key: cord-0868208-jfmbnm97
authors: Jhaveri, Ravi
title: How COVID-19 is Helping Us Learn More about Diabetes Pathogenesis
date: 2021-09-10
journal: Clin Ther
DOI: 10.1016/j.clinthera.2021.08.013
sha: d11939cb5d8b788ce6aac8ed81574bbec5dbfa38
doc_id: 868208
cord_uid: jfmbnm97

nan

Chicago, IL 60611-2991 Email: ravi.jhaveri@northwestern.edu In this month's topic update, we present a collection of articles on various aspects of Diabetes Mellitus (DM). The authors discuss novel treatments for Non-Alcoholic Fatty Liver Disease (NAFLD) and the promise of candidate biomarkers for both Diabetic Neuropathy and NAFLD. We want to thank our topic editor, Uazman Alam, and all of the contributing authors for sharing their expertise. This issue comes at the same time as yet another resurgence of COVID-19 infections in the US and elsewhere around the world. Driven by the increased transmissibility of the delta variant, the ongoing infections remind us that our continued vigilance will continue to be needed for the foreseeable future(1, 2). I want to take a moment to tie the 2 topics of DM and COVID-19 together. Early in the pandemic, DM was associated with increased mortality and severity of disease with COVID-19(3). Since that time, there have been some fascinating studies focused on the impact of COVID-19 infection on those with DM.

Rather than being specific to this infection, these studies highlight some of the common ways that different infections are linked with DM.

A consistent observation in the first few months of the initial surge of COVID-19 cases was the description of worse outcomes for diabetic patients, who were overrepresented in the patients who required hospitalization and subsequent ICU admission (4) . What was also interesting was the rate of diabetic ketoacidosis (DKA) that was associated with COVID-19 infection (5) . The T1D Exchange Quality Improvement Collaborative conducted a US based study to evaluate patients with type 1 DM who presented with COVID-19 infection. In their analysis, they found that more than half of patients were hyperglycemic when they presented with COVID-19 and almost one third were diagnosed with DKA.

Compared to usually more common type 1 DM patient, a subsequent study further described a very high rate of DKA among patients with type 2 DM when they developed COVID-19 infection (6) . These pathways was associated with pancreatic -cell dedifferentiation, so this could happen with any virus that activates these pathways and is not specific to SARS-CoV-2 (10) . Not only do the findings of reduced insulin secretion support the increased cases of DKA, but the overall body of work supports the longheld hypothesis that viral infections are a key inciting event for developing type 1 DM that drives the autoimmune destruction of pancreatic -cells (11) .

With a 2019 global prevalence estimate of almost 500 million people, DM has evolved into one of the world's greatest health threats(12). Superimposed upon a global pandemic with many highly populous countries with woefully inadequate vaccination rates, the unique synergy of SARS-CoV-2 and DM will continue to drive severe morbidity and mortality for the duration (13) . We can only hope that some of the biomarkers and new therapies discussed by our guest authors in this topic update help to improve outcomes for these patients sooner rather than later. In the meantime, please everyone get your vaccines, get your booster doses, wear a mask and be safe.

Increased transmissibility and global spread of SARS-CoV-2 variants of concern as at

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia -A systematic review, meta-analysis, and meta-regression

Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 -United States

Type 1 Diabetes and COVID-19: Preliminary Findings From a Multicenter Surveillance Study in the U

Diabetic ketoacidosis and mortality in COVID-19 infection

Diabetic ketoacidosis: risk factors and management strategies

SARS-CoV-2 infects human pancreatic beta cells and elicits beta cell impairment

SARS-CoV-2 infection induces beta cell transdifferentiation

Virus-like infection induces human beta cell dedifferentiation

Immunology in the clinic review series

International Diabetes Foundation. Global Diabetes data report

COVID-19 Global Cases Map