SGLT2 inhibition and COVID‐19: The road not taken

Das, Liza; Dutta, Pinaki

The COVID‐19 pandemic, caused by SARS‐CoV‐2, is an immense challenge for global healthcare. Diabetes mellitus, hypertension and obesity have been shown to portend poor prognosis in COVID‐19 despite no greater susceptibility to the infection (1). Chronic hypertension is commonly associated with vasculopathy which can predispose to severe infection. In patients with diabetes, severity is attributable to impaired innate, adaptive immunity, upregulation of ACE2 (entry receptor for SARS‐CoV2) by acute hyperglycemia and diabetic vasculopathy. The background of chronic low grade inflammation characterised by increased levels of IL‐6 and CRP in diabetes and obesity can also lead to an enhanced ‘cytokine storm’ in COVID‐19 (2). ACE2 expression on endothelial cells has been reported to cause viral mediated endothelitis and precipitate vascular dysfunction manifesting as acute respiratory distress syndrome as well as myocarditis, heart failure, arrhythmias, myocardial infarction and renal failure (3). In patients with pre‐existing comorbidities like hypertension, diabetes, obesity and chronic kidney disease, this new‐onset organ dysfunction can have deleterious additive effects.