- ACE2,or angiotensin-converting enzyme 2, is a protein on the surface of pneumocyte cells that assists with transport of proteins through the membrane
- Diabetes causes the ACE2 protein to under perform as well as for there to be less total
- Because of this, many diabetes medications increase the activity rate of ACE2
- These drugs stimulate ACE2 so much that the protein will sometimes let other things through that it is not supposed to, this includes SARS-CoV-2
- This accounts for the increased risk of COVID in diabetes mellitus patients
- Some drugs which have been identified to have this effect are pioglitazone and liraglutide in animal studies

COVID-19, diabetes mellitus and ACE2: The conundrum

Figure: How SARS-CoV-2 Enters Pneumocytes Through ACE2

Smith College

Ohio State University, Columbus

- 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

Diabetes as a Comorbidity of COVID-19

Pal, R., & Bhansali, A. (2020). COVID-19, diabetes mellitus and ACE2: The conundrum. Diabetes research and clinical practice, 162, 108132. https://doi.org/10.1016/j.diabres.2020.108132

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118535/

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/. 

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