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Review
. 2020 Dec;21(4):451-463.
doi: 10.1007/s11154-020-09573-6.

COVID-19 and diabetes mellitus: how one pandemic worsens the other

William S Azar  1   2   3 , Rachel Njeim  1   2 , Angie H Fares  1   2 , Nadim S Azar  1   2 , Sami T Azar  2   4 , Mazen El Sayed  5 , Assaad A Eid  6   7
Affiliations
Review

COVID-19 and diabetes mellitus: how one pandemic worsens the other

William S Azar et al. Rev Endocr Metab Disord. 2020 Dec.

Abstract

In light of the most challenging public health crisis of modern history, COVID-19 mortality continues to rise at an alarming rate. Patients with co-morbidities such as hypertension, cardiovascular disease, and diabetes mellitus (DM) seem to be more prone to severe symptoms and appear to have a higher mortality rate. In this review, we elucidate suggested mechanisms underlying the increased susceptibility of patients with diabetes to infection with SARS-CoV-2 with a more severe COVID-19 disease. The worsened prognosis of COVID-19 patients with DM can be attributed to a facilitated viral uptake assisted by the host's receptor angiotensin-converting enzyme 2 (ACE2). It can also be associated with a higher basal level of pro-inflammatory cytokines present in patients with diabetes, which enables a hyperinflammatory "cytokine storm" in response to the virus. This review also suggests a link between elevated levels of IL-6 and AMPK/mTOR signaling pathway and their role in exacerbating diabetes-induced complications and insulin resistance. If further studied, these findings could help identify novel therapeutic intervention strategies for patients with diabetes comorbid with COVID-19.

Keywords: Adenosine monophosphate kinase (AMPK); Angiotensin-converting enzyme 2; COVID-19; Cytokine storm; Diabetes mellitus; Mechanistic target of Rapamycin (mTOR).

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Schematic diagram representing (a) SARS-CoV-2 entry into the host cell and (b) the role of ACE2 in the renin-angiotensin system
Fig. 2
Fig. 2
COVID-19, Diabetes Mellitus, cytokine storm: a vicious cycle
Fig. 3
Fig. 3
Proposed crosstalk between COVID-19 and Diabetes Mellitus
See this image and copyright information in PMC

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