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Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning
Open accessAbstract
The increased prevalence of obesity, diabetes, and cardiovascular risk factors in people hospitalized with severe COVID-19 illness has engendered considerable interest in the metabolic aspects of SARS-CoV-2-induced pathophysiology. Here, I update concepts informing how metabolic disorders and their co-morbidities modify the susceptibility to, natural history, and potential treatment of SARS-CoV-2 infection, with a focus on human biology. New data informing genetic predisposition, epidemiology, immune responses, disease severity, and therapy of COVID-19 in people with obesity and diabetes are highlighted. The emerging relationships of metabolic disorders to viral-induced immune responses and viral persistence, and the putative importance of adipose and islet ACE2 expression, glycemic control, cholesterol metabolism, and glucose- and lipid-lowering drugs is reviewed, with attention to controversies and unresolved questions. Rapid progress in these areas informs our growing understanding of SARS-CoV-2 infection in people with diabetes and obesity, while refining the therapeutic strategies and research priorities in this vulnerable population.
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“Increased inflammation, defective adaptative immune responses, endothelial dysfunction and coagulation-related disorders are all phenomena that have been well described in obesity and might represent a plausible explanation to the link we observed between high BMI and long COVID [33].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [33]
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Female gender is associated with long COVID syndrome: a prospective cohort study
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Metadata
- Authors
- Drucker, D. J.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Drucker, Daniel J.
- ORCID
- Drucker, Daniel J.
- Venue
- Cell Metabolism
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 33
- Issue
- 3
- Pages
- 479-498
- ISSN
- 1550-4131 (ISSN-L)
- PMC
- PMC7825982
- OpenAlex
- W3124063857
- Cited by
- 272
- References
- 190
- Citations by year
- 2026: 16 · 2025: 25 · 2024: 38 · 2023: 49 · 2022: 86 · 2021: 58
- FWCI
- 6.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (vor, 366 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Cell Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (154321)
- University of Toronto
- Novo Nordisk
- Novo Nordisk Fonden
- Pfizer (GLP-2)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- SARS-CoV-2, COVID-19 pandemic, obesity, diabetes mellitus, metabolic disorders, ACE2 expression, adipose tissue, pancreatic islets, glycemic control, cholesterol metabolism, antidiabetic drugs, lipid-lowering drugs, immune response, viral persistence, disease severity, genetic susceptibility, comorbidities
- MeSH terms
- Heart Disease Risk Factors, Angiotensin-Converting Enzyme 2, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Blood Glucose, Cholesterol, Diabetes Mellitus, Glucose, Humans, Hyperglycemia, Metabolic Diseases, Obesity, Comorbidity, Genetic Predisposition to Disease
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