Diabetes mellitus is a common comorbidity associated with Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome (SARS-CoV-2). Patients with COVID-19 and diabetes have shown to have more virus entry, impaired immunity response, less viral elimination, and dysregulated inflammatory cytokines. The aim of this study is to identify specific molecules that may cause inflammation in the COVID-19 and diabetes mellitus pathways as well as potential treatment methods for disease-related inflammation.
Bioinformatics analysis was performed to identify molecules that are associated with COVID-19 and Type 2 diabetes disease via Qiagen’s Ingenuity Pathway Analysis System. Molecules that resulted in inflammation were then selected in the pathway analysis. Pro-inflammatory molecules identified were interleukin 1 beta (IL-1β), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-2 (IL-2). The molecules identified in the pathway analysis are defined as cytokines. When pro-inflammatory cytokines are released in large volumes, infected people may face hyperactivity of immune cells and resulting hyper-inflammation. An overactive, untreated immune response can potentially be deadly, indicating that the progression of COVID-19 from severe to critical is likely driven by hyperinflammation.
A bidirectional relationship exists between COVID-19 and diabetes. Hyperglycemia could potentially stimulate the synthesis of cytokines. This is seen in inflammation-related biomarkers such as IL-6, serum ferritin, ESR, and CRP being present in higher concentrations in diabetic patients. This may indicate that diabetic patients with COVID-19 will experience symptom deterioration and increased disease progression due to increased levels of inflammatory biomarkers. Coinfection with diabetes and SARS-CoV-2 can also trigger stress and increase the secretion of hyperglycemia hormones, which result in increased blood glucose concentrations and other diabetic complications. A chronic state of low-grade inflammation may also contribute to the increased susceptibility of COVID-19 among individuals with diabetes.
Bioinformatic analysis was performed to identify drugs that could treat COVID-19 and Type 2 diabetes via Qiagen’s Ingenuity Pathway Analysis System. Six drugs were identified in the pathway analysis. Adalimumab was selected among these drugs due to its anti-inflammatory properties. Adalimumab inhibits TNF-α and was reported to reduce glucose and TNF-α levels in diabetic rats, indicating that it has a therapeutic effect in controlling the blood glucose. In addition, adalimumab may block the spread of SARS-CoV-2 and protect from developing acute lung failure and respiratory distress syndrome by regulating the renin-angiotensin system. Potential side effects of adalimumab include acute liver injury and potential reactivation of latent tuberculosis and hepatitis B. It is important that patients are informed of these side effects prior to treatment with adalimumab.