People with diabetes are prone to a number of complications from this condition. But one of the newest pandemic era developments seems to show a link between diabetes and more severe illness from those with COVID-19.
A particular enzyme thatâ€™s often overactive in people with diabetes is angiotensin converting enzyme 2 (ACE2). It may be at least partly to blame for this predisposition to severe COVID-19 symptoms, as well as other non-COVID-19 complications.
This article explores the relationship between diabetes and ACE2 and how it relates to COVID-19.
What is ACE2 and its connection to diabetes?
ACE2 is a substance in your body that helps regulate several critical functions. Amino acids (peptides) are the chemicals that help build proteins in your body, and in general, these ACE peptides are major players in the renin-angiotensin- aldosterone system (RAAS) that regulates how the body controls things such as:
- blood volume
- blood flow (vascular resistance and arterial pressure)
- nervous system responses
- blood pressure
- salt and fluid balance
- kidney function
An imbalance of these enzymes and peptides can contribute to the development of a number of conditions, such as high blood pressure, inflammation, cardiovascular disease, and kidney disease.
According to a 2011 study, people with diabetes â€” particularly those with diabetes-related kidney disease â€” often have overactive or early expression of ACE2 enzymes. The amplification of these enzymes can lead to complications alone, but that complication risk increases when combined with a virus that binds to these same receptors as these enzymes.
Why is COVID-19 more severe in people with diabetes?
Diabetes is associated with increased complications with all kinds of conditions, and COVID-19 is no exception.
Several studies have highlighted the increased risk of infection, severe illness, and even death in people with diabetes who have COVID-19.
The reason for this increase may be becoming clearer.
Researchers found that in China, 20 percent of people hospitalized with COVID-19 also had diabetes as their most common comorbidity. That research also shows that a third of the people who died from their COVID-19 also lived with diabetes. Another study linked diabetes, cardiovascular disease, and cancer to two-thirds of COVID-19 deaths in Italy.
Many theories exist on why a diabetes diagnosis appears to make COVID-19 illness worse. Two leading theories are that worsened illness is:
- a result of blood sugars that arenâ€™t well managed over time, leading to high glucose levels (hyperglycemia) and other diabetes complications
- a result of diabetes increasing the risk of infection, which raises the risk of more severe illness
However, the real answer may have more to do with the types of cells that the SARS-CoV-2 virus targets in the first place, leading to COVID-19.
How is ACE2 associated with diabetes and COVID-19 risk?
In many people with diabetes, ACE2 levels are increased, or these enzymes are more active. The virus that causes COVID-19, SARS-CoV-2, is particularly attracted to these ACE sites because the spiked proteins that coat the virus attach to the body at ACE2 receptor sites.
In people with elevated ACE activity, this means there are more host sites for the virus to attach to once it enters your body.
COVID-19 is known to cause severe lung, heart, and even kidney complications, and developing research reveals that this may be in part due to how active ACE2 cells are in these tissues in people who are infected with the virus. ACE2 levels have been found to be abnormally high in people with severe COVID-19, particularly in the lung tissues of people who died from COVID-19.
While this all isnâ€™t yet fully understood, it appears that the elevated expression of ACE2 in people with diabetes may set the stage for additional problems once the COVID-19 virus is introduced.
Is ACE2 important in diabetes beyond COVID-19 implications?
Early overexpression of ACE2 may contribute to the development of some forms of diabetes, as well as the appearance of diabetes-related complications.
The ACE2 enzyme and the peptides it helps to control contribute to:
- glucose management
- insulin sensitivity
- the overall function of your pancreas
A lack of balance in these areas is believed to contribute to many of the microvascular changes that occur in people with diabetes, including loss of kidney function and nerve damage (neuropathy).
Our bodies depend on balance to function properly, and any time even the smallest components of our system are disrupted, problems can arise. People with diabetes already face a number of complications, but now it appears that some of the chemical imbalances that can contribute to diabetes complications can also increase the risk and severity of a SARS-CoV-2 infection.
Talk with a doctor or healthcare professional about how to control your blood glucose and protect yourself from all sorts of infections â€” including SARS-CoV-2 infection â€” if you have diabetes.