ABSTRACT

The link between COVID-19 infection and diabetes has been explored in several studies since the start of the pandemic, with associations between comorbid diabetes and poorer prognosis in patients infected with the virus and reports of diabetic ketoacidosis occurring with COVID-19 infection. As such, significant interest has been generated surrounding mechanisms by which the virus may exert effects on the pancreatic β cells. In this review, we consider possible routes by which SARS-CoV-2 may impact β cells. Specifically, we outline data that either support or argue against the idea of direct infection and injury of β cells by SARS-CoV-2. We also discuss β cell damage due to a “bystander” effect in which infection with the virus leads to damage to surrounding tissues that are essential for β cell survival and function, such as the pancreatic microvasculature and exocrine tissue. Studies elucidating the provocation of a cytokine storm following COVID-19 infection and potential impacts of systemic inflammation and increases in insulin resistance on β cells are also reviewed. Finally, we summarize the existing clinical data surrounding diabetes incidence since the start of the COVID-19 pandemic.

摘要

自大流行开始以来，多项研究探讨了 COVID-19 感染与糖尿病之间的联系，其中包括合并糖尿病与病毒感染患者预后较差之间的关联，以及 COVID-19 感染发生糖尿病酮症酸中毒的报告。因此，围绕病毒可能对胰腺 β 细胞发挥作用的机制产生了极大的兴趣。在这篇综述中，我们考虑了 SARS-CoV-2 可能影响 β 细胞的可能途径。具体来说，我们概述了支持或反对 SARS-CoV-2 直接感染和损伤 β 细胞的想法的数据。我们还讨论了由于“旁观者”效应引起的 β 细胞损伤，其中病毒感染导致对 β 细胞存活和功能必不可少的周围组织的损伤，如胰腺微血管系统和外分泌组织。还回顾了阐明 COVID-19 感染后细胞因子风暴的激发以及全身炎症和胰岛素抵抗增加对 β 细胞的潜在影响的研究。最后，我们总结了自 COVID-19 大流行开始以来有关糖尿病发病率的现有临床数据。