Diabetes and metabolic syndrome as risk factors for COVID-19

Diabetes Metab Syndr. Jul-Aug 2020;14(4):671-677. doi: 10.1016/j.dsx.2020.05.013. Epub 2020 May 8.


Background and aims: Clinical evidence exists that patients with diabetes are at higher risk for Coronavirus disease 2019 (COVID-19). We investigated the physiological origins of this clinical observation linking diabetes with severity and adverse outcome of COVID-19.

Methods: Publication mining was applied to reveal common physiological contexts in which diabetes and COVID-19 have been investigated simultaneously. Overall, we have acquired 1,121,078 publications from PubMed in the time span between 01-01-2000 and 17-04-2020, and extracted knowledge graphs interconnecting the topics related to diabetes and COVID-19.

Results: The Data Mining revealed three pathophysiological pathways linking diabetes and COVID-19. The first pathway indicates a higher risk for COVID-19 because of a dysregulation of Angiotensin-converting enzyme 2. The other two important physiological links between diabetes and COVID-19 are liver dysfunction and chronic systemic inflammation. A deep network analysis has suggested clinical biomarkers predicting the higher risk: Hypertension, elevated serum Alanine aminotransferase, high Interleukin-6, and low Lymphocytes count.

Conclusions: The revealed biomarkers can be applied directly in clinical practice. For newly infected patients, the medical history needs to be checked for evidence of a long-term, chronic dysregulation of these biomarkers. In particular, patients with diabetes, but also those with prediabetic state, deserve special attention.

Keywords: ACE2; Hypertension; Inflammation; Liver dysfunction; SARS-Coronavirus-2.

MeSH terms

  • Angiotensin-Converting Enzyme 2
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Betacoronavirus / immunology*
  • COVID-19
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / physiopathology
  • Diabetes Mellitus / immunology*
  • Diabetes Mellitus / mortality
  • Diabetes Mellitus / physiopathology
  • Humans
  • Metabolic Syndrome / immunology*
  • Metabolic Syndrome / mortality
  • Metabolic Syndrome / physiopathology
  • Pandemics
  • Peptidyl-Dipeptidase A / immunology*
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / physiopathology
  • SARS-CoV-2


  • Angiotensin-Converting Enzyme Inhibitors
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2