The Diabetes-Viral Respiratory Syndemic: Pathophysiological Insights and Precision Management: A Scoping Review

Area of Science:

• Immunology
• Endocrinology
• Virology

Background:

• Patients with diabetes mellitus (DM) experience more severe viral respiratory tract infections (VRTIs) compared to the general population.
• A post-pandemic framework is needed to manage combined metabolic and viral threats in diabetic individuals.

Purpose of the Study:

• To synthesize recent evidence on VRTIs in diabetic patients.
• To propose a precision management framework addressing metabolic susceptibility and viral threats.

Main Methods:

• Scoping review of literature from 2023-2026.
• Focus on clinical outcomes and mechanistic interactions between DM and respiratory pathogens.

Main Results:

• Human Metapneumovirus (hMPV) and adenovirus pose significant risks, with mortality risks similar to influenza.
• A 'two-hit' model explains increased severity: innate immune paralysis and cytokine overreaction.
• Stress hyperglycemia ratio (SHR) predicts mortality and mechanical ventilation risk.
• Consider suspending SGLT2 inhibitors and using GLP-1 receptor agonists for management.

Conclusions:

• Closing the mortality gap requires a precision model addressing metabolic susceptibility.
• Metabolic health must be a high clinical priority in managing VRTIs in diabetic patients.