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Mechanisms of COVID-19 pathogenesis in diabetes

Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus, is a global pandemic impacting 254 million people in 190 countries. Comorbidities, particularly cardiovascular disease, diabetes, and hypertension, in-crease the risk of infection and poor outcomes. SARS-CoV-2 enters host cells through the angio-tensin converting enzyme 2 (ACE2) receptor, generating inflammation and cytokine storm, often resulting in multi-organ failure. The mechanisms and effects of COVID-19 on high-risk diabetic patients is not yet completely understood. In this review, we discuss the variety of coronaviruses, structure of SARS-CoV-2, mutations in SARS-CoV-2 spike proteins, receptors associated with viral host entry, and disease progression. Further, we focus on possible mechanisms of SARS-CoV-2 in diabetes, leading to inflammation and heart failure. Finally, we discuss existing therapeutic approaches, unanswered questions, and future directions.