The contribution of diabetic micro-angiopathy to adverse outcomes in COVID-19

Area of Science:

• Vascular Biology
• Infectious Diseases
• Endocrinology

Background:

• Endothelial cell dysfunction is increasingly recognized in severe COVID-19, contributing to microthrombi and altered vascular tone.
• Diabetes and Black, Asian, and Minority Ethnic (BAME) populations are at higher risk for adverse COVID-19 outcomes.
• Hyperglycemia, a common issue in diabetes, correlates with worse COVID-19 prognosis, but its causal role is unclear.

Purpose of the Study:

• To propose that pre-existing endothelial dysfunction, common in diabetes and BAME groups, predisposes individuals to severe COVID-19.
• To explore the link between hyperglycemia, microangiopathy, and COVID-19-associated endothelial dysfunction ('endothelitis').

Main Methods:

• This article presents a hypothesis based on existing scientific literature and evidence.
• It synthesizes findings on endothelial function, diabetes, BAME populations, hyperglycemia, and COVID-19 pathophysiology.

Main Results:

• The hypothesis suggests that underlying microangiopathy and endothelial dysfunction, prevalent in diabetes and BAME individuals, create vulnerability.
• This vulnerability may lead to more severe 'endothelitis' upon SARS-CoV-2 infection.

Conclusions:

• Pre-existing endothelial dysfunction, particularly in individuals with diabetes or from BAME backgrounds, is proposed as a key factor increasing susceptibility to severe COVID-19.
• Hyperglycemia's role as either a causative agent or a marker in this context warrants further investigation.