To the Editors:

As the latest issues of MEDICC Review reveal, the global scientific community is fully engaged in unraveling the mysteries of COVID-19, including its relationship to chronic conditions such as diabetes mellitus (DM), a frequent comorbidity with SARS-CoV-2 infection. Various studies report up to 30% of persons with COVID-19 are diabetic,[¹1. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol [Internet]. 2020 Mar 11 [cited 2020 Jul 10];109:531–8. Available at: https://doi.org/10.1007/s00392-020-01626-9
https://doi.org/10.1007/s00392-020-01626... ] and such patients are at greater risk of intrahospital deaths from the disease.[²2. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet [Internet]. 2020 Mar 28 [cited 2020 Jul 10];395(10229):1054–62. Available at: https://doi.org/10.1016/S0140-6736(20)30566-3
https://doi.org/10.1016/S0140-6736(20)30... ]

Huang’s meta-analysis in China reviewed 30 studies assessing 6452 cases showed that DM patients had worse prognosis (RR 2.38 [CI 95%: 1.88–3.03; p <0.001]) and higher risk of death (RR 2.12 [CI 95%: 1.44–3.11; p <0.001]), severe COVID-19 (RR 2.45 [CI 95%: 1.79–3.35; p <0.001]) and disease progression (RR 3.31 [CI 95%: 1.08–10.14; p = 0.04]).[³3. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr [Internet]. 2020 Jul–Aug [cited 2020 Jul 10];14(4):395–403. Available at: https://doi.org/10.1016/j.dsx.2020.04.018
https://doi.org/10.1016/j.dsx.2020.04.01... ] Diabetic patients with compromised immune systems and those aged >65 years also had greater risk of dying from COVID-19.[⁴4. Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, Vargas-Vázquez A, González-Díaz A, Márquez-Salinas A, et al. Predicting mortality due to SARS-CoV-2: a mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab [Internet]. 2020 [cited 2020 Jul 10]. Available at: https://academic.oup.com/jcem/article/105/8/2752/5849337
https://academic.oup.com/jcem/article/10... ]

Among the physiopathological factors relating COVID-19 with DM is over expression of angiotensin converting enzyme 2 (ACE2), above all in those patients treated with ACE2 inhibitors for comorbidities or diabetic complications, as well as the cytokine storm induced by glucolipid disorders.

These observations give us ample warning of the need to protect DM patients in the context of COVID-19. However, circumstances provoked by the pandemic, in which specialist consults and follow up for these patients have been limited, can contribute to deteriorating disease control. The lack of physical activity coupled with the stress brought on by social isolation further aggravates the situation for those living with diabetes. Thus, it is left up to patients and their families to pay greater attention to self-care and safety measures.

Health systems and their professionals must seek alternatives that facilitate personalized medical care in the context of the pandemic, including telemedicine options. At the same time, health professionals are challenged to continuously update their knowledge concerning DM and its relation to COVID-19.

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