Coronavirus infections and type 2 diabetes-shared pathways w
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The coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with Type 2 diabetes (T2D). This review focuses on the basic and clinical science spanning the intersections of diabetes, coronavirus infections, ACE2, and DPP4 biology, highlighting clinical relevance and evolving areas of uncertainty underlying the pathophysiology and treatment of T2D in the context of coronavirus infection.

DPP-IV inhibitors and GLP-1 receptor agonists, which are widely used in the treatment of type 2 diabetes, may exert anti-inflammatory actions in humans, and the agents have been used to control glucose in hospitalized patients, Daniel J. Drucker, MD, wrote in the updated review. However, there is “insufficient evidence” to suggest such agents might safely replace insulin for critically ill individuals with diabetes and coronavirus infection, he wrote.

“It has become clear over the last few months that people with diabetes, and people with obesity, are at greater risk for more severe COVID-19 infections,” Drucker told. “We also know that GLP-1 levels and DPP-IV activity are regulated by infection and inflammation, and in turn, DPP-IV inhibitors and GLP-1 receptor agonists may also modulate inflammation. There is also science linking DPP-IV to coronavirus infection, specifically with MERS-CoV.”

“The severe acute respiratory syndrome SARS-CoV2 (also referred to as COVID-19) coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with type 2 diabetes,” Drucker wrote.

Some important takeaways for clinicians:

-- ACE2 and DPP-IV are coronavirus receptors. DPP-IV is a MERS-CoV receptor, but not a SARS-CoV-2 receptor, that is, not a COVID-19 receptor.
-- ACE2 and DPP-IV control inflammation and cardiometabolic physiology.
-- DPP-IV inhibitors do not meaningfully modify immune response in humans.
-- COVID-19 hospitalizations are more common among people with diabetes and obesity.
-- Acute COVID-19 illness requires reevaluation of any medications used for type 2 diabetes.
-- Insulin is the glucose-lowering therapy of choice for acute coronavirus-related illness in hospital.

Source: https://academic.oup.com/edrv/article/doi/10.1210/endrev/bnaa011/5820492
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