Abstract Body

People with diabetes compared with people without exhibit worse prognosis if affected by COVID-19 induced by the SARS-CoV2, particularly when compromising metabolic control and concomitant cardiovascular disorders are present.

This perspective article seeks to explore newly occurring cardio-renal-pulmonary organ damage induced or aggravated by the disease process of COVID-19 and its implications for the cardiovascular risk management of people with diabetes, especially also taking into account potential interactions with mechanisms of cellular intrusion of SARS-CoV2. Severe infection with SARS-CoV2 can precipitate myocardial infarction, myocarditis, heart failure, and arrhythmias as well as an acute-respiratory-distress-syndrome and renal failure. They may evolve along with multi-organ failure due to directly SARS-CoV2 infected endothelial cells and resulting endotheliitis. This complex pathology may bear challenges for the use of most diabetes medications in terms of emerging contraindications that need close monitoring of all people with diabetes diagnosed with SARS-CoV2-infection. Whenever possible, continuous-glucose-monitoring should be implemented to ensure stable metabolic compensation. Patients in intensive-care-unit requiring therapy for glycemic control should solely be handled by intravenous insulin using exact dosing with a perfusion device. Although not only ACE-inhibitors and angiotensin-2-receptor-blockers, but also SGLT2-inhibitors, GLP1-receptor-agonists, pioglitazone, and probably insulin seem to increase the number of ACE2-receptors on the cells utilized by SARS-CoV2 for penetration, no evidence presently exists that this might be harmful in terms of acquiring or worsening COVID-19 with unequivocal proof urgently awaited. In conclusion, COVID-19 and related cardio-renal-pulmonary damage can profoundly affect cardiovascular risk management of people with diabetes.