key: cord-0950467-uhfmfb0l
authors: Blanke, Charles D.
title: In response: Diabetes is a risk factor for the progression and prognosis of COVID‐19
date: 2020-05-26
journal: Diabetes Metab Res Rev
DOI: 10.1002/dmrr.3331
sha: 3a3251a4480f69ad2f7e8ff0e195d58e9f2c0096
doc_id: 950467
cord_uid: uhfmfb0l

The article cited does not differentiate between Type I and Type II diabetes. More information is needed to properly assess risk.

gest "intensive attention should be paid to patients with diabetes." Unfortunately, the article lacks significant data, making application of its results impossible.

First, there is no mention of whether the patients included in the study had Type I or Type II diabetes, two completely different diseases. The authors state 29.2% took insulin before admission;

100% of type I diabetics require insulin and 27% of those with type II disease need this medication, 2 suggesting either there was a mix in their study, or that all the patients had the latter. In addition, there is a solitary reference to type: "Type 2 diabetes is viewed as a chronic, low-grade inflammatory disease caused by long-standing immune system imbalance." This perhaps suggests all the patients had type 2 disease. Type I diabetes is an autoimmune disease characterized by an antibody-mediated attack on islet cells. Type 2, as referenced in the manuscript, has increased release of inflammatory factors and chemokines. 1,3 Thus, both are conditions which might plausibly be associated with the overblown immune response which bodes for worse outcome from COVID-19 infection. However, the reader is left guessing as to the type(s) of diabetics included in the manuscript.

Differentiating the type of diabetes in their patients is critical. A total of 90%-95% of diabetics are type 2, 4 and these patients will thus be seen (and potentially adversely affected by COVID) more frequently.

But type I patients are much younger, and older age is a prognosticator for poor outcome with COVID infection. 5 Physicians might otherwise dismiss young patients with infections; knowing which young patients are actually at high risk might lead to earlier interventions.

Next, despite a plethora of included laboratory findings, the authors do not furnish glucose levels, at or preceding admission. Do the worsened COVID outcomes only apply to those with poor glycemic control (which would be suggested by high glucose levels at admission)? Or are the immune responses cited above responsible, regardless of tight regulation?

In conclusion, the authors' recommendations in the manuscript are too broad. We realize patient numbers are small, but knowing the type of diabetes and patients' glucose control at admission would dramatically help physicians apply these recommendations to diabetics with COVID-19 and thus would help them provide better care.

Charles D. Blanke

Diabetes is a risk factor for the progression and prognosis of COVID-19

The immune system's involvement in obesity-driven type 2 diabetes

Severe outcomes among patients with coronavirus disease 2019-United States