COVID-19: Diabetes Perspective—Pathophysiology and Management.

Recent evidence relating to the impact of COVID-19 on people with diabetes is limited
but continues to emerge. COVID-19 pneumonia is a newly identified illness spreading rapidly
throughout the world and causes many disabilities and fatal deaths. Over the ensuing 2 years,
the indirect effects of the pandemic on healthcare delivery have become prominent, along with
the lingering effects of the virus on those directly infected. Diabetes is a commonly identified risk
factor that contributes not only to the severity and mortality of COVID-19 patients, but also to the
associated complications, including acute respiratory distress syndrome (ARDS) and multi-organ
failure. Diabetic patients are highly affected due to increased viral entry into the cells and decreased
immunity. Several hypotheses to explain the increased incidence and severity of COVID-19 infection
in people with diabetes have been proposed and explained in detail recently. On the other hand,
20–50% of COVID-19 patients reported new-onset hyperglycemia without diabetes and new-onset
diabetes, suggesting the two-way interactions between COVID-19 and diabetes. A systematic review
is required to confirm diabetes as a complication in those patients diagnosed with COVID-19. Diabetes
and diabetes-related complications in COVID-19 patients are primarily due to the acute illness caused
during the SARS-CoV-2 infection followed by the release of glucocorticoids, catecholamines, and
pro-inflammatory cytokines, which have been shown to drive hyperglycemia positively. This review
provides brief insights into the potential mechanisms linking COVID-19 and diabetes, and presents
clinical management recommendations for better handling of the disease.