Diabetes and COVID-19 comorbidity: Matters arising and public health implications

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused significant public health emergency globally. Although the clinical manifestation of COVID-19 is heterogeneous with flu-like symptoms to acute pneumonia and multiple organ failure, its risk, severity and mortality have been associated with diabetes and other non-communicable chronic diseases. Accumulated evidence from emerging epidemiological data has shown enormous global public health concern with hypothetical association existing between COVID-19 and diabetes. Possible mechanisms recently explored as underlying association between COVID-19 and diabetes are hyperglycemia, chronic inflammation, impairment of immune response, increased and prolonged coagulation activity and rapid pancreatic damage by SARS-CoV-2. Furthermore, the discontinuation of angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in individuals with diabetes due to COVID-19 has not been scientifically concluded. The burden associated with COVID-19 and diabetes comorbidity may exacerbate this pandemic, especially in developing countries. However, early diagnosis, comprehension and management of these comorbidities may contribute to better outcomes, hence mitigating severe clinical complications and mortalities.