RESUMO
Up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders. Notably, there are many direct links between COVID-19 and the metabolic and endocrine systems. Thus, not only are patients with metabolic dysfunction (eg, obesity, hypertension, non-alcoholic fatty liver disease, and diabetes) at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders. In this Review, we provide an update on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Additionally, we update the practical recommendations and management of patients with COVID-19 and post-pandemic. Furthermore, we summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.
Assuntos
COVID-19/epidemiologia , COVID-19/metabolismo , Gerenciamento Clínico , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/metabolismo , Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/terapia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/metabolismo , Diabetes Mellitus/terapia , Humanos , Hipertensão/epidemiologia , Hipertensão/metabolismo , Hipertensão/terapia , Doenças Metabólicas/terapia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade/epidemiologia , Obesidade/metabolismo , Obesidade/terapiaRESUMO
Metabolic diseases are associated with an increased risk of severe COVID-19 and conversely, new-onset hyperglycemia and complications of preexisting diabetes have been observed in COVID-19 patients. Here, we performed a comprehensive analysis of pancreatic autopsy tissue from COVID-19 patients using immunofluorescence, immunohistochemistry, RNA scope and electron microscopy and detected SARS-CoV-2 viral infiltration of beta-cells in all patients. Using SARS-CoV-2 pseudoviruses, we confirmed that isolated human islet cells are permissive to infection. In eleven COVID-19 patients, we examined the expression of ACE2, TMPRSS and other receptors and factors, such as DPP4, HMBG1 and NRP1, that might facilitate virus entry. Whereas 70% of the COVID-19 patients expressed ACE2 in the vasculature, only 30% displayed ACE2-expression in beta-cells. Even in the absence of manifest new-onset diabetes, necroptotic cell death, immune cell infiltration and SARS-CoV-2 viral infection of pancreatic beta-cells may contribute to varying degrees of metabolic dysregulation in patients with COVID-19.
Assuntos
Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/patologia , Células Secretoras de Insulina/virologia , Receptores de Coronavírus/metabolismo , SARS-CoV-2/isolamento & purificação , Serina Endopeptidases/metabolismo , Adulto , Idoso , Autopsia , Complicações do Diabetes/patologia , Complicações do Diabetes/virologia , Diabetes Mellitus/patologia , Dipeptidil Peptidase 4/metabolismo , Feminino , Proteínas HMGN/metabolismo , Humanos , Células Secretoras de Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Neuropilina-1/metabolismo , Especificidade de Órgãos/fisiologiaRESUMO
ZusammenfassungBei Menschen mit einer Infektion mit dem neuartigen Coronavirus SARS-CoV-2 und einer COVID-19-Erkrankung sind Diabetes mellitus und kardiovaskuläre Erkrankungen sehr häufige Komorbiditäten. Patienten mit Diabetes und Begleit- beziehungsweise Folgeerkrankungen scheinen ein erhöhtes Risiko für einen schweren Krankheitsverlauf bei COVID-19 einschließlich ARDS und Multiorganversagen zu haben. Die genauen Zusammenhänge zwischen Diabetes und COVID-19-Krankheitsverlauf sind noch nicht vollständig geklärt. Die DDG hat daher prinzipielle Handlungsempfehlungen zur Diabetestherapie bei Diabetes mellitus und COVID-19-Erkrankung zusammengefasst.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Diabetes Mellitus , Pandemias , Pneumonia Viral , COVID-19 , Humanos , SARS-CoV-2RESUMO
Diabetes is one of the most important comorbidities linked to the severity of all three known human pathogenic coronavirus infections, including severe acute respiratory syndrome coronavirus 2. Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure. Depending on the global region, 20-50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes. Given the importance of the link between COVID-19 and diabetes, we have formed an international panel of experts in the field of diabetes and endocrinology to provide some guidance and practical recommendations for the management of diabetes during the pandemic. We aim to briefly provide insight into potential mechanistic links between the novel coronavirus infection and diabetes, present practical management recommendations, and elaborate on the differential needs of several patient groups.