Diabetes and COVID-19:Role of insulin resistance as a risk factor for COVID-19 severity

摘要

Patients with diabetes are more susceptible to coronavirus disease 2019(COVID-19),and as a consequence,develop more severe form of disease.This is partly due to a systemic inflammatory state and pro thrombotic milieu seen in metabolic syndrome.In this review,we attempt to explore the pathogenetic links between insulin resistance and COVID-19 disease severity.Insulin resistance is an underlying condition for metabolic syndromes,including type 2 diabetes,which impairs insulin signaling pathways affecting metabolic and cardiovascular homeostasis.A high concentration of circulating insulin shifts the balance to mitogen activated protein kinase(MAPK)-dependent signaling and causes endothelial cell damage.The phosphatidylinositol 3 kinase and MAPK dependent signaling pathways maintain a balance between nitric oxide-dependent vasodilator and endothelin-1 dependent vasoconstriction actions of insulin.Vascular smooth muscle cell dysfunction is responsible for inflammation and blood coagulation leading to microvascular and macrovascular complications in diabetes.Hyperactivity in renin-angiotensin system is implicated in development of islet oxidative stress and subsequentβ-cell dysfunction,as it alters the islet blood flow.These deleterious effects of insulin resistance involving altered blood pressure,vascular dysfunction,and inflammation could be associated with increased severity in COVID-19 patients.We conclude that clinical and/or biochemical markers of insulin resistance should be included as prognostic markers in assessment of acute COVID-19 disease.