Diabetes and COVID-19 Disease; Why do Diabetics have Worse Outcomes?
This is carefully looked at in The Lancet Diabetes and Endocrinology by Matteo Apicella and others and they suggest that the reason for worse prognosis in people with diabetes is likely to be multifactorial, and reflects the syndromic nature of diabetes. Age, sex, ethnicity and comorbidities such as hypertension and cardiovascular disease, obesity and a pro-inflammatory and pro-coagulative state contribute to this risk of worse outcomes.
Glucose-lowering agents and anti-viral treatments can modulate this risk, but limitations to their use and potential interactions with COVID-19 treatments need to be carefully assessed.
Severe acute respiratory syndrome infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through a direct negative effect on β-cell function. These effects on β-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with an unknown history of diabetes, and potentially new-onset diabetics.