Uncurtaining the Effect of COVID-19 In Diabetes 

People with diabetes are more sensitive to increased inflammatory response, contributing to a fast spread of COVID-19 infection. 

The purpose of this review is to provide an overview of standard features of coronavirus and, as a result, demonstrate the early onset of coronavirus in people with diabetes and its treatment. According to statistics, India has the second-largest population of people with diabetes in the world; literature review has been implemented inside the databases.  

Infections have a weak immune response in patients with diabetes. Individuals with diabetes have a higher risk of bacterial, viral, parasite, and mycotic infections when compared to those without diabetes. These findings support the hypothesis that diabetes patients are more sensitive to increased inflammatory response, contributing to a fast spread of COVID-19 infection and a high death rate. In the current pandemic situation, managing diabetes appears quite tricky, and diabetes patients infected with COVID-19 should take their antihypertensive and antidiabetic medications as prescribed (taking sodium-glucose co-transporters-2 inhibitors, which can cause dehydration and ketoacidosis, should be discussed with their HCPs). In light of the preceding discussion, this article focuses on the suggested mechanism of COVID-19 infection and its relation to diabetes and the antidiabetic medicines to be used in COVID-19 infection, their benefits and drawbacks, and the management of COVID-19 infection in diabetes patients. 

Coronavirus has been infecting people for a long time, as it is the same virus that causes the common cold. It is a contagious viral infection mainly transferred by droplets in the air emitted by infected people in the open air due to coughing and sneezing, which are subsequently breathed by healthy people or by touching infected people’s items (Byass 2020). Coronavirus has a genome of around 30000 nucleotides. It recognizes four structural proteins: nucleocapsid (N) protein, membrane (M) protein, spike (S) protein, and envelope (E) protein, as well as a slew of non-structural proteins (Cai 2020). 

When an infected person sneezes or coughs, tiny drops of the COVID-19 virus are released into the surroundings. Anyone within 6 feet of an infected individual is at risk of coming into touch with the droplets (El-Farhan et al., 2017; Mohammadi et al., 2020). COVID-19 can also be transferred by contacting surfaces that an infected person has touched often. Diabetes patients can protect themselves from COVID-19 infection by washing their hands frequently, avoiding contact with infected people, and avoiding surfaces that others have touched (Laffel 2000; Bornstein et al. 2016; Qin et al. 2019; Umpierrez and Pasquel 2017; Tandon et al. 2017; Prajapat et al. 2020). 

Compared to persons who do not have diabetes, diabetes patients elicit higher neutrophils (Davies et al. 2020; Eslami and Jalili 2020; Fan et al. 2020), C-reactive protein, procalcitonin, and D-dimer, as well as lower levels of lymphocytes and albumin. Furthermore, these patients have a considerably more significant risk of bilateral pneumonia, respiratory difficulty, severe heart damage, and mortality. Therefore, diabetes appears to be an independent risk factor for COVID-19 projection (Wang et al. 2020a; Liu et al. 2020b). 

When selecting parenteral nutrition, it is essential to strike a balance between calorie intake, nutritional intake balance, and sleep to establish adequate blood glucose management (Brancatella et al., 2020; Hultström et al. 2020; Luo et al. 2020). Investigative and therapeutic parsimony concepts should be applied to all diabetes patients with coronavirus infection (Ornstein et al. 2020; Zhang et al. 2020). According to these systems, the minimal number of investigations, medicines, drug combinations, dosage, and dosing frequency should be utilized to achieve the best treatment results (Chen et al. 2020a; Kronbichler et al. 2020). 

Infection prevention methods for COVID-19: maintaining a healthy blood glucose level is crucial since high and low blood glucose levels are linked to increased inflammatory responses and acute cardiovascular events. Different glucose-lowering and anti-inflammatory medications, including insulin and GLP-1RAs, provide a robust therapeutic strategy for treating asymptomatic and non-critically sick COVID-19 diabetes patients, whether used alone or in combination. However, more prospective and comprehensive studies are needed to evaluate the use of these glucose-lowering injectable medicines and link them to improved results that reduce morbidity. 

Practice Pearls: 

• When selecting parenteral nutrition, it is essential to balance calorie intake, nutritional intake, and sleep to establish adequate blood glucose management. 
• Diabetes patients have a considerably more significant risk of bilateral pneumonia, respiratory difficulty, severe heart damage, and mortality. 
• Maintaining a healthy blood glucose level during COVID-19 is crucial. 

Kashyap, R. Bala. Uncurtaining the effect of COVID-19 in diabetes mellitus: a complex clinical management approach. Environ Sci Pollut Res Int. 2021 Jul;28(27):35429-35436.  doi: 10.1007/s11356-021-14480-7. Epub 2021 May 21. 

Idris Aderoju, Pharm.D. Candidate, Florida A&M University  

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