• Mara Andreea VULTUR Pulmonology Clinic of Târgu Mureș, Romania
  • Sárközi HÉDI-KATALIN “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology Târgu Mureș, Romania
  • Maria Beatrice IANOSI Pulmonology Clinic of Târgu Mureș, Romania
  • Mioara SZATHMARY “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology Târgu Mureș, Romania
  • Edith Simona IANOSI “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology Târgu Mureș, Romania
  • Paraschiva POSTOLACHE “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania
  • Gabriela JIMBOREAN “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology Târgu Mureș, Romania


The aim of our study was to establish the relationship between diabetes mellitus (DM) and SARS-CoV-2 infection, given that DM patients have an increased risk of developing severe infections/complications. Material and methods: The study included 108 (33.4%) patients with known or unknown DM or prediabetes PD (fasting blood glucose 100-126 mg%) from a group of 323 COVID-19 patients. Age distribution in the first group with DM/PD: 15.7% ≤ 40 years old, 27.7% 41-60 years old, 52.7% 61-80 years old, 3.7% > 80 years old. Results: We noted a higher percentage in the age group 61-80 and > 80 years old in nondiabetic patients. 92 (85.16%) from the first group and 174 (80.9%) in the second group also associated obesity/overweight. DM/PD were not previously known in 33.4%. 40% required either introduction of insulin or increased doses, due to marked imbalances. Severity of COVID-19 was higher in the DM: 17.6% vs. 53.4% mild forms, 37% vs. 27.9% moderate pneumonias, 45.3% vs. 18.6% severe forms (CT: multiple bilateral “ground glass” infiltrates or consolidation; respiratory failure) with extrapulmonary complications. Fatality was 12% in the first group and 7.4% in the nondiabetic group. All patients associated increased inflammatory markers (CRP, LDH, ferritin) and lymphopenia. Conclusions: DM was an important risk factor for high severity and fatality of infection even in middle-aged people while SARS-CoV-2 infection determined an imbalanced DM and clinical de novo DM/PD. Obesity was a major risk factor for SARS-CoV-2 in both groups (with or without DM). The recommendation of close monitoring after discharge is part of a personalized management to prevent further unfavorable evolution and post COVID-19 complications.

Author Biography

Paraschiva POSTOLACHE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania

Faculty of Medicine
Department of Medical Specialties (I)


1. Walls AC, Jun Park Y, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein. Cell 2000; 181(2): 281-292.e6 / 10.1016/j.cell.2020.02.058.
2. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation, and Treatment of Coronavirus, Treasure Island (FL): Stat Pearls Publishing, 2020,
3. Soo Lim, Jae Hyun Bae, Hyuk-Sang Kwon, Michael A. Nauck. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nature Reviews Endocrinology 2021; 17: 11-30 /
4. Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, H van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203(2): 631-637 / doi: 10.1002/path.1570.
5. Zhang H, Penninger J M, Li Y, Zhong N, Slutsky A S, Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46: 586-590 / doi: 10.1007/s00134-020-05985-9.
6. ***Centers for Diseases Control and Prevention, COVID-19 - People with Certain Medical Condi-tions, medical - conditions.html.
7. Drucker DJ. Coronavirus Infections and Type 2 Diabetes-Shared Pathways with Therapeutic Impli-cations. Endocr Rev 2020; 41(3): bnaa011 / doi: 10.1210/endrev/bnaa011.
8. Bornstein SR, Francesco Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol 2020; 8: 546-550.
9. Kharroubi AT, Darwish HM. Diabetes mellitus: The epidemic of the century. World J Diabetes
1. 2015; 6(6): 850-867 / doi: 10.4239/wjd.v6.i6.850.
10. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
11. ***International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium:
International Diabetes Federation, 2017. Accessed on January 23, 2019).
12. *** WHO - Diabetes. Key facts.
13. *** Guvernul României prin Autoritatea pentru Digitalizarea României.COVID-19, Date Oficiale, date la zi.
14. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immu-nosuppression. Lancet 2020; 395(10229): 1033-1034.
15. Giovanni de Simone. Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers, 2020. Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-onhypertension-on-ace-inhibitors-and-ang (ac-cessed April 15, 2020).
16. Gheblawi M, Wang K, Viveiros A, et al. ACE2: SARS-CoV-2 receptor and regulator of the renin angiotensin system: celebrating the 20th anniversary of the ACE2 discovery. Circ Res 2020; 126(10): 1456-1474.
17. Wang L, Liang J, Leung PS. The ACE2/Ang-(1-7)/Mas axis regulates the development of pancreatic endocrine cells in mouse embryos. PLoS ONE 2015; 10: e0128216.
18. Lu CL, Wang Y, Yuan L, et al. The angiotensin-converting enzyme 2 / angiotensin (1-7) / Mas axis protects the function of pancreatic β cells by improving the function of islet microvascular endothelial cells. Int J Mol Med 2014; 34: 1293-1300.
19. Yang J K, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 2010; 47: 193-199.
20. Bhatraju PK, Bijan J Ghassemieh BJ, Nichols M, et al. COVID-19 in critically ill patients in the Seattle region - case series. N Engl J Med 2020; 382(21): 2012-2022.
21. Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state. JAMA 2020; 323(16): 1612-1614.
22. Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with COVID-19. N Engl J Med 2020; 382(17): e38 (2020).
23. Nansen A, Christensen J P, Marker O, Thomsen A R, Sensitization to lipopolysaccharide in mice with asymptomatic viral infection: role of T cell-dependent production of interferon-gamma. J Infect Dis 1997; 176: 151-157.
24. Sestan M, Marinović S, Kavazović I, et al. Virus-induced interferon-γ causes insulin resistance in skeletal muscle and derails glycemic control in obesity. Immunity 2018; 49(1): 164-177.e6
25. Teuwen L A, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol 2020; 20: 389-391.
26. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18: 844-847.
27. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229): 1054-1062.
28. ***Lab Tests Online [Internet]. Washington DC: American Association for Clinical Chemistry; c2001-2018. C-Reactive Protein (CRP); Available from: tests/c-reactive-protein-crp.
29. Wang S, Ma P, Zhang S, et al. Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study. Diabetologia 2020; 63(10): 2102-2111.
30. Wu L, Girgis CM, Cheung NW. COVID-19 and diabetes: insulin requirements parallel illness severity in critically unwell patients. Clin Endocrinol 2020; 93: 390-393.
31. Lim S, Shin SM, Nam GE, Jung CH, Koo BK, Proper management of people with obesity during the COVID-19 pandemic. J Obes Metab Syndr 2020; 29: 84-98.
32. Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol 2020; 57(6): 759-764 / doi: 10.1007/s00592-020-01522-8.
33. Lim S, Oh TJ, Dawson J, Sattar N. Diabetes drugs and stroke risk: intensive versus conventional glucose-lowering strategies, and implications of recent cardiovascular outcome trials. Diabetes Obes Metab 2020; 22(1): 6-15 / doi: 10.1111/dom.13850.
34. Stoian AP, Papanas N, Prazny M, Rizvi AA, Rizzo M. Incretin-Based Therapies Role in COVID-19 Era: Evolving Insights. J Cardiovasc Pharmacol Ther 2020; 25(6): 494-496 / doi: 10.1177/ 1074248420937868.
35. Nauck MA, Meier JJ. Management of endocrine disease: are all GLP-1 agonists equal in the treatment of type 2 diabetes? Eur J Endocrinol 2019; 181: R211-R234.
36. Shi Q, Zhang X, Jiang F, et al. Clinical characteristics and risk factors for mortality of COVID-19 patients with diabetes in Wuhan, China: a two-center, retrospective study. Diabetes Care 2020; 43(7): 1382-1391.
37. Agarwal S, Schechter C, Southern W, Crandall JP, Tomer Y. Preadmission diabetes-specific risk factors for mortality in hospitalized patients with diabetes and coronavirus disease 2019. Diabetes Care 2020; 43: 2339-2344.
38. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection, Lancet Respir Med 2020; 8: e21.
39. ***CDC. Centers for Disease Control and Prevention. 23 December 2020. coronavirus/2019-ncov/vaccines/recommendations.html.
40. Ciurba BE, Sárközi HK, Szabó IA, et al. Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review. Acta Marisiensis - Seria Medica 2021; 67(2): 73-76 / doi: 10.2478/amma-2021-0019.