Approach Patients with Diabetes and Covid-19

Author(s): Wael Almistehi

The Covid-19 pandemic caused by SARS-CoV-2 infection that first case reported in December 2019, which reach currently infected more than 8 million persons. As evidence is evolving rapidly, diabetes is an independent risk for morbidity and mortality in patients admitted to the hospital with Covid-19. There are multiple studies showed that Covid-19 and diabetes have an unknown relationship. Notably, case reports about new-onset diabetes with Covid-19. The mechanism of COVID-19 affected patients with diabetes is unclear. The acknowledged evidence involves in alteration of the immune system in many aspects for patients with diabetes. Other evolving research about angiotensin-converting enzyme 2 (ACE2), a key enzyme in the RAAS, catalyzes the conversion of angiotensin II to angiotensin ACE2 is highly expressed in the lungs, pancreas and serves as the entry point for SARS-CoV-2. After endocytosis of the virus complex, ACE2 expression is downregulated. Management of Covid-19 involved use of Dexamethasone, and previously some countries used methylprednisolone as part of the medications used for the treatment of severe Covid-19 pneumonia, which clearly can affect patients with diabetes and worsening hyperglycemia. During the pandemic, diabetes management needs more attention to alleviate the morbidity and mortality associated with Covid-19 patients with diabetes. Insulin therapy still the cornerstone treatment for in-hospital patients admitted in the critical care units. Continuous glucose monitoring did great help, as minimizing close contact with Covid-19 patients, which helps, to some degree, decrease infections to the staff. In conclusion, the physician should be aware of the adverse outcome of Covid-19 with diabetes and deliver the best quality care possible to those patients