Implications for the treatment of diabetic patients with infection SARS-CoV-2

Authors: František Sándor 1;  Milan Kriška 2;  Juraj Payer 3;  Peter Jackuliak 3;  Andrej Dukát 3
Authors‘ workplace: Klinika pneumológie a ftizeológie LF UK a UNB, Nemocnica Ružinov, Bratislava 1;  Ústav farmakológie a klinickej farmakológie LF UK v Bratislave 2;  V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava 3
Published in: Forum Diab 2022; 11(1): 35-38


Severe infection of acute respiratory syndrome caused by new coronavirus lead to changes in therapeutic approaches of clinical practice all over the world. Epidemiologic data from recent years showed, that patients with diabetes mellitus had more severe course of coronavirus infection. They also needed intensive care and mechanic ventilation. Mortality among patients with diabetes mellitus and COVID-19 is significantly higher, than in the group of patients without diabetes. They had also significantly higher presence of risk factors. With treatment also more interactions in this process may be present. Many biological mechanisms are not known at present time, but the main target is the improvement of their prognosis.


diabetes mellitus – therapy – SARS-CoV-2


1. Williams DM, Nawaz A, Evans M. Diabetes and Novel Coronavirus Infection: Implications for Treatment. Diabetes Ther 2020; 11(9): 1915–1924. Dostupné z DOI: <–020–00858–2>.
2. Cariou B, Hadjadi S, Wargny M et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia 2020; 63(8): 1500–1515. Dostupné z DOI: <–020–05180-x>.
3. Vankadari N, Wilce JA. Emerging WuHan (COVID-19) coronavirus: glycan shield and structure prediction of spike glycoprotein and its interaction with human CD26. Emerg Microbes Infect 2020; 9(1): 601–604. Dostupné z DOI: <>.
4. Williams DM, Nawaz A, Evans M. Renal outcomes in type 2 diabetes: a review of cardiovascular and renal outcome trials. Diabetes Ther 2020; 11: 369–386. Dostupné z DOI: <–019–00747–3>.
5. Iacobellis G. COVID-19 and diabetes. Can DPP4 inhibition play a role? Diabetes Res Clin Pract 2020; 162: 108125. Dostupné z DOI: <>.
6. Strollo R, Pozzilli P. DPP4 inhibition: preventing SARS-CoV-2 infection and/or progression of COVID-19? Diabetes Metab Res Rev 2020; 36(8): e3330. Dostupné z DOI: <>.
7. []. Sitagliptin Treatment in Diabetic COVID-19 Positive Patients (SIDIACO-RETRO). Dostupné z WWW: <>.
8. Romani-Pérez M, Outeiriňo-Iglesias V, Moya C. Activation of the GLP-1 receptor by liraglutide increases ACE2 expression, reversing right ventricle hypertrophy, and improving the production of SP-A and SP-B in the lungs of type 1 diabetes rats. Endocrinology 2015; 156(10): 3559–3569. Dostupné z DOI: <–1685>.
9. Yang M, Ma X, Xuan X et al. Liraglutide attenuates non-alcoholic fatty liver disease in mice by regulating the local renin-angiotensin system. Front Pharmacol 2020; 11: 432. Dostupné z DOI: <>.
10. McMurray JJV, Solomon SD, Inzucchi SE et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381(21): 1995–2008. Dostupné z DOI: <>.
11. Dennis JM, Henley WE, McGovern AP et al. Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: a retrospective analysis of primary care data, 2010–2017. Diabetes Obes Metab 2019; 21(7): 1576–1584. Dostupné z DOI: <>.
12. Ansary TM, Nakano D, Nishiyama A. Diuretic effects of sodium glucose cotransporter 2 inhibitors and their influence on the renin-angiotensin system. Int J Mol Sci 2019; 20(3): 629. Dostupné z DOI: <>.
13. Bornstein SR, Dalan R, Hopkins D et al. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol 2020; 16(6): 297–298. Dostupné z DOI: <–020–0353–9>.
14. Mudaliar S, Alloju S, Henry RR. Can a shift in fuel energetics explain the beneficial cardiorenal outcomes in the EMPA-REG OUTCOME study? A unifying hypothesis. Diabetes Care 2016; 39(7): 1115–1122. Dostupné z DOI: <–0542>.
15. Bonnet F, Scheen AJ. Effects of SGLT2 inhibitors on systemic and tissue low-grade inflammation: the potential contribution to diabetes complications and cardiovascular disease. Diabetes Metab 2018; 44)6): 457–464. Dostupné z DOI: <>.
16. American College of Cardiology. Dapagliflozin in Respiratory Failure in Patients with COVID-19 – DARE-19. 2020. Dostupné z DOI: <>.
17. Rosenstock J, Ferrannini E. Euglycemic diabetic ketoacidosis: a predictable, detectable, and preventable safety concern with SGLT2 inhibitors. Diabetes Care 2015; 38(9): 1638–1642. Dostupné z DOI: <–1380>.
18. Hoffmann M, Kleine-Weber H, Schroeder S et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181(2): 271–280.e8. Dostupné z DOI: <>.
19. Chen D, Li X, Song Q et al. Hypokalemia and clinical implications in patients with coronavirus disease 2019 (COVID-19). medRxiv.2020. Dostupné z DOI: <>.
20. Puelles VG, Lutgehetmann M, Lindenmeyer MT et al. Multiorgan and renal tropism of SARS-CoV-2. N Engl J Med 2020; 383(6): 590–592. Dostupné z DOI: <>.
21. Yang JK, Feng Y, Yuan MY et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med 2006; 23(6): 623–628. Dostupné z DOI: <–5491.2006.01861.x>.
22. Fang L, Karakiulakis D, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020; 8(4): e21. Dostupné z DOI: <–2600(20)30116–8>.
23. Zhao Y, Zhao Z, Wang Y et al. Single-cell RNA expression profiling of ACE2, the putative receptor of Wuhan2019-nCov. Bioryxiv 2020. Dostupné z DOI: <>.
24. Cao Y, Li L, Feng Z et al. Comparative genetic analysis of the novel coronavirus (2019-nCoV/SARS-CoV-2) receptor ACE2 in different populations. Cell Discov 2020; 6: 11. Dostupné z DOI: <–020–0147–1>.
25. Bornstein SR, Rubino F, Khunti K et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol 2020; 8: 546–550. Dostupné z DOI: <–8587(20)30152–2>.
26. Li J, Wang X, Chen J et al. COVID-19 infection may cause ketosis and ketoacidosis. Diabetes Obes Metab 2020; 22(10): 1935–1941. Dostupné z DOI: <>.
27. Yang JK, Lin SS, Ji XJ et al. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 2010; 47(3): 193–199. Dostupné z DOI: <–009–0109–4>.
28. Docherty AB, Harrison EM, Green CA et al. Features of 16,749 hospitalised UK patients with COVID-19 useing the ISARIC WHO Clinical mCharacterisation Protokol. medRxiv 2020. Dostupné z DOI: <>.
29. Barron E, Bakhai C, Kar P et al. Type 1 and Type 2 diabetes and COVID-19 related mortality in England 2020. Dostupné z WWW: <>.
30. NHS England. Statistics: COVID-19 Daily Deaths 2020. Dostupné z WWW: <>.
31. COVID-19: underlying metabolic health in the spotlight. Lancet Diabetes Endocrinol 2020; 8(6): 457. Dostupné z DOI: <–8587(20) 30164–9>.

Diabetology Endocrinology Internal medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account