key: cord-0709101-7rboc10j
authors: Boccardi, Virginia
title: Autonomic dyshomeostasis in patients with diabetes mellitus during COVID-19
date: 2021-01-15
journal: Nat Rev Endocrinol
DOI: 10.1038/s41574-021-00466-5
sha: 2bff08dd2e9bbdf145de03ab06ea0aeab00adf48
doc_id: 709101
cord_uid: 7rboc10j

nan

system via the neuro-inflammatory pathway and via the cholinergic anti-inflammatory pathway, and also controls the function of the respiratory system 5 . Thus, the early identification of autonomic dyshomeostasis in patients with diabetes mellitus and COVID-19 is clinically important. Indeed, it is possible to hypothesize that the modulation of autonomic nervous system homeostasis (such as with the use of non-invasive transcutaneous electrical vagal nerve stimulation) might improve clinical outcomes in patients at risk of progressing to severe COVID-19.

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The author declares no competing interests.abnormal heart rate variability (from severe bradycardia to tachycardia and arrhythmia), haemodynamic instability and altered mental status. Thus, it seems that the pathophysiological processes of COVID-19 change the interplay of the immune, endocrine and nervous systems. These systems interact with each other by means of cytokines, hormones and neurotransmitters 3 .Interestingly, the nervous systems communicate with the immune system and regulate its activity through the autonomic nervous system (via sympathetic and parasympathetic activity) 3 . It is well established that diabetes mellitus is a condition associated with autonomic dysfunction, where sympathetic activity is hyperactivated alongside withdrawal of parasympathetic activity 4 . Moreover, when the balance between the sympathetic and parasympathetic nervous systems is disturbed by certain events, such as serious stress and inflammation during COVID-19, a stronger sympathetic impulse might shift homeo stasis of the autonomic nervous system towards further sympathetic dominance, potentially leading to increased mortality. The autonomic nervous system interacts with the immune Autonomic dyshomeostasis in patients with diabetes mellitus during COVID-19Virginia Boccardi C o r r e s p o n d e n C e Nature reviews | Endocrinology