Pathophysiological mechanisms of coronavirus disease (COVID-19) progression and fatal complications in patients with diabetes

Abstract

Pandemic of the coronavirus disease (COVID-19) is still one of the most acute medical and social problem in the world. It's well known that development of severe complications, including acute respiratory distress syndrome, is most often associated with comorbid condition and patients age (category over 50 years). Diabetes mellitus is the most common endocrine disease, clinical and epidemiological trials confirm it's a high risk factor for progression and mortality in patients with COVID-19. The aim of the work was to analyze the data of the scientific literature on the suspected pathophysiological mechanisms between diabetes mellitus and coronavirus disease association. The article highlights role of angiotensin-converting enzyme-2 expression changes, which is defined as a functional target on the cell surface for SARS-CoV-2 penetration. The review analyzes the results of experimental studies about effects of medicines included in diabetes clinical protocols (insulin, glucagon like peptide-1 analogues, thiazolidinediones derivates, angiotensin-converting enzyme inhibitors, angiotensin-2 receptor blockers, statins) on ACE-2 activity. Immunological disorders in diabetes mellitus patients, may significantly affect the COVID-19 state, in particular, due late hyperinflammatory condition and cytokine storm syndrome formation, which are predictors of serious complications, including acute respiratory distress syndrome. The results of the retrospective clinical study that involves people with COVID-19 and diabetes mellitus who don't have other comorbidities were analyzed. Conclusions. The data presented in current review necessitate further clinical trials for objective assessment of the potential benefits and risks of medicines used in patients with diabetes under COVID-19 and for treatment regimens revision in case of adverse effect on disease progression and state. The review data indicate a high risk of unfavorable prognosis of SARS-CoV-2 infection in patients with diabetes mellitus.