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What your doctor is reading on Medscape.com:
APRIL 14, 2020 — Diabetes may be an independent risk factor for rapid progression and poor prognosis of COVID-19 through several known pathways and a possible new one: direct damage to pancreatic islets.
As with nearly every finding related to the novel 2019 coronavirus disease, the evidence thus far comes primarily from case series and anecdotal reports, and as such has obvious limitations.
In one of the latest case series, Chinese researchers compared 137 individuals without diabetes to 37 with diabetes, and then compared the subsets of those two groups without comorbidities (26 and 24 people, respectively).
In the latter comparison, those with diabetes still had a significantly greater risk of severe pneumonia, release of tissue injury-related enzymes, excessive uncontrolled inflammatory responses, and hypercoagulable state associated with dysregulated glucose metabolism, compared to those with no diabetes.
And those with diabetes also had higher levels of biomarkers suggesting an inflammatory “storm” preceding rapid deterioration of COVID-19, say Weina Guo, of Huazhong University of Science and Technology, Wuhan, China, and colleagues in their article, published online March 31 in Diabetes Metabolism Research and Reviews.
“While results of this study should be read in the light of some limitations — such as the low sample size and the large age difference between study groups when comorbidities were excluded — it still provides relevant insights that could inform about how COVID-19 interacts with pre-existing conditions,” note Ernesto Maddaloni, MD, PhD, and Raffaella Buzzetti, MD, both of Sapienza University of Rome, Italy, in an accompanying editorial.
Possibly “Alarming” Interaction, Given Initial Symptoms May Be Silent
The editorialists note it has previously been observed that diabetes worsened outcomes of other similar viral infections, including the 2003 SARS coronavirus and 2009 H1N1 influenza.
Such an interaction in the current pandemic would be “alarming considering the high transmission rate of SARS-CoV-2 [the virus that causes COVID-19] and the global prevalence of diabetes,” they emphasize
They also point to another concern from the Chinese article, namely that “the severity of COVID-19 in diabetes may be hidden by an initial milder presentation of SARS-CoV-2 infection.”
