Diabetes and COVID-19

Abstract

The relationship between COVID-19 and diabetes is best described as bidirectional. Patients with diabetes are at higher risk of severe COVID-19 infection, acute and chronic sequelae and conversely, some evidence suggests that COVID-19 itself may lead to acute hyperglycemia and as well as more persistent metabolic alterations that are associated with increased risk of developing diabetes mellitus later. The impact of the virus includes both direct viral action, encouragement of a proinflammatory state, and the effects of various treatments, for example, dexamethasone. It is clear that many people were newly diagnosed with diabetes at the time they presented with COVID-19 infection. These diagnoses represent not only the impact of the infection itself as a “final push” for patients otherwise predisposed to hyperglycemia, but also reflects a large portion of the population that had undiagnosed diabetes who otherwise would not have sought medical attention. The latter in particular shows the impact of healthcare disparities across various demographics as patients with a new diagnosis of diabetes tended to be non-white and underinsured. These findings represent an opportunity to improve not only care for patients with COVID-19 but also for patients with diabetes mellitus as has been showcased by the emergence of the more widespread use of continuous glucose monitoring in the hospital setting.