DIABETES AND RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM: IMPLICATIONS FOR COVID-19 PATIENTS WITH DIABETES TREATMENT MANAGEMENT
DOINA CATRINOIU 1#, ANTONIO CERIELLO 2#, MANFREDI RIZZO 3,4, CRISTIAN SERAFINCEANU 5, NICOLA MONTANO 6, ANCA PANTEA STOIAN 5*, DENISA IOANA UDEANU 7, VIOREL JINGA 8, GABRIELA IORGULESCU 9#, ION-BOGDAN DUMITRESCU 7
1Department of Internal Medicine, Faculty of Medicine, “Ovidius” University, Constanța, Romania
2IRCCS MultiMedica, 300 Milanese str, 20099 Sesto San Giovanni MI Milan, Italy
3Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of South Carolina, Columbia, SC, USA
4Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
5Diabetes, Nutrition and Metabolic Diseases Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
6Department of Clinical Sciences and Community Health, University of Milano, Italy
7Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
8Urology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
9Behavioral Sciences Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
*corresponding author: ancastoian@yahoo.com
#Authors with equal contribution


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Abstract:
In the context of the COVID-19 continuous spreading, this paper focuses on the increased risk of diabetic patients regarding the metabolic control and the uncertainties related to SARS-CoV-2 infection. Chronic hyperglycaemia negatively affects the immune system, which triggers an increase of morbidity and mortality for viral infections. A key aspect of COVID-19 resides in the involvement of renin-angiotensin-aldosterone (RAAS) system that causes a cascade of reactions mediated by vasoactive peptides with implications in vasoconstriction, vascular permeability, oxidative stress remodelling and tissue injuries. Activation of RAAS at pulmonary level, is responsible for the local damage. Many questions regarding the treatment with ACE inhibitors and angiotensin receptor blockers were raised considering the correlation between RAAS and viral infection in diabetic patients.






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