COVID-19 and Metabolic Disease: Mechanisms and Clinical Management

Up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders. Notably, there are many direct links between COVID-19 and the metabolic and endocrine systems. Thus, not only are patients with metabolic dysfunction (eg, obesity, hypertension, non-alcoholic fatty liver disease, and diabetes) at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders. In this Review, we provide an update on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Additionally, we update the practical recommendations and management of patients with COVID-19 and post-pandemic. Furthermore, we summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.

Citing Articles

The COVID-19 pandemic and clinical characteristics of colorectal cancer: a multicenter retrospective study.

Han Y, Bae S, Kim W, Lim D, Kim C Sci Rep. 2025; 15(1):8903.

PMID: 40087486 DOI: 10.1038/s41598-025-93349-y.

Insulin Resistance in Long COVID-19 Syndrome.

Man D, Andor M, Buda V, Kundnani N, Duda-Seiman D, Craciun L J Pers Med. 2024; 14(9).

PMID: 39338165 PMC: 11433386. DOI: 10.3390/jpm14090911.

COVID-19 and diabetes research: Where are we now and what does the future hold? A bibliometric visualization analysis.

Zhang X, Wen R, Chen H, Liu J, Wu Y, Xu M Heliyon. 2024; 10(18):e37615.

PMID: 39315181 PMC: 11417241. DOI: 10.1016/j.heliyon.2024.e37615.

Genomic insight into COVID-19 severity in MAFLD patients: a single-center prospective cohort study.

Buchynskyi M, Oksenych V, Kamyshna I, Budarna O, Halabitska I, Petakh P Front Genet. 2024; 15:1460318.

PMID: 39296547 PMC: 11408174. DOI: 10.3389/fgene.2024.1460318.

Metabolic homeostasis in fungal infections from the perspective of pathogens, immune cells, and whole-body systems.

Weerasinghe H, Stolting H, Rose A, Traven A Microbiol Mol Biol Rev. 2024; 88(3):e0017122.

PMID: 39230301 PMC: 11426019. DOI: 10.1128/mmbr.00171-22.

References

Conti P, Ronconi G, Caraffa A, Gallenga C, Ross R, Frydas I . Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents. 2020; 34(2):327-331. DOI: 10.23812/CONTI-E. View

Hollstein T, Schulte D, Schulz J, Gluck A, Ziegler A, Bonifacio E . Autoantibody-negative insulin-dependent diabetes mellitus after SARS-CoV-2 infection: a case report. Nat Metab. 2020; 2(10):1021-1024. DOI: 10.1038/s42255-020-00281-8. View

Quinn L, Davies M, Northern A, Brough C, Schreder S, Stribling B . Use of MyDesmond digital education programme to support self-management in people with type 2 diabetes during the COVID-19 pandemic. Diabet Med. 2020; 38(3):e14469. PMC: 7744872. DOI: 10.1111/dme.14469. View

Horby P, Lim W, Emberson J, Mafham M, Bell J, Linsell L . Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2020; 384(8):693-704. PMC: 7383595. DOI: 10.1056/NEJMoa2021436. View

Naguib M, Raymond J, Vidmar A . New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19. J Pediatr Endocrinol Metab. 2020; 34(1):147-150. DOI: 10.1515/jpem-2020-0426. View

Boucher J, Kleinridders A, Kahn C . Insulin receptor signaling in normal and insulin-resistant states. Cold Spring Harb Perspect Biol. 2014; 6(1). PMC: 3941218. DOI: 10.1101/cshperspect.a009191. View

Akhmerov A, Marban E . COVID-19 and the Heart. Circ Res. 2020; 126(10):1443-1455. DOI: 10.1161/CIRCRESAHA.120.317055. View

Simpson A, Simpson C, Frost H, Welburn S . COVID-19: Obesity, deprivation and death. J Glob Health. 2020; 10(2):020389. PMC: 7648908. DOI: 10.7189/jogh.10.020389. View

Rhee S, Lee J, Nam H, Kyoung D, Shin D, Kim D . Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19. Diabetes Metab J. 2021; 45(2):251-259. PMC: 8024148. DOI: 10.4093/dmj.2020.0206. View

10.

Yang J, Lin S, Ji X, Guo L . Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol. 2009; 47(3):193-9. PMC: 7088164. DOI: 10.1007/s00592-009-0109-4. View

11.

Bailey B, Whelen M, Strunk D . Adhering to COVID-19 health guidelines: Examining demographic and psychological predictors of adherence. Appl Psychol Health Well Being. 2021; 13(4):968-985. PMC: 8239601. DOI: 10.1111/aphw.12284. View

12.

Cantuti-Castelvetri L, Ojha R, Pedro L, Djannatian M, Franz J, Kuivanen S . Neuropilin-1 facilitates SARS-CoV-2 cell entry and infectivity. Science. 2020; 370(6518):856-860. PMC: 7857391. DOI: 10.1126/science.abd2985. View

13.

Kusmartseva I, Wu W, Syed F, van der Heide V, Jorgensen M, Joseph P . Expression of SARS-CoV-2 Entry Factors in the Pancreas of Normal Organ Donors and Individuals with COVID-19. Cell Metab. 2020; 32(6):1041-1051.e6. PMC: 7664515. DOI: 10.1016/j.cmet.2020.11.005. View

14.

Alai S, Gujar N, Joshi M, Gautam M, Gairola S . Pan-India novel coronavirus SARS-CoV-2 genomics and global diversity analysis in spike protein. Heliyon. 2021; 7(3):e06564. PMC: 7972664. DOI: 10.1016/j.heliyon.2021.e06564. View

15.

Fignani D, Licata G, Brusco N, Nigi L, Grieco G, Marselli L . SARS-CoV-2 Receptor Angiotensin I-Converting Enzyme Type 2 (ACE2) Is Expressed in Human Pancreatic -Cells and in the Human Pancreas Microvasculature. Front Endocrinol (Lausanne). 2020; 11:596898. PMC: 7691425. DOI: 10.3389/fendo.2020.596898. View

16.

Bornstein S, Rubino F, Ludwig B, Rietzsch H, Schwarz P, Rodionov R . Consequences of the COVID-19 pandemic for patients with metabolic diseases. Nat Metab. 2021; 3(3):289-292. DOI: 10.1038/s42255-021-00358-y. View

17.

Scheen A . Metformin and COVID-19: From cellular mechanisms to reduced mortality. Diabetes Metab. 2020; 46(6):423-426. PMC: 7395819. DOI: 10.1016/j.diabet.2020.07.006. View

18.

Ceriello A, Prattichizzo F . Pharmacological management of COVID-19 in type 2 diabetes. J Diabetes Complications. 2021; 35(7):107927. PMC: 8052602. DOI: 10.1016/j.jdiacomp.2021.107927. View

19.

Coate K, Cha J, Shrestha S, Wang W, Mateus Goncalves L, Almaca J . SARS-CoV-2 Cell Entry Factors ACE2 and TMPRSS2 Are Expressed in the Microvasculature and Ducts of Human Pancreas but Are Not Enriched in β Cells. Cell Metab. 2020; 32(6):1028-1040.e4. PMC: 7664344. DOI: 10.1016/j.cmet.2020.11.006. View

20.

Bornstein S, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld A . Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020; 8(6):546-550. PMC: 7180013. DOI: 10.1016/S2213-8587(20)30152-2. View