Anil Kumar Goel1, Seema Shah2. 1. Professor, Departments of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India. 2. Assistant Professor, Departments of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Dear Editor,In the journal's September 2020 issue, the commentary “Behera KK, Hota D, Mahapatra A. COVID 19 and diabetes: An endocrinologist's perspective. J Family Med Prim Care 2020;9:4512-5“[1] briefly summarizes the pathogenesis of increased mortality and desirable actions by the physicians in diabeticpatients with COVID-19infection.The authors have stressed the role of prevailing chronic inflammation in inviting infections in diabetes. An increased synthesis of advanced glycated end products and pro-inflammatory cytokines and prevailing high oxidant state favors production of adhesion molecules thereby causing a chronic inflammatory state in diabetes with a higher propensity to infections.[2] However, the prevalence of diabetes in COVID 19 is reported to be lower or similar to that in general population may be either because of use of DPP-4 inhibitors in treatment of diabetes or because of underreporting or higher precautionary measures taken by diabeticpatients.[3] It becomes important to highlight here that dipeptidyl peptidase-4 (DPP-4) is the primary receptor of MERS- CoV, which may also be a receptor for SARS CoV-2.[4]Nonetheless, preexisting diabetes in COVID 19 infection increases the risk of complications, contributed significantly by a preexisting pro-coagulant thrombotic state, higher cytokine levels, existing vascular inflammation and endothelial dysfunction in diabeticpatients.[5] COVID-19infection in diabeticpatients triggers greater release of stress hormones e.g., glucocorticoids and catecholamine which in turn further increases the blood glucose levels.However, we want to highlight the importance of monitoring of blood glucose even in nondiabetic COVID -19 positive patients, as hyperglycemia worsens the prognosis of COVID-19 more in nondiabetic person than in diabeticpatient as reported by Sing A.[6] The mechanism of hyperglycemia in COVID -19 can be explained on the basis of high stress, causing release of stress hormones, which are hyperglycemic by function. Secondly attachment of SARS CoV-2 virus to ACE II receptors on pancreatic beta cells, causes dysregulated insulin release, contributing to hyperglycemia.Considering the increasing COVID-19 numbers with not yet declared community transmission stage, a regular self blood glucose monitoring along with monitoring of oxygen saturation by pulse oximetry, should be advocated for all, to raise a suspicion of possible infection and need for confirmatory testing.