COVID-19 in people with diabetes: understanding the reasons for worse outcomes
COVID-19 in people with diabetes: understanding the reasons for worse outcomes
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DOI：
10.1016/s2213-8587(20)30238-2
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发表时间：
2020-09-01
影响因子：
44.5
通讯作者：
Prato, Stefano Del
中科院分区：
文献类型：
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作者：
Apicella, Matteo;Campopiano, Maria Cristina;Prato, Stefano Del
自 COVID-19 在中国首次爆发以来，由于感染者的预后较差，糖尿病患者受到了广泛关注。最初的报告主要针对 2 型糖尿病患者，尽管最近的调查显示 1 型糖尿病患者也面临严重 COVID-19 的风险。糖尿病患者预后较差的原因可能是多因素的，从而反映了糖尿病的综合征性质。年龄、性别、种族、高血压和心血管疾病等合并症、肥胖以及促炎症和促凝血状态都可能导致更糟糕结果的风险。降血糖药物和抗病毒治疗可以调节风险，但应仔细评估其使用限制以及与 COVID-19 治疗的潜在相互作用。最后，严重急性呼吸综合征冠状病毒2感染本身可能是糖尿病患者病情恶化的一个因素，因为它可以通过对β细胞功能的直接负面影响而引发急性代谢并发症。这些对 β 细胞功能的影响还可能导致糖尿病患者出现糖尿病酮症酸中毒、糖尿病史不明的患者入院时出现高血糖，以及可能导致新发糖尿病。
Since the initial COVID-19 outbreak in China, much attention has focused on people with diabetes because of poor prognosis in those with the infection. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk, but limitations to their use and potential interactions with COVID-19 treatments should be carefully assessed. Finally, severe acute respiratory syndrome coronavirus 2 infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through direct negative effects on beta-cell function. These effects on beta-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with unknown history of diabetes, and potentially new-onset diabetes.