US Pharm. 2020;45(11):5.

In a recent clinical study, researchers demonstrate how diabetes contributes to mortality from Middle East respiratory syndrome coronavirus (MERS-CoV) infections, and the finding might offer insight into why other respiratory illnesses, such as the flu and pneumonia, might more severely affect patients with diabetes.

Since MERS-CoV emerged in Saudi Arabia in 2012, there have been more than 2,400 confirmed cases of the infection, resulting in more than 800 deaths for an alarming 35% fatality rate. For this reason, researchers have eagerly sought to identify risk factors that lead to severe or lethal disease. Evidence currently points to diabetes as a major risk factor, in addition to other comorbidities such as kidney disease, heart disease, and lung disease.

Researchers from the University of Maryland School of Medicine (UMSOM) and the Johns Hopkins University School of Medicine have demonstrated in a new study, funded in part by the National Institutes of Health and published last month in the Journal of Clinical Investigation Insights, how diabetes contributes to mortality from MERS-CoV infections. The study’s conclusions could help explain why other respiratory illnesses such as influenza or pneumonia might strike those with diabetes more severely.

The scientists looked at the link between diabetes and MERS-CoV in a mouse model and found that although the virus did not replicate more readily in the diabetic mice compared with the control mice, the mice with diabetes exhibited a delayed, prolonged inflammatory response in their lungs. Also, the diabetic mice had lower levels of inflammatory cytokines, inflammatory macrophages, and T-cells. This indicates that the increased severity of MERS-CoV infection in patients with diabetes is probably due to a malfunction in the body’s response to infection.

“Understanding how diabetes contributes to disease severity following MERS-CoV infection in this context is critical,” said Matthew Frieman, PhD, associate professor of microbiology and immunology and corresponding author of the study. “Our next step is to determine what drives the altered immune response in diabetics and how to reverse those effects with therapeutics for treatment of patients.”

“We have long known that diabetic patients have worse outcomes when they get a serious infectious disease, but this new insight on immune function could pave the way for better treatments,” said UMSOM Dean E. Albert Reece, MD, PhD, MBA.

For treatment considerations in patients with diabetes who contract the current novel coronavirus, see “The Effect of COVID-19 on Patients With Diabetes,” by Kimberly E. Ng, PharmD, BCPS, page 9.

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