Pre-diabetes should be treated as a comorbidity for COVID-19 and all patients infected with the virus need to be screened for the diabetes condition to reduce deaths and provide optimal clinical care.
This is according to a paper written by researchers from UKZN’s School of Laboratory Medicine and Medical Sciences PhD student Mr Aubrey Sosibo and senior lecturer and physiologist Dr Andile Khathi.
The paper has been published in the Experimental Biology and Medicine Journal as a press release.
The researchers say pre-diabetes could be a silent-killer in the fight against COVID-19 as it is not traditionally viewed as a comorbidity.
Elaborating on the study, Sosibo said: ‘It is widely accepted that Type 2 diabetes patients infected with the virus tend to experience more severe COVID-19 complications. However, investigations into the association between pre-diabetes and COVID-19 are almost unchartered. If this association is left unattended, then the potential of missing a silent killer will persist. Therefore, using pieces of evidence from recent literature, we address why pre-diabetes and COVID-19 can be a deadly combination. We think it is plausible that similar COVID-19 induced complications observed in individuals with Type 2 diabetes may also occur in people with pre-diabetes.’
In the light of these results, there will be further discussions and investigations which are expected to ultimately play a significant role in how COVID-19 infected patients with pre-diabetes are managed.
The researchers explained that pre-diabetes (or intermediate hyperglycemia) was a state in which the blood glucose concentration was above normal but not high enough to diagnose Type 2 diabetes. ‘The condition is characterised by the reduction in insulin sensitivity which causes glycemic dysregulation. This impaired regulation of glucose concentrations causes moderate hyperglycemia and is associated with chronic microvascular and macrovascular complications, cognitive dysfunction as well as blood pressure changes. Nevertheless, the body can maintain this intermediate hyperglycemic state over a prolonged period through compensatory mechanisms. However, these compensatory mechanisms can reach a point of exhaustion, resulting in a more severe hyperglycaemic state that eventually leads to Type 2 diabetes.’
Said Khathi: ‘The severity of the COVID-19 symptoms has been shown to be increased by the existence of comorbidities such as diabetes mellitus. This is also accompanied by data that states that COVID-19 has a higher fatality rate in people with pre-existing Type 2 diabetes than in those without. Additionally, Type 2 diabetes has been proven to independently suppress the immune response as well as lead to chronic inflammation. Other experimental and observational studies have shown that pre-diabetes is associated with elevated C-reactive protein and interleukin-6.11,12 These biochemical markers contribute significantly to the cytokine storm development which has been detected in severe cases of COVID-19 infected patients.
Taken together, these observations suggest that pre-diabetes could be a silent-killer in the fight against COVID-19 as it is not traditionally viewed as a comorbidity.
‘This study therefore proposes that pre-diabetes be treated as a comorbidity for COVID-19. It further suggests that all COVID-19 infected patients be screened for pre-diabetes to reduce the risk of fatality and improve clinical care,’ he said.
This paper further recommends that scientific trials be conducted to assess drugs such as metformin and other antidiabetic drugs to establish their effects on blood sugar control and the resultant clinical outcomes of COVID-19 infection in people with pre-diabetes.
The prognosis of COVID-19 in hospitalised patients with pre-diabetes is yet to be established due to the minimal data currently available. However, the two researchers are confident that the current information presented in this commentary can assist researchers in endocrinology and virology as well as those caring for COVID-19 patients with pre-diabetes.
• This commentary paper, which has been included in an Experimental Biology and Medicine press release, will be open for 90 days and is accessible here: https://journals.sagepub.com/doi/pdf/10.1177/1535370220973451
Words: Lihle Sosibo