|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 583
Hyperglycemia: An independent accompaniment of COVID -19
Anil Kumar Goel1, Seema Shah2
1 Professor, Departments of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Assistant Professor, Departments of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
|Date of Submission||13-Oct-2020|
|Date of Acceptance||02-Dec-2020|
|Date of Web Publication||30-Jan-2021|
Dr. Seema Shah
Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goel AK, Shah S. Hyperglycemia: An independent accompaniment of COVID -19. J Family Med Prim Care 2021;10:583
In the journal's September 2020 issue, the commentary “Behera KK, Hota D, Mahapatra A. COVID 19 and diabetes: An endocrinologist's perspective. J Family Med Prim Care 2020;9:4512-5“ briefly summarizes the pathogenesis of increased mortality and desirable actions by the physicians in diabetic patients with COVID-19 infection.
The authors have stressed the role of prevailing chronic inflammation in inviting infections in diabetes. An increased synthesis of advanced glycated end products and pro-inflammatory cytokines and prevailing high oxidant state favors production of adhesion molecules thereby causing a chronic inflammatory state in diabetes with a higher propensity to infections. However, the prevalence of diabetes in COVID 19 is reported to be lower or similar to that in general population may be either because of use of DPP-4 inhibitors in treatment of diabetes or because of underreporting or higher precautionary measures taken by diabetic patients. It becomes important to highlight here that dipeptidyl peptidase-4 (DPP-4) is the primary receptor of MERS- CoV, which may also be a receptor for SARS CoV-2.
Nonetheless, preexisting diabetes in COVID 19 infection increases the risk of complications, contributed significantly by a preexisting pro-coagulant thrombotic state, higher cytokine levels, existing vascular inflammation and endothelial dysfunction in diabetic patients. COVID-19 infection in diabetic patients triggers greater release of stress hormones e.g., glucocorticoids and catecholamine which in turn further increases the blood glucose levels.
However, we want to highlight the importance of monitoring of blood glucose even in nondiabetic COVID -19 positive patients, as hyperglycemia worsens the prognosis of COVID-19 more in nondiabetic person than in diabetic patient as reported by Sing A. The mechanism of hyperglycemia in COVID -19 can be explained on the basis of high stress, causing release of stress hormones, which are hyperglycemic by function. Secondly attachment of SARS CoV-2 virus to ACE II receptors on pancreatic beta cells, causes dysregulated insulin release, contributing to hyperglycemia.
Considering the increasing COVID-19 numbers with not yet declared community transmission stage, a regular self blood glucose monitoring along with monitoring of oxygen saturation by pulse oximetry, should be advocated for all, to raise a suspicion of possible infection and need for confirmatory testing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Behera KK, Hota D, Mahapatra A. COVID 19 and diabetes: An endocrinologist's perspective. J Family Med Prim Care 2020;9:4512-5. [Full text]
Sylvia K. Diabetes and infection: Is there a link?-A mini-review. Gerontology 2013;59:99-104.
Fadini GP, Morieri ML, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest 2020;. 1-3. doi: 10.1007/s40618-020-01236-2 [Epub ahead of print]
Song Z, Xu Y, Bao L, Zhang L, Yu P, Qu Y. From SARS to MERS, thrusting coronaviruses into the spotlight. Viruses 2019;11:59.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:P1054-1062.
Sing A. Hyperglycemia without diabetes and new-onset diabetes are both associated with poorer outcomes in COVID-19. Diab Res Clin Pract 2020;167:108382.