COVID19 coronavirus and diabetes

mar18

COVID19 coronavirus and diabetes

Researchers say (source: TheLancet) that medications taken by many people with high blood pressure and diabetes may increase the risk of complications and more severe symptoms of coronavirus, especially in the elderly. These are ACE inhibitors and angiotensin receptor blockers, that can lead to worsening of the disease.

ACE inhibitors and angiotensin receptor blockers and COVID-19 coronavirus

First of all, it should be added that patients should arbitrarily never stop taking their medications (ACE inhibitors and angiotensin receptor blockers), unless advised by a doctor and switching to a different type of medicine. These preparations increase the amount of enzyme used by coronavirus to infect the body.

Experts said (source: TheLancet) that patients with high blood pressure or diabetes who have been infected with the COVID-19 virus should be monitored in addition. Researchers say that people with high blood pressure and diabetes may be more likely to have severe or fatal coronavirus symptoms due to the effects of drugs. Drugs called ACE inhibitors and angiotensin receptor blockers can change the shape of cells in a way that makes it easier for the coronavirus to infect them and cause more serious disease. Last year, these drugs were widely prescribed in England almost 65 million times and cost the British NFZ (NHS) over £ 100 million. They are given to treat diabetes or high blood pressure, and it is estimated that around 10 percent of people in the UK - around 6.6 million - take them regularly.

An article published in the prestigious British medical journal The Lancet Respiratory Medicine investigated how coronavirus seizes human cells to infect them. Researchers have stipulated that patients taking medication cannot stop taking them on their own - they should talk to their doctor if they are in doubt. Drugs called ACE inhibitors and angiotensin receptor blockers can change the shape of someone's cells in a way that could make it easier for you to get COVID-19. Researchers have found that medicines taken by thousands of people can increase the risk of fatal symptoms in coronavirus.


The article was published by scientists from the University Hospital of Basel in Switzerland and the University of Thessaloniki in Greece, explains that the coronavirus attaches to the cells and attacks them, grabbing what is called angiotensin 2 converting enzyme (ACE2). Some people with high blood pressure or type 1 or type 2 diabetes take medications that increase the amount of ACE2 in their cells to control the disease. Drugs of interest to scientists are called ACE inhibitors and angiotensin receptor blockers (ARBs). According to NHS data, the most recommended versions in England are Ramipril, Losartan, Lisinopril and Candesartan.


The most characteristic comorbidities in 32 survivors out of 52 patients in the intensive care unit with the new coronavirus 2019 (COVID-19) in the Xiaobo Yang and colleagues study were cerebrovascular disease (22%) and diabetes (22% ). Another study involved 1099 patients with confirmed COVID-19, of which 173 had severe disease with co-existing hypertension (23.7%), diabetes (16.2%), coronary heart disease (5.8%) and cerebrovascular disease 3 %). In the third study, of 140 patients admitted to hospital with COVID-19, 30% had hypertension and 12% had diabetes. In particular, the most common comorbidities reported in these three studies of patients with COVID-19 are often treated with angiotensin converting enzyme (ACE) inhibitors; however, the treatment was not evaluated in any study.


Human pathogenic coronaviruses (acute respiratory distress syndrome [SARS-CoV] and SARS-CoV-2) bind to target cells by angiotensin 2 converting enzyme (ACE2), which is expressed by epithelial cells of the lungs, intestines, kidneys, and vessels vessels. ACE2 expression is significantly increased in patients with type 1 or type 2 diabetes who are treated with ACE inhibitors and type I angiotensin II receptor blockers (ARBs). Hypertension is also treated with ACE and ARB inhibitors, which increases ACE2 regulation. ACE2 may also be increased by the use of thiazolidinedione and ibuprofen. These data suggest that ACE2 expression increases in diabetes, and treatment with ACE and ARB inhibitors increases ACE2 expression. Consequently, increased ACE2 expression will facilitate COVID-19 infection. Therefore, we hypothesize that the treatment of diabetes and hypertension with ACE2 stimulating drugs may increase the risk of developing severe and fatal COVID-19.

Coronavirus_diabetes

Confirmation of this hypothesis can lead to a treatment conflict, as ACE2 reduces inflammation and has been proposed as a potential new therapy for inflammatory lung diseases, cancer, diabetes and hypertension. Another aspect that needs to be further explored is a genetic predisposition to an increased risk of SARS-CoV-2 infection, which may be due to ACE2 polymorphisms associated with diabetes, stroke and hypertension, particularly in Asian populations. To summarize this information, the individual's sensitivity may result from a combination of therapy and ACE2 polymorphism.

CoronavirusCOVID-19 from electron microscope, source: www.sciencephoto.com

It is suggested that patients with heart disease, hypertension or diabetes who are treated with drugs that increase ACE2 are more likely to have severe COVID-19 infection and should therefore be monitored for ACE2 modulating drugs such as ACE or ARB inhibitors. Based on the PubMed study of February 28, 2020, no evidence was found suggesting that other drugs, such as calcium channel blockers, increase ACE2 expression or activity, and therefore may be a suitable alternative treatment in these patients.

source: TheLancet, PubMed

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