RESUMO
Evidence suggests severe coronavirus disease-19 (COVID-19) infection is characterised by pulmonary and systemic microvasculature dysfunction, specifically, acute endothelial injury, hypercoagulation and increased capillary permeability. Diabetes, which is also characterised by vascular injury in itself, confers an increased risk of adverse COVID-19 outcomes. It has been suggested that pre-existing endothelial dysfunction and microvascular disease in diabetes will exacerbate the vascular insults associated with COVID-19 and thus lead to increased severity of COVID-19 infection. In this article, we evaluate the current evidence exploring the impact of microvascular complications, in the form of diabetic retinopathy and nephropathy, in individuals with COVID-19 and diabetes. Future insights gained from exploring the microvascular injury patterns and clinical outcomes may come to influence care delivery algorithms for either of these conditions.
Assuntos
COVID-19/fisiopatologia , Angiopatias Diabéticas/fisiopatologia , Endotélio Vascular/patologia , Microcirculação , Pandemias , SARS-CoV-2 , Trombofilia/etiologia , Albuminúria/etiologia , COVID-19/complicações , Permeabilidade Capilar , Atenção à Saúde , Angiopatias Diabéticas/complicações , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/fisiopatologia , Retinopatia Diabética/complicações , Retinopatia Diabética/fisiopatologia , Endotélio Vascular/lesões , Humanos , Obesidade/complicações , Obesidade/fisiopatologia , Circulação Pulmonar , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Índice de Gravidade de Doença , Trombofilia/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Vitamin D is a hormone regulating not only calcium and phosphate homeostasis but also, at the same time, exerting many other extraskeletal functions via genomic effects (gene transcription) and probably by non-genomic effects as well. Availability is ensured by dietary intake of its precursors and by de novo production via sunlight. Yet, vitamin D deficiency and insufficiency are very common across the globe and are connected to many pathophysiological states, for example, diabetes mellitus, allergies, autoimmune diseases, pregnancy complications, and recently have also been associated with worse COVID-19 clinical outcomes. SUMMARY: In this review, we summarize current knowledge about vitamin D metabolism in general, its role in diabetes mellitus (mainly type 2) and diabetic complications (mainly diabetic kidney disease), and potential therapeutic perspectives including vitamin D signalling as a druggable target. Key Messages: Vitamin D is not only a vitamin but also a hormone involved in many physiological processes. Its insufficiency or deficiency can lead to many pathological states.