It is well known that those with diabetes are more susceptible to infections. There are two coronavirus receptor proteins involved in regulating inflammation, glucose handling, kidney function and cardiovascular physiology.
We caught up with Dr. Raymond de la Rosa of Millennium Physician Group in Englewood to find out more about receptors and drug inhibitors that affect immune function during COVID-19 in individuals with Diabetes.
“COVID-19 is thought to modify immune system pathways through two receptor proteins commonly associated with diabetes mellitus. Inhibition of the DPP4 receptor is the mechanism of action for drugs like sitagliptin (Januvia) or linagliptin (Tradjenta). In rodents, disruption of DPP4 activity plays a role in regulating inflammation, which is typically increased in patients with COVID-19. There is no evidence that DPP4 inhibitors significantly modify immune response in humans.”
“Diabetic patients should stay on their prescribed medications, as discontinuing them can be dangerous and increase the probability of experiencing diabetic-related comorbidities.”
“The other diabetes-related receptor protein is ACE-2. This protein appears in large quantities in the organs of patients with COVID-19 and may cause increased inflammation in the lungs. Nearly every patient with diabetes is on an ACE inhibitor or an angiotensin receptor blocker to protect their kidneys from diabetes and to keep blood pressure under control.”
“If you have concerns regarding any of your diabetes medications and COVID-19, it would be prudent to speak with your doctor either in person or remotely.”
“Preliminary data from China and Italy indicate that 15 % of patients with COVID-19 have diabetes. Keep in mind that the prevalence of diabetes worldwide is about 10%. Diabetics also tend to be overweight and obesity is another risk factor for developing complications from coronavirus.”
“Diabetics are known to have compromised immune systems. A rise in blood glucose may be an early sign of impending clinical infection in some individuals. Patients with diabetes who have their blood sugar under control have a better chance of recovering from an infection.”
“In the United States, about 24 % of patients hospitalized for COVID-19 have diabetes mellitus. Up to 32% of patients in the ICU with COVID-19 have diabetes. During the 2003 SARS epidemic, patients with diabetes and SARS had 3 times the risk of dying compared to non-diabetics.”
“There are reports of younger individuals developing thyroid dysfunction after infection with COVID-19. The effects of this virus on fertility, cholesterol, bone loss and long-term blood sugar control on COVID-19 survivors remains unclear until we have more data.”
“My advice is to continue to keep blood sugar regulated, monitor your glucose levels regularly, stay on your medications. Keep your scheduled appointments with your endocrinologist or primary care physician. If you are more comfortable with telehealth, virtual visits are available. The staff at our practice will guide you through the steps needed to have a remote visit.”
“Many people are apprehensive about visiting a doctor’s office, but we have implemented measures to further protect our patients and staff. We do not have large numbers of people sitting in our waiting areas; patients can wait in their cars until we are ready to see them. We also ask them to wear face masks when social distancing is not possible. Our treatment areas, waiting areas, and equipment are stringently cleaned and disinfected. We also monitor all patients for fever, cough, nasal discharges before they enter our facilities. It may actually be safer to go to a doctor’s office than other public spaces like supermarkets and gas stations.”
Studies on ACE-2 and DPP-4
In a recent peer-reviewed study, researchers looked at the effects of diabetes and COVID-19 patients in regards to ACE 2 inhibitors. This is what they found: The clinical spectrum of COVID-19 is heterogeneous, ranging from mild flu-like symptoms to acute respiratory distress syndrome, multiple organ failure and death. Older age, diabetes and other comorbidities are reported as significant predictors of morbidity and mortality. Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying mechanisms of the association between diabetes and COVID-19. No conclusive evidence exists to support the discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers because of COVID-19 in people with diabetes. Caution should be taken to potential hypoglycemic events with the use of chloroquine in these subjects. Patient tailored therapeutic strategies, rigorous glucose monitoring and careful consideration of drug interactions might reduce adverse outcomes.1
Similarly, another recent study by D. Drucker, looked at the same receptor proteins and reported that both ACE2 and DPP-4 are established transducers of metabolic pathways that regulate diabetic conditions; however, stopping taking the inhibitor drugs is more of a risk to stop taking in those with diabetes.
The available evidence implicates diabetes and obesity as significant risk factors impacting the clinical severity of coronavirus infections, including SARS-CoV-2. Although ACE2 and DPP4 are important physiological regulators of glucose homeostasis, there is little compelling clinical evidence that drugs targeting ACE2- or DPP4-related pathways produce differential harm or benefit in the context of human coronavirus infections.2
Dipeptidyl Peptidase-4 (DPP4) is an established transducer of metabolic signals and pathways regulating inflammation, renal and cardiovascular physiology, and glucose homeostasis. Moreover, glucose-lowering agents such as the DPP4 inhibitors, widely used in subjects with T2D, are known to modify the biological activities of multiple substrates.2
If your physician suspects that the underlying cause of a medical condition is related to hormone production, they may refer you to an endocrinologist who specializes in endocrinology and hormone production in various organs. They have extensive training in diseases that affect the glands and hormones, such as diabetes, thyroid disease, cancers, infertility, metabolic disorder, and other conditions.
Raymond de la Rosa, M.D., earned his Doctor of Medicine at the University of the Philippines College of Medicine in Manila. Dr. de la Rosa finished his residency in Internal Medicine at Lutheran Medical Center in Brooklyn, New York. He later completed his fellowship in Endocrinology at the Brown University Program in Providence, Rhode Island.
Dr. de la Rosa has over 24 years of experience as an Endocrinologist and is certified by the American Board of Internal Medicine in Endocrinology, Diabetes and Metabolism. He is the author of several scientific articles in the area of diabetes, thyroid dysfunction and other metabolic conditions. He has also served as a principal investigator in over 30 clinical trials for new diabetes treatments.
Millennium Physician Group is one of the largest comprehensive independent physician groups with more than 500 healthcare providers located throughout Florida.
Learn more about us today and how joining Millennium as a patient, a provider, or a team member can benefit you. We are here to connect you to a healthier life.
Millennium Physician Group
3000 S. McCall Rd
Englewood, FL 34224
1. A Hussain, COVID-19 and Diabetes: Knowledge in Progress, Diabetes Res Clin Pract. 2020 Apr 9 : 108142.doi: 10.1016/j.diabres.2020.108142 [Epub ahead of print]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144611/
2. D Drucker, Coronavirus Infections and Type 2 Diabetes—Shared Pathways with Therapeutic Implications, Endocrine Reviews, Volume 41, Issue 3, June 2020, bnaa011, https://doi.org/10.1210/endrev/bnaa011