Proximal tubular cells isolated from diabetic patients have also been found to exhibit altered cellular respiration, inducing a switch from oxidative phosphorylation to aerobic glycolysis . Increased glycolysis drives the metabolism of pro-inflammatory monocytes and macrophages and amplifies viral load upon infection. However, dichloroacetate, an inhibitor of aerobic glycolysis, can significantly reduce viral load . ACE2 expression is also enhanced in kidney organoids due to elevated glucose levels in diabetic conditions, and these imbalances can be directly linked to higher viral loads in COVID-19 patients .
Incident Diabetes and Long COVID
One study published in 2022 sought to determine the link between incident diabetes and the effects of long COVID, a condition characterized by new, recurring, or ongoing health problems following initial SARS-CoV-2 infection. Although none of the participants were diagnosed with diabetes prior to infection, those that survived the first 30 days of infection were more likely to require the use of antihyperglycemic medication and/or develop incident diabetes compared to those who had not tested positive for the virus . Furthermore, individuals with severe illness were determined to be at a greater risk of developing diabetes .
Conclusion and Future Perspectives
Although the relationship between SARS-CoV-2 infection and diabetes has become more apparent, their effects on each other have yet to be fully understood. While diabetes enhances viral loads of SARS-CoV-2, the rise of incident diabetes following infection may yet compound this problem. Consequently, additional preclinical and clinical studies are required to clarify the relationship between these conditions, and ultimately inform clinical management and treatment.