SARS-CoV-2 and diabetes: New challenges for the disease

Abstract

A novel small enveloped RNA virus with the typical characteristic of the family to which it belongs, a crown, hence the name coronavirus, appeared in December 2019 in Wuhan, China, and subdued the world to its influence. The particular severity of the disease and higher mortality rates in patients with associated morbidities, including hypertension, obesity and diabetes, increases the concern over the consequences of this pandemic. In this review, the features of SARS-CoV-2 will be addressed, as well as the reasons why it poses a particular challenge to diabetic patients. We will also highlight the recent treatment strategies being explored to control this pandemic. Emerging evidence demonstrates that the correct management of diabetes in those patients infected with SARS-CoV-2 is of utmost importance for the viral disease progression, therefore, the importance of blood glucose control will also be addressed.

Keywords: ACE inhibitors; ACE-2; COVID-19; Diabetes; Glycemic control; SARS-CoV-2.

Fig. 1

Schematic representation of SARS-CoV-2 internalization in the host cell and possible causes or effects of uncontrolled glycemia in viral infection. The virus may take advantage of physiopathological features of DM to trigger a more efficient infection, either by attaching to putatively overexpressed ACE2 in target organs of DM treated with ACEIs/ARBs or taking advantage of an underactive immune system characteristic of the disease. The viral mechanism of action affects diabetes, direct and indirectly, and can possible be treated by TMPRSS2 inhibitor or chloroquine, among other treatments previously mentioned. ACE2: angiotensin-converting enzyme 2; ACEI: ACE1 inhibitor drugs; ARBs: angiotensin II receptor blockers; RBD: receptor-binding domain; TMPRSS2: transmembrane serine protease 2.