Diabetes mellitus remains one of the chronic illnesses prevalent in Nigeria and its effects are palpable economically, socially, psychologically and medically. Several studies have highlighted the increased mortality of diabetic patients during the COVID-19 pandemic. Why do diabetics have severe outcomes?
Ugwueze et al (2020) highlighted that Furin, a protease which enhances viral entry has been documented to be elevated in diabetic patients along with other favourable factors like increased acidity in the cell known to occur in diabetics, a reduced innate immunity and an increase in angiotensin-converting enzyme 2 receptors (ACE2) receptors. These factors illustrate the increased risks diabetics face in being infected with the COVID-19 virus.
A reduced innate immunity promotes easy viral entry and replication and spread of the illness. In our environment where multiple factors impact on our immunity, the presence of chronic illness like diabetes mellitus worsens the individual’s immune response to the virus. Factors prevalent in our environment which reduce immunity include poor nutrition, environmental pollution, stress and abuse of drugs particularly antibiotics.
Furthermore, certain medications used in the management of diabetes mellitus complicate the disease process especially in their upregulation of ACE 2 receptors present in the lungs, kidney and intestines. ACE 2 receptors facilitate the entry of COVID-19 into the cells particularly the respiratory system which is the first port of entry for the virus (Yang J et al, 2020). Drugs commonly prescribed and used in the management of diabetes mellitus and its complications which upregulate ACE2 receptors include ACE inhibitors like Lisinopril, enalapril; diabetic medications like Pioglitazone and Liraglutide. Physicians therefore have a duty to advise their diabetic patients and relatives on the need to take precautions by strict control of the blood glucose levels to optimize immune functions and reduce the risk of severe illness. Also, optimize the medications particularly drugs like ACE- inhibitors (lisinopril, enalapril), Angiotensin receptor blockers (Losartan, Valsartan), Pioglitazone, Liraglutide which promote viral entry.
COVID-19 symptoms vary in individuals from mild to severe. Patients with diabetes mellitus, hypertension and other chronic illnesses have been shown scientifically to have worse outcomes. Nonetheless, a meticulous approach to health can achieve excellent results for the patient and physicians.
Edwin Okon is a Medical Doctor and Lecturer. He is a member of the Royal College of Surgeons Edinburgh. He can be contacted via e-mail on eddyeti2004@gmail.com.
