ArticleDiabetes & metabolic syndrome
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic.
Article in Diabetes & metabolic syndrome. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05711810 (Cardiac Transfer of SARS-CoV-2 Spike Protein Circulation Techniques - Medicine Induced Hemodialysis on "Vaccinated" Immune Attacks), which is not on this map. Cited by 66 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cardiac Transfer of SARS-CoV-2 Spike Protein Circulation Techniques - Medicine Induced Hemodialysis on "Vaccinated" Immune Attacks
Who cites it
66 citing papers in PubMed, 3 syntheses or guidelines pooled it, 126 citations in OpenAlex.
- Potential use of sodium glucose co-transporter 2 inhibitors during acute illness: a systematic review based on COVID-19.Endocrine · 2024Pooled it
- The epidemiology, pathophysiological mechanisms, and management toward COVID-19 patients with Type 2 diabetes: A systematic review.Primary care diabetes · 2021Pooled it
- Type 2 Diabetes Mellitus and COVID-19: A Narrative Review.Frontiers in endocrinology · 2021Pooled it
- Well-controlled vs poorly-controlled diabetes in patients with COVID-19: Are there any differences in outcomes and imaging findings?Diabetes research and clinical practice · 2020Trial
- Nurse-led social media-based education in diabetic patients: Effects on COVID-19 fear and self-care - A 6-month follow-up trial.Journal of education and health promotion · 2025Article
- Immunomodulatory Effects of Vitamin D and Zinc on Viral Infection.Biological trace element research · 2025Review
- Cognitive dysfunctions in the course of SARS‑CoV‑2 virus infection, including NeuroCOVID, frontal syndrome and cytokine storm (Review).Biomedical reports · 2024Review
- Diabetes as one of the long-term COVID-19 complications: from the potential reason of more diabetic patients' susceptibility to COVID-19 to the possible caution of future global diabetes tsunami.Inflammopharmacology · 2023Review
- Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus: Real-World Data Analysis.Diabetes & metabolism journal · 2023Article
- COVID-19: Diabetes Perspective-Pathophysiology and Management.Pathogens (Basel, Switzerland) · 2023Review
- Impact of ACE and Endoplasmic Reticulum Aminopeptidases Polymorphisms on COVID-19 Outcome.Diagnostics (Basel, Switzerland) · 2023Article
- COVID-19 effect on patients with noncommunicable diseases: A narrative review.Health science reports · 2023Article
- Prerequisite for COVID-19 Prediction: A Review on Factors Affecting the Infection Rate.International journal of environmental research and public health · 2022Review
- How can sports entrepreneurs achieve their corporate sustainable development goals under the COVID-19 epidemic?Environmental science and pollution research international · 2022Article
- COVID-19 and diabetes: Association intensify risk factors for morbidity and mortality.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2022Review
- Nutraceutical potential of Amazonian oilseeds in modulating the immune system against COVID-19 - A narrative review.Journal of functional foods · 2022Review
- Angiotensin-converting enzyme 2 as a potential therapeutic target for COVID-19: A review.Journal of pharmaceutical analysis · 2022Review
- Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study.BMC cardiovascular disorders · 2022Observational
- Article
- Nano-Technological Approaches for Targeting Kidney Diseases With Focus on Diabetic Nephropathy: Recent Progress, and Future Perspectives.Frontiers in bioengineering and biotechnology · 2022Review
6 more citing papers are in PubMed but not listed here.
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Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The novel coronavirus disease 2019 (COVID-19) outbreak once again demonstrated the importance of the renin-angiotensin system (RAS) in patients with diabetes. Activation of the RAS increases in patients with diabetes. The virus attaches to the ACE2 enzyme at low cytosolic pH values and enters into the cell and causes infection. Especially in the presence of diabetes mellitus and accompanying comorbid conditions such as hypertension, obesity, old age, and smoking, cytosolic pH is low, thus the virus easily may enter the cell by attaching to ACE2. ACEIs and ARBs lead to a reduction in angiotensin II level by increasing the ACE2 level, thus they cause a low cytosolic pH. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem. The release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system. This activation causes systemic vasoconstriction and the patient's blood pressure increases. The most important event is the increased sympathetic activity via the central stimulation, this activity increases pulmonary capillary leaking, causing the ARDS. As the cytosolic pH, which is already low in patients with diabetes will decrease further with the mechanisms mentioned above, the viral load will increase and the infection will be exacerbated. As a result, the use of ACEIs and ARBs in patients with diabetes can lead to increased morbidity and mortality of COVID-19.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.