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This review discusses the reasons associated with a poorer prognosis for people with diabetes and COVID-19. There are many factors that place these patients at risk for poor outcomes, including comorbidities (hyperglycemia, hypertension, obesity, CV disease, and pro-coagulative and pro-inflammatory states), age, ethnicity, and gender. Risk mitigation is discussed with proper disease management via the use of antiviral medications and glucose-lowering agents.
Diabetes management in patients with COVID-19 presents clinical challenges. More research is needed to determine how COVID-19 affects the diabetic patient and how best to manage complications.
This abstract is available on the publisher's site.
Since the initial COVID-19 outbreak in China, much attention has focused on people with diabetes because of poor prognosis in those with the infection. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk, but limitations to their use and potential interactions with COVID-19 treatments should be carefully assessed. Finally, severe acute respiratory syndrome coronavirus 2 infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through direct negative effects on β-cell function. These effects on β-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with unknown history of diabetes, and potentially new-onset diabetes.