Unraveling the Mystery: COVID-19 and Diabetic Complications - A Journey from Pathophysiology to Treatment.

The connection between COVID-19 and DM unveils a multifaceted interplay that significantly impacts disease severity and management strategies. Initial studies reveal that people with DM had higher severity rates of COVID-19 due to the infection by SARS-CoV-2. The virus solely induces hyperglycemia and, at the same time, profoundly influences the immune and inflammatory reactions, increasing the rate of severe complications and death among diabetes patients. Therefore, understanding the underlying mechanisms behind this interplay is critical for effective treatment. Furthermore, COVID-19 also brings new factors to the equation of managing diabetes. Although the virus thoroughly relies on the ACE2 receptor for viral entry, DPP4 is a substitute receptor. However, glucose-lowering DPP4 inhibitors provide only a minor association with COVID-19 vulnerability. Also, the SGLT2 inhibitors are contraindicated in certain conditions with COVID-19, and hence, insulin is generally recommended as a first-line treatment for acute glycemic control in hospitalized or critically ill COVID-19 patients, particularly those with severe hyperglycemia or diabetic ketoacidosis. COVID-19-associated aggravating factors, such as cardiovascular disease, chronic kidney disease, and neuropathy, predispose people with diabetes to severe conditions. Thus, it is important to explore this speculation, and the present review aims to understand this complex interaction during patient care models and specify the therapeutic approaches to address this problematic convergence of two substantial health concerns.