortality in COVID-19 patients with diabetes mellitus came out to be 1.9
- 1.9 indicates that those with diabetes mellitus are at a 90% increased risk of dying due 
to COVID-19 compared to those without COVID-19
- The odds ratio for one patients came out to be 57.77, indicating that this patient is ~58 times more likely to die from COVID-19

Diabetes Mellitus and a study of its Epidemiology in relation to COVID-19

- Increased glucose levels negatively impact how the immune system responds when a virus is present
- Hyperglycemia is associated with how the lung functions
- IL-6 and D-dimer are elevated in those with hyperglycemia
- In fact, IL-6 plays a role in inflammation, which can negatively affect those with COVID-19

The effect of hyperglycemia in relation ot COVID-19

- Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID‐19
- Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration

Degree of Hyperglycemia on COVID-19 Mortality

- Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

Diabetes Medication on COVID-19 Mortality 

People with diabetes mellitus are among those with the highest risk of COVID-19 infection related complications as chronic hyperglycemia has a negative impact on immune function and increases the risk of morbidity and mortality with any infections. This was was evident with the H1N1 pandemic in which diabetes tripled the risk of ICU admissions when hospitalized. Around February 2020, diabetes accounted for 42.3% of major comorbidities in COVID-19 cases in Wuhan, China. A mortality of 7.3% was also reported for people with diabetes. Due to likeliness of people with diabetes to experience a deterioration of glycemic control when infected with COVID-19, it is essential for people with diabetes to contact their healthcare providers for advice an avoiding a loss of control over their diabetes.  

COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology

Campos Codo, A. Elevated Glucose Levels Favor SARS-CoV-2 Infection and Monocyte Response through a HIF-1α/Glycolysis-Dependent Axis https://pubmed.ncbi.nlm.nih.gov/32697943/. 

How Elevated Glucose Levels Favor SARS-CoV-2
Infection? 

- Prevalence of pathophysiology, prognosis, and practical considerations
- Knowledge in progress
- The link between diabetes and ACE2
- Diabetes in COVID-19 patients by geographic location 
- Degree of Hyperglycemia on COVID-19 mortality
- Diabetes Medication on COVID-19 mortality
- COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology

Smith College

University of Michigan - Ann Arbor

Ohio State University, Columbus

Rutgers University

COVID-19 comorbidities are high risk conditions that put patients at greater risk for infection and negative outcomes. Some COVID-19 comorbidities have been found to be: 
- Cancer 
- Cardiovascular Disease
- Diabetes
- Digestive Diseases
- HIV
- Hypertension
- Immunological Disease
- Liver Injury
- Obesity
- Renal disease
- Respiratory System Disease

COVID-19 Patient Comorbidities

Among 174 patients, the median age is 59 (age range: 49-67) and 76 out of 174 are men. Compared with patients without diabetes, patients with diabetes had more cardiovascular disease (32.4% vs 14.6%) and less fever (59.5% vs 83.2%), but had no significant differences in gender and age. Diabetes group has lower lymphocytes, red blood cells, and hemoglobin than non-diabetes group. These data showed that the COVID‐19 patients with diabetes are at higher risk of excessive uncontrolled inflammation responses and hypercoagulable state, which may contribute to a poorer prognosis of COVID‐19. Diabetes should be considered as a risk factor for a rapid progression and bad prognosis of COVID‐19. More intensive attention should be paid to patients with diabetes, in case of rapid deterioration

- Note: for more journal articles supporting this claim, please see the children of this node.

Diabetes is a risk factor for the progression and prognosis of COVID-19

- AIDS and Behavior
- American Journal of Cancer Research
- American Journal of Hypertension
- American Society of Clinical Oncology Journals
- Annals of Allergy, Asthma & Immunology
- Annals of Internal Medicine
- Annals of Oncology
- Blood Advances
- BMC
- Brain, Behavior, and Immunity
- Cancer Discovery
- Cell Metabolism
- Clinical Immunology
- Clinical Infectious Diseases
- Clinical Reviews in Allergy & Immunology
- Clinical Transplantation
- Cureus
- Diabetes Care
- Diabetes & Endocrinology
- Diabetes & Metabolic Syndrome: Clinical Research & Reviews
- Diabetes, Obesity, and Metabolism
- Diabetes Research and Clinical Practice
- EClinicalMedicine
- European Journal of Cardio-Thoracic Surgery
- European Journal of Clinical Nutrition
- European Respiratory Journal
- Frontiers in Medicine 
- Frontiers in Public Health
- Gut
- Haematologica
- International Journal of Infectious Diseases
- International Journal of Obesity
- Journal of Alzheimer’s Disease
- Journal of American Nephrology
- Journal of Clinical Medicine
- Journal of Endocrinological Investigation
- Journal of Infection
- Journal of Infectious Diseases
- Journal of Intensive Care Medicine
- Mayo Clinic Proceedings
- Medicine
- Nature
- Nutrition, Metabolism & Cardiovascular Diseases
- Obesity
- Obesity Research & Clinical Practice
- Oxford Academic Journals
- Paediatric Respiratory Reviews
- Polish Archives of Internal Medicine
- Practical Diabetes
- PRiMER (Peer-Reviewed Reports in Medical Education Research) 
- Proceedings of the National Academy of Sciences 
- Public Library of Science
- The Brazilian Journal of Infectious Diseases
- The Journal of the American Medicine Association Cardiology
- The Journal of Allergy and Clinical Immunology
- The Lancet
- The National Center for Biotechnology Information
- The New England Journal
- Thrombosis Research
- Translational Stroke Research 

COVID-19 Comorbidities References by Journal

COVID-19 may be worse in patients with comorbidities, and this can cause damage to the heart, liver, kidneys, and blood and immune systems. Many patients have had multiple organ failure that started with pneumonia, and became worse when therapeutic effects were unsatisfactory. Comorbidities can cause a patient's deterioration, leading to multiple organ failure. Organ function should be closely monitored and protective measures such as mechanical ventilation, glucocorticoids, antivirals, symptomatic treatments, and anti-shock therapy should be administered if necessary. 

Multiple Organ Injuries in COVID- 19 Patients with Comorbidities

- Implication of Obesity In Patients with COVID-19 
- Obesity in COVID-19 Patients by Geographic Location 
- Risk of Cytokine Storm in Obese COVID-19 Patients
- Higher Concentrations of IL-17 and TNF-α Lead to Greater Respiratory Damage
- Association of Obesity and Age with severe cases of COVID-19
- Association of Obesity and Hospital Stay Length

Obesity as a Comorbidity of COVID-19 

- Hypertension and COVID-19 by Geographic Location
- Hypertension and COVID-19 by Topic

Hypertension as a Comorbidity of COVID-19

- Respiratory System Disease in COVID-19 Patients by Geographic Location 
- Asthma as a Comorbidity of COVID-19

Respiratory System Disease as a Comorbidity of COVID-19

- Clinical Features and Outcomes of Patients With Human Immunodeficiency Virus With COVID-19
- The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective (General Summary of HIV and COVID-19 Interaction)
- Maintaining HIV care during the COVID-19 pandemic
- HIV in COVID-19 Patients by Geographic Location
- COVID-19 and HIV Coinfection

HIV as a Comorbidity of COVID-19

- By country
- Liver Transplantation
- Chronic Liver Disease

Liver Injuries as a Comorbidity of COVID-19 

- This node acts as a general summary of the comorbidity of cancer and COVID-19 from a paper that analyzed many other papers detailing the same thing at its time of release.
- Via a pooled meta-analysis of studies from around the globe analyzing the prevalence of cancer in COVID-19 patients, it was found that the prevalence of cancer in COVID-19 patients is about 2%, which is higher than the overall prevalence of cancer in the population (I think).
- This leads to a hypothesized conclusion that while there is not a lot of data for COVID-19 infection and cancer patients, there is an elevated risk for these patients. However, due to inconclusive and generally lacking data on this topic, this conclusion is not concrete.
- Many major cancer centers worldwide have taken extra precaution when it comes to the treatment of these patients as many cancer treatments (e.g., chemotherapy) weaken the immune system as a side effect.
- There has currently been no order to withhold chemotherapy, radiotherapy, immunotherapy, or delaying adjuvant therapy to treat cancer patients, however extra care must be taken by patients and physicians alike to not allow these high-risk patients to become infected.

Cancer as a Comorbidity of COVID-19 

Patients with digestive diseases like inflammatory bowel disease (IBD) or gastrointestinal cancer are at a higher risk to experience more severe symptoms of COVID-19. Autopsy studies are important in understanding how COVID-19 affects the digestive system. More data needs to be collected to determine the exact relationship between digestive diseases and COVID-19. 

Digestive Diseases as a Comorbidity of COVID-19

- Cytokine Storm Syndrome
    -  Secondary Haemophagocytic Lymphohistiocytosis
- Common Variable Immunodeficiency 
- Figure illustrating how pathogenic T cells and inflammatory monocytes enter pulmonary circulation and incite an inflammatory storm and immune disorder 
- Severe Combined Immunodeficiency

Immunological Diseases as a Comorbidity of COVID-19

Diabetes as a Comorbidity of COVID-19

During the COVID-19 era the regular treatment and communication between physicians and patients regarding preexisting comorbidities has been disrupted. New guidelines and safety precautions must be put in place in order for physicians to still treat their patients and treat them through the use of telehealth or other means. While there are a lot of similarities between new communication policies being implemented across different areas of medicine, there are also many differences due to comorbidity specific criteria which facilitates different levels of involvement and communication between physicians and patients.


The comorbidities addressed under this node include:
- Cancer
- Cardiovascular Diseases
- Digestive Diseases
- Elective Surgeries
- Liver Diseases
- Psychological Disorders
- Renal Diseases

Changes to COVID-19 Patient Comorbidity Treatment and Communication

Cardiovascular disease is a risk factor for severe COVID-19, and COVID-19 causes cardiovascular complications. 

Cardiovascular Disease and COVID-19

- A retrospective multi-center experience of renal transplants from India during COVID-19 pandemic

Renal Diseases as a Comorbidity of COVID-19

Researchers conducted a cohort study in which data from people with either type 1 or type 2 diabetes in England was collected from death registrations to analyze potential risk factors for COVID-19-related mortality.  It was found that being of male sex and being of older age was linked to a higher risk of COVID-19-related mortality in both type 1 and type 2 diabetic individuals.  Preceding hyperglycaemia and impaired renal function were also found to cause a significant increase in risk of COVID-19-related mortality for both type 1 and 2 diabetes.  Specifically, for individuals with type 2 diabetes, having an HbA1c of 59 mmol/mol caused a significantly elevated risk for COVID-19-related mortality than those who had HbA1c of 48–53 mmol/mol.  

Risk Factors for COVID-19-Related Mortality in People with Type 1 and Type 2 Diabetes

1. diabetes patients often suffer from comorbidities which further worsen clinical outcomes and how to adapt to glucose-lowering therapy
2. access of diabetes patients to outpatient clinics is limited during the ongoing season urging alternative treatment options, particularly the implementation of novel telemedicine strategies.

Diabetes and COVID-19 : Disease-Management-People

Summary of Is Diabetes Mellitus Associated with Mortality and Severity of COVID-19? A Meta-analysis

-risk of disease progression and mortality is significantly high in COVID-19 patients with diabetes than in those without diabetes
- individuals with impaired glucose tolerance or diabetes to have 50–60% higher risk of pulmonary infection
-diabetic cases consists of up to 50% COVID-19 cases
-diabetes characterized by hyperglycemia has been reported to downregulate immune response and increased inflammation

Diabetes and COVID-19: A pooled analysis related to disease severity and mortality

Hypercoagulability with elevation in D-dimer levels has been demonstrated in patients with COVID-19. Patients of COVID-19 with diabetes had more severe disease levels, and this study showed that individuals with existing diabetes had higher D-dimer levels in COVID-19. It is concluded that D-dimer levels can be a valuable biomarker of severity of COVID-19 in patients of diabetes.

Relation of D-dimer levels of COVID-19 patients with diabetes mellitus

- Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID‐19

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