Diabetes Can Increase Complications of COVID-19 by Dr. Joseph Mercola for Mercola
For a limited time only, PBS is streaming a free documentary on America’s diabetes epidemic (it may not be available in all areas; check your local PBS to see if it’s in your area). Coincidentally, diabetes is a comorbidity that can increase your chances of contracting and even dying from COVID-19,1 making this documentary particularly timely.
One of the best strategies to beat COVID-19 is to get any underlying chronic conditions under control. Type 2 diabetes and high blood pressure — both of which have been implicated as underlying factors causing serious COVID-19 disease — can often be reversed via healthy diet and lifestyle.
According to a January 2019 update by the U.S. Centers for Disease Control and Prevention, more than 122 million American adults have diabetes or prediabetes,2 and the economic ramifications of this condition are enormous. The U.S. spent $350 billion treating diabetes in 2019 alone, according to the film.
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Also according to the film, projections predict half the American population will be prediabetic or diabetic by 2025. Such predictions reflect poor research because if you use insulin resistance as your definition, 80% of the country is diabetic or prediabetic already.3,4
Glucose Metabolism Influences Cytokine Storms
An April 15, 2020, article5 in The Scientist reviews evidence6,7 that helps explain why obesity and diabetes are such potent risk factors for severe COVID-19 infection.
In a nutshell, higher blood glucose levels appear to play a significant role in viral replication and the development of cytokine storms. While the research in question looked at influenza A-induced cytokine storms, these findings may well be applicable in COVID-19 as well.
Cytokines are signaling molecules that are released by your immune system in response to foreign invaders. They, in turn, act as messengers that instruct other immune cells to fight the pathogen. In some cases, this immune response goes into overdrive, resulting in what’s known as a “cytokine storm” that can cause severe tissue damage and lead to death.
A cytokine storm response is typically the primary reason why people die from infections, be it the seasonal flu, Ebola, urinary tract infection or COVID-19. A critical player in cytokine production is the transcription factor interferon regulatory factor 5 (IRF5). In mice, genetically eliminating IRF5 protects them from influenza-induced cytokine storms.8
Interestingly, “the inflammatory response to influenza infections is also known to drive up glucose metabolism,” The Scientist reports,9 “in part so that immune cells have the necessary energy to mount a strong response, and also because the virus needs the sugar to replicate.”
According to researchers at the State Key Laboratory of Virology at Wuhan University, the hexosamine biosynthesis pathway — a glucose metabolism pathway — is responsible for activating IRF5-induced cytokine production in cells and mice. The same pathway is also responsible for viral replication, they say.10,11,12 As reported by The Scientist:13
“Hexosamine biosynthesis starts with glucose and results in an end product called uridine diphosphate N-acetylglucosamine (UDP-GlcNAc) … Liu’s team now shows that O-GlcNAcylation of IRF5 is necessary for the transcription factor’s cytokine-producing activity …
The team also showed that patients infected with influenza have higher blood glucose levels and more O-GlcNacylation of IRF5 than healthy controls. Furthermore, blood glucose levels correlated tightly with levels of inflammatory cytokines.
The results show that ‘there is a connection [between] influenza virus infection, enhanced glucose metabolism and cytokine storm, all linked through O-GlcNAcylation of IFR-5,’ Mengji Lu, a virologist at the University Hospital Essen and a coauthor of the study, writes in an email to The Scientist …”
In a Science Advances press release, co-author Shi Liu states:14
“We believe that glucose metabolism contributes to various COVID-19 outcomes since both influenza and COVID-19 can induce a cytokine storm, and since COVID-19 patients with diabetes have shown higher mortality.”
