| Abstract | COVID-19, bolest uzrokovana novim koronavirusom SARS-CoV-2, pojavila se u Kini krajem 2019. godine i ubrzo počela širiti cijelim svijetom. SARS-CoV-2 pretežno inficira dišne putove, izazivajući blage simptome do težih, poput akutnog respiratornog sindroma koji može rezultirati zatajenjem organa koje na kraju dovodi do smrti. Bolest kod većine ljudi uzrokuje blage simptome, dok je opasna za novorođenčad, starije i imunokompromitirane osobe te osobe s komorbiditetima. Druga epidemijska bolest je šećerna bolest od koje broj oboljelih u svijetu drastično raste: svjetske procjene govore da 463 milijuna osoba u dobi između 20 i 79 godina živi sa šećernom bolešću od koje se vremenom razvijaju kronične komplikacije i rizici od razvoja ozbiljnih bolesti te smrti. Šećerna bolest kronični je metabolički sindrom nastao zbog apsolutnog i/ili relativnog manjka inzulina, a karakteriziran je kroničnom hiperglikemijom koju prate poremećaji u metabolizmu ugljikohidrata, masti i proteina. Šećernu bolest prati razvoj različitih akutnih komplikacija koje nastaju naglo i brzo i zahtijevaju hitnu intervenciju, a zbog loše kontrole bolesti i dugotrajne hiperglikemije dolazi do kroničnih komplikacija šećerne bolesti koje su posljedica oštećenja različitih tkiva i organa, a glavni su uzrok morbiditeta i mortaliteta osoba koje boluju od šećerne bolesti. Osobe sa šećernom bolešću su puno osjetljivije na infekciju SARS-CoV-2 virusom te nakon obolijevanja od bolesti COVID-19 imaju težu kliničku sliku i lošiji ishod bolesti. Neki od mogućih razloga leže u tome da infekcija virusom SARS-CoV-2 može dovesti do povećanih razina medijatora upale u krvi kao što su upalni citokini, toksični metaboliti i lipopolisaharidi te može doći do modulacije već ionako disreguliranog imunološkog odgovora u pacijenata sa šećernom bolešću. Uz to, infekcija virusom može dovesti do povećane proizvodnje reaktivnih kisikovih vrsta, fibroze i akutnog oštećenja pluća te akutnog respiratornog distres sindroma. Proizvodnja ROS-a i virusna aktivacija renin-angiotenzin-aldosteronskog sustava uzrokuju inzulinsku rezistenciju, hiperglikemiju i oštećenje vaskularnog endotela, dolazi i do povećanja komponenti zgrušavanja, fibrinogena i D-dimera, što dovodi do povećanja viskoznosti krvi i oštećenja vaskularnog endotela te naposljetku to sve doprinosi razvoju kardiovaskularnih problema, tromboemboliji i diseminiranoj intravaskularnoj koagulaciji (DIK). Lijekovi za snižavanje razine glukoze u krvi te oni za prigušivanje citokinske oluje i snižavanje razina laktata su korisni za učinkovitu terapiju kod COVID pacijenata sa šećernom bolešću, a ono što bi pomoglo u samom sprječavanju razvoja bolesti su poboljšanje metaboličkog zdravlja promjenom načina prehrane i života. |
| Abstract (english) | COVID-19, a disease caused by the new coronavirus SARS-CoV-2, appeared in China in late 2019 and soon began to spread around the world. SARS-CoV-2 predominantly infects the airways, causing mild to severe symptoms, such as acute respiratory syndrome that can result in organ failure that eventually leads to death. The disease causes mild symptoms in most people, while it is dangerous for newborns, the elderly and immunocompromised people and people with comorbidities. Another epidemic is diabetes, which is growing dramatically worldwide: world estimates say that 463 million people between the ages of 20 and 79 live with diabetes, which over time develops chronic complications and risks of developing serious diseases and death. Diabetes mellitus is a chronic metabolic syndrome caused by an absolute and/or relative lack of insulin, and is characterized by chronic hyperglycemia accompanied by disorders in the metabolism of carbohydrates, fats and proteins. Diabetes mellitus is accompanied by the development of various acute complications that occur suddenly and rapidly and require urgent intervention, and due to poor disease control and long-term hyperglycemia, chronic complications of diabetes occur as a result of damage to various tissues and organs, and are the main cause of morbidity and mortality in people with diabetes. People with diabetes are much more susceptible to SARS-CoV-2 virus infection and have a more severe clinical picture and poorer disease outcome after developing COVID-19. Some possible reasons are that SARS-CoV-2 infection can lead to increased levels of inflammatory mediators in the blood such as inflammatory cytokines, toxic metabolites and lipopolysaccharides and may modulate an already dysregulated immune response in diabetic patients. In addition, virus infection can lead to increased production of reactive oxygen species, fibrosis and acute lung damage, and acute respiratory distress syndrome. ROS production and viral activation of the renin-angiotensin-aldosterone system cause insulin resistance, hyperglycemia and vascular endothelial damage. There is also an increase in coagulation components, fibrinogen and D-dimer, which leads to increased blood viscosity and damage to the vascular endothelium and ultimately all this contributes to the development of cardiovascular problems, thromboembolism and disseminated intravascular coagulation (DIC). Drugs to lower blood glucose levels and those to dampen cytokine storm and lower lactate levels are useful for effective therapy in COVID patients with diabetes, and what would help prevent the development of the disease are improving metabolic health by changing diet and lifestyle. |
