COVID-19 and diabetes mellitus: from pathophysiology to clinical management.
COVID-19 and diabetes mellitus: from pathophysiology to clinical management.
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DOI：
10.1038/s41574-020-00435-4
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Nauck MA
中科院分区：
文献类型：
--
作者：
Lim S;Bae JH;Kwon HS;Nauck MA
最初的研究发现，糖尿病患者感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）的严重程度增加。此外，COVID-19还可能使受感染者易患高血糖症。与其他风险因素相互作用，高脂血症可能会调节免疫和炎症反应，从而使患者易于患上严重的COVID-19，并可能导致致命的后果。血管紧张素转换酶2（ACE 2）是肾素-血管紧张素-醛固酮系统（RAAS）的一部分，是SARS-CoV-2的主要进入受体;尽管二肽基肽酶4（DPP 4）也可能作为结合靶点。然而，初步数据并不表明降糖DPP 4抑制剂对SARS-CoV-2易感性有显著影响。由于其药理学特性，钠-葡萄糖协同转运蛋白2（SGLT 2）抑制剂可能会对COVID-19患者造成不良影响，因此不推荐使用。目前，胰岛素应是控制急性高血糖症的主要手段。大多数现有证据没有区分糖尿病的主要类型，并与2型糖尿病有关，因为其发病率很高。然而，目前关于1型糖尿病和COVID-19的证据有限。这些结论大多是初步的，需要进一步研究糖尿病患者的最佳治疗方法。冠状病毒病19（COVID-19）和糖尿病的病理生理学相互关联，糖尿病与严重的COVID-19结局相关。本综述重点介绍了糖尿病和COVID-19的新进展，考虑了糖尿病患者在持续大流行中的疾病机制和临床管理。潜在的糖尿病和心血管疾病被认为是2019冠状病毒病（COVID-19）疾病严重程度增加和结局恶化（包括死亡率升高）的风险因素。COVID-19和糖尿病之间的潜在发病机制联系包括对葡萄糖稳态、炎症、免疫状态改变和肾素-血管紧张素-醛固酮系统（RAAS）激活的影响。在COVID-19大流行期间，严格控制血糖水平和预防糖尿病并发症可能对糖尿病患者保持低易感性和预防COVID-19严重病程至关重要。有证据表明，胰岛素和二肽基肽酶4抑制剂可安全用于糖尿病和COVID-19患者;二甲双胍和钠-葡萄糖协同转运蛋白2抑制剂可能需要在重度疾病高风险患者中停用。正在研究的用于治疗COVID-19的药物制剂会影响葡萄糖代谢，特别是糖尿病患者;因此，需要频繁监测血糖并个性化调整药物。由于COVID-19至今缺乏明确的治疗方法，糖尿病患者应严格遵守一般预防规则，并更频繁地监测血糖水平，从事体力活动，健康饮食并控制其他风险因素。
Initial studies found increased severity of coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals to hyperglycaemia. Interacting with other risk factors, hyperglycaemia might modulate immune and inflammatory responses, thus predisposing patients to severe COVID-19 and possible lethal outcomes. Angiotensin-converting enzyme 2 (ACE2), which is part of the renin–angiotensin–aldosterone system (RAAS), is the main entry receptor for SARS-CoV-2; although dipeptidyl peptidase 4 (DPP4) might also act as a binding target. Preliminary data, however, do not suggest a notable effect of glucose-lowering DPP4 inhibitors on SARS-CoV-2 susceptibility. Owing to their pharmacological characteristics, sodium–glucose cotransporter 2 (SGLT2) inhibitors might cause adverse effects in patients with COVID-19 and so cannot be recommended. Currently, insulin should be the main approach to the control of acute glycaemia. Most available evidence does not distinguish between the major types of diabetes mellitus and is related to type 2 diabetes mellitus owing to its high prevalence. However, some limited evidence is now available on type 1 diabetes mellitus and COVID-19. Most of these conclusions are preliminary, and further investigation of the optimal management in patients with diabetes mellitus is warranted. The pathophysiology of coronavirus disease 19 (COVID-19) and diabetes mellitus are interlinked, and diabetes mellitus is associated with severe COVID-19 outcomes. This Review highlights new advances in diabetes mellitus and COVID-19, considering disease mechanisms and clinical management of patients with diabetes mellitus in the ongoing pandemic. Underlying diabetes mellitus and cardiovascular diseases are considered risk factors for increased coronavirus disease 2019 (COVID-19) disease severity and worse outcomes, including higher mortality. Potential pathogenetic links between COVID-19 and diabetes mellitus include effects on glucose homeostasis, inflammation, altered immune status and activation of the renin–angiotensin–aldosterone system (RAAS). During the COVID-19 pandemic, tight control of glucose levels and prevention of diabetes complications might be crucial in patients with diabetes mellitus to keep susceptibility low and to prevent severe courses of COVID-19. Evidence suggests that insulin and dipeptidyl peptidase 4 inhibitors can be used safely in patients with diabetes mellitus and COVID-19; metformin and sodium–glucose cotransporter 2 inhibitors might need to be withdrawn in patients at high risk of severe disease. Pharmacological agents under investigation for the treatment of COVID-19 can affect glucose metabolism, particularly in patients with diabetes mellitus; therefore, frequent blood glucose monitoring and personalized adjustment of medications are required. As COVID-19 lacks definitive treatment so far, patients with diabetes mellitus should follow general preventive rules strictly and monitor glucose levels more frequently, engage in physical activity, eat healthily and control other risk factors.
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DOI：
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