A novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has been responsible to almost 153,000 mortalities in Indonesia as of March 2022 based on Indonesian Government database and has caused many disruptions in the communities. SARS-CoV-2 uses angiotensin- converting enzyme 2 (ACE2) as the receptor, in which the enzyme is available in various organs (such as lungs, heart, kidneys, intestines, and so on). Diabetes mellitus is a condition responsible for high number of global morbidities, especially due to vascular diseases it induces through chronic inflammation. As any other underlying diseases, diabetes mellitus could contribute to the poor prognosis of COVID-19. This is ascribed to the role of inflammation in the pathogenesis of severe COVID-19, where chronic inflammation is a common condition in individuals with diabetes mellitus. 4 Common comorbidities found in diabetes mellitus, such as obesity and hypertension, have been evidenced to be responsible for acute respiratory disease syndrome (ARDS) as well as multi-organ dysfunction.
Understanding clinical characteristics of diabetes mellitus of patients who are infected with SARS-CoV-2 is important to provide proper management. For example, those with poor glycemic control could have worse viral infections, as proven by SARS and influenza H1N1 cases. Respiratory distress induced by the viral infection could lead to the apoptosis of pancreatic beta cells that consequently causes insulin insufficiency. Therefore, glucose-lowering therapies should be continued or performed during the COVID-19 management. Nonetheless, clinicians should also consider the pro-inflammatory effect of some antidiabetic drugs which could contribute to the progression of severe COVID-19. Thiazolidinediones (TZDs) is one of the antidiabetic therapies that has been found to induce inflammation by elevating ACE2 and angiotensin 1-7 expressions. Moreover, in a meta-analysis of 13 trials, increased risk of developing pneumonia was found in TZD group. These explanations suggest that there are strong associations between COVID-19 and both diabetes mellitus and its management.
In the case of COVID-19, based on a meta-analysis, the number of patients with diabetes mellitus could reach 8% of the total patients. However, the prevalence was dramatically higher (36%) in Italian population, where 34% of which died during the treatment. In Indonesia itself, the data from Jakarta province (n=20,481) revealed that the prevalence was only 3.4%, but the mortality rate was higher in diabetes mellitus group (21.28%) than that in non-diabetes mellitus group (2.77%). By using a larger data set from the Indonesian COVID-19 Task Force, a study revealed that diabetes mellitus as the second most common comorbidity (33.6%) after hypertension (52.1%). Taken altogether, it is still uncertain whether the prevalence of diabetes mellitus among COVID-19 patients, especially in Indonesia, is high. Herein, we reported the data from East Java Province, Indonesia, regarding the clinical characteristics of the COVID-19 and diabetes mellitus patients and the treatment they received during the hospitalization. Moreover, we also reported the outcomes from symptomatic management for COVID-19 in combination with diabetes mellitus therapies which could be recommended for hospitals in developing countries with limited medical and financial resources.
Penulis: Erwin Astha Triyono
