\documentclass[twocolumn,twoside]{article}
\makeatletter\if@twocolumn\PassOptionsToPackage{switch}{lineno}\else\fi\makeatother

\usepackage{amsfonts,amssymb,amsbsy,latexsym,amsmath,tabulary,graphicx,times,xcolor}

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
% Following additional macros are required to function some 
% functions which are not available in the class used.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
\usepackage{url,multirow,morefloats,floatflt,cancel,tfrupee}
\makeatletter


\AtBeginDocument{\@ifpackageloaded{textcomp}{}{\usepackage{textcomp}}}
\makeatother
\usepackage{colortbl}
\usepackage{xcolor}
\usepackage{pifont}
\usepackage[nointegrals]{wasysym}
\urlstyle{rm}
\makeatletter

%%%For Table column width calculation.
\def\mcWidth#1{\csname TY@F#1\endcsname+\tabcolsep}

%%Hacking center and right align for table
\def\cAlignHack{\rightskip\@flushglue\leftskip\@flushglue\parindent\z@\parfillskip\z@skip}
\def\rAlignHack{\rightskip\z@skip\leftskip\@flushglue \parindent\z@\parfillskip\z@skip}

%Etal definition in references
\@ifundefined{etal}{\def\etal{\textit{et~al}}}{}


%\if@twocolumn\usepackage{dblfloatfix}\fi
\usepackage{ifxetex}
\ifxetex\else\if@twocolumn\@ifpackageloaded{stfloats}{}{\usepackage{dblfloatfix}}\fi\fi

\AtBeginDocument{
\expandafter\ifx\csname eqalign\endcsname\relax
\def\eqalign#1{\null\vcenter{\def\\{\cr}\openup\jot\m@th
  \ialign{\strut$\displaystyle{##}$\hfil&$\displaystyle{{}##}$\hfil
      \crcr#1\crcr}}\,}
\fi
}

%For fixing hardfail when unicode letters appear inside table with endfloat
\AtBeginDocument{%
  \@ifpackageloaded{endfloat}%
   {\renewcommand\efloat@iwrite[1]{\immediate\expandafter\protected@write\csname efloat@post#1\endcsname{}}}{\newif\ifefloat@tables}%
}%

\def\BreakURLText#1{\@tfor\brk@tempa:=#1\do{\brk@tempa\hskip0pt}}
\let\lt=<
\let\gt=>
\def\processVert{\ifmmode|\else\textbar\fi}
\let\processvert\processVert

\@ifundefined{subparagraph}{
\def\subparagraph{\@startsection{paragraph}{5}{2\parindent}{0ex plus 0.1ex minus 0.1ex}%
{0ex}{\normalfont\small\itshape}}%
}{}

% These are now gobbled, so won't appear in the PDF.
\newcommand\role[1]{\unskip}
\newcommand\aucollab[1]{\unskip}
  
\@ifundefined{tsGraphicsScaleX}{\gdef\tsGraphicsScaleX{1}}{}
\@ifundefined{tsGraphicsScaleY}{\gdef\tsGraphicsScaleY{.9}}{}
% To automatically resize figures to fit inside the text area
\def\checkGraphicsWidth{\ifdim\Gin@nat@width>\linewidth
	\tsGraphicsScaleX\linewidth\else\Gin@nat@width\fi}

\def\checkGraphicsHeight{\ifdim\Gin@nat@height>.9\textheight
	\tsGraphicsScaleY\textheight\else\Gin@nat@height\fi}

\def\fixFloatSize#1{}%\@ifundefined{processdelayedfloats}{\setbox0=\hbox{\includegraphics{#1}}\ifnum\wd0<\columnwidth\relax\renewenvironment{figure*}{\begin{figure}}{\end{figure}}\fi}{}}
\let\ts@includegraphics\includegraphics

\def\inlinegraphic[#1]#2{{\edef\@tempa{#1}\edef\baseline@shift{\ifx\@tempa\@empty0\else#1\fi}\edef\tempZ{\the\numexpr(\numexpr(\baseline@shift*\f@size/100))}\protect\raisebox{\tempZ pt}{\ts@includegraphics{#2}}}}

%\renewcommand{\includegraphics}[1]{\ts@includegraphics[width=\checkGraphicsWidth]{#1}}
\AtBeginDocument{\def\includegraphics{\@ifnextchar[{\ts@includegraphics}{\ts@includegraphics[width=\checkGraphicsWidth,height=\checkGraphicsHeight,keepaspectratio]}}}

\DeclareMathAlphabet{\mathpzc}{OT1}{pzc}{m}{it}

\def\URL#1#2{\@ifundefined{href}{#2}{\href{#1}{#2}}}

%%For url break
\def\UrlOrds{\do\*\do\-\do\~\do\'\do\"\do\-}%
\g@addto@macro{\UrlBreaks}{\UrlOrds}



\edef\fntEncoding{\f@encoding}
\def\EUoneEnc{EU1}
\makeatother
\def\floatpagefraction{0.8} 
\def\dblfloatpagefraction{0.8}
\def\style#1#2{#2}
\def\xxxguillemotleft{\fontencoding{T1}\selectfont\guillemotleft}
\def\xxxguillemotright{\fontencoding{T1}\selectfont\guillemotright}

\newif\ifmultipleabstract\multipleabstractfalse%
\newenvironment{typesetAbstractGroup}{}{}%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

\usepackage[authoryear]{natbib}



\newif\ifnokeywords\nokeywordsfalse

\makeatletter\input{size10-pointfive.clo}\makeatother%
\definecolor{kwdboxcolor}{RGB}{242,242,242}
\usepackage[hidelinks,colorlinks=true,allcolors=blue]{hyperref}
\linespread{1}                 
\def\floatpagefraction{0.8}

\usepackage[paperheight=11.69in,paperwidth=8.26in,top=1in,bottom=1in,left=1in,right=.75in,headsep=24pt]{geometry}

\usepackage{multirow-custom}

\makeatletter

\def\hlinewd#1{%
  \noalign{\ifnum0=`}\fi\hrule \@height #1%
  \futurelet\reserved@a\@xhline}
\def\tbltoprule{\hlinewd{1pt}\\[-14pt]}
\def\tblbottomrule{\noalign{\vspace*{6pt}}\hline\noalign{\vspace*{2pt}}}
\def\tblmidrule{\hline\noalign{\vspace*{2pt}}}



\let\@articleType\@empty
\let\@journalDoi\@empty
\let\@journalVolume\@empty
\let\@journalIssue\@empty
\let\@crossMarkLink\@empty
\let\@receivedDate\@empty
\let\@acceptedDate\@empty
\let\@revisedDate\@empty
\let\@publishedDate\@empty
\let\@copyrightYear\@empty
\let\@firstPage\@empty
\def\articleType#1{\gdef\@articleType{#1}}
\def\journalDoi#1{\gdef\@journalDoi{#1}}
\def\crossMarkLink#1{\gdef\@crossMarkLink{#1}}
\def\receivedDate#1{\gdef\@receivedDate{#1}}
\def\acceptedDate#1{\gdef\@acceptedDate{#1}}
\def\revisedDate#1{\gdef\@revisedDate{#1}}
\def\publishedDate#1{\gdef\@publishedDate{#1}}
\def\copyrightYear#1{\gdef\@copyrightYear{#1}}
\def\journalVolume#1{\gdef\@journalVolume{#1}}
\def\journalIssue#1{\gdef\@journalIssue{#1}}
\def\firstPage#1{\gdef\@firstPage{#1}}
\let\@issuelogo\@empty%
\let\@issuelogoex\@empty%
\def\issuelogo#1{\gdef\@issuelogo{#1}}
\def\issuelogoex#1{\gdef\@issuelogoex{#1}}


\def\author#1{%
  \gdef\@author{%
    \hskip-\dimexpr(\tabcolsep)\hskip5pt%
    \parbox{\dimexpr\textwidth-1pt}%
    {\fontsize{11}{13}\selectfont\raggedright #1}%
  }%
}


\usepackage{pharmascope-abs}
\usepackage{caption}
\usepackage{lastpage}
\usepackage{fancyhdr}
\usepackage[noindentafter,explicit]{titlesec}
\usepackage{fontspec}

\setmainfont[%
BoldFont=cambriab.ttf,%
ItalicFont=CAMBRIAI.TTF,%
BoldItalicFont=CAMBRIAZ.TTF]{Cambria.ttf}
\lefthyphenmin = 3

\def\title#1{%
  \gdef\@title{%
      \vspace*{-40pt}%
       \ifx\@articleType\@empty\else{\fontsize{10}{12}\scshape\selectfont\hspace{8pt}\@articleType\hfill\mbox{}\par\vspace{2pt}}\fi%
       \minipage{\linewidth}
         \hrulefill\\[-0.7pt]%%{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}\hfill
         \mbox{~}\hspace{5pt}\parbox{.1\linewidth}{\IfFileExists{images/\@issuelogo.\@issuelogoex}{\includegraphics[width=79pt,height=61pt]{images/\@issuelogo.\@issuelogoex}}{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}}\hfill
         \fcolorbox{kwdboxcolor}{kwdboxcolor}{\parbox{.792\linewidth}{%
          \begin{center}\fontsize{17}{17}\selectfont\scshape\vskip-7pt International Journal of Research in Pharmaceutical Sciences\hfill\end{center}%
          \vspace*{-10pt}\hspace*{4pt}{\fontsize{8}{9}\selectfont Published by JK Welfare \& Pharmascope Foundation\hfill  Journal Home Page: \href{www.ijrps.com}{\color{blue}\underline{\smash{www.ijrps.com}}}}\hspace*{4pt}\mbox{}}}%
       \par\vspace*{-1pt}\rule{\linewidth}{1.3pt}%
       \endminipage%
    \par\vspace*{9.2pt}\parbox{.98\linewidth}{\linespread{.9}\raggedright\fontsize{14}{17}\selectfont #1}%
    \vspace*{-8pt}%
  }
}


\setlength{\parindent}{0pt}
\setlength{\parskip}{0.4pc plus 1pt minus 1pt}

\def\abbrvJournalTitle{Int. J. Res. Pharm. Sci.}

\fancypagestyle{headings}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
}\pagestyle{headings}

                                                         
\fancypagestyle{plain}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}%
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
  \ifx\@firstPage\@empty\else\setcounter{page}{\@firstPage}\fi
}


\def\NormalBaseline{\def\baselinestretch{1.1}}
\usepackage{textcase}
\setcounter{secnumdepth}{0}

\titleformat{\section}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{13}\selectfont}
{\thesection}
{6pt}
{\MakeTextUppercase{#1}}
[]
\titleformat{\subsection}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsection}
{6pt}
{#1}
[]
\titleformat{\subsubsection}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsubsection}
{6pt}
{#1}
[]
\titleformat{\paragraph}[block]{\NormalBaseline\filright\fontsize{10.5}{10}\selectfont}
{\theparagraph}
{6pt}
{#1}
[]
\titleformat{\subparagraph}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubparagraph}
{6pt}
{#1}
[]

\titlespacing{\section}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsubsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\paragraph}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subparagraph}{0pt}{.5\baselineskip}{.5\baselineskip}

\captionsetup[figure]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}
\captionsetup[table]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}

\def\bibyear#1{#1}
%\def\bibjtitle#1{#1}   %%Publisher request
\def\bibauand{}
\setlength\bibsep{3pt}
\setlength\bibhang{8pt}

\makeatother
\date{}


\begin{document}


\def\RunningAuthor{Syed Yasir Afaque}
\firstPage{1198}
\articleType{Original Article}
\receivedDate{28 Aug 2020}
\acceptedDate{28 Sep 2020}
\revisedDate{25 Sep 2020}
\journalVolume{2020, 11 (SPL)}
\journalIssue{1}
\journalDoi{ijrps.v11iSPL1.3591}
\copyrightYear{2020}
\def\authorCount{1}
\def\affCount{1}

\def\journalTitle{International Journal of Research in Pharmaceutical Sciences}

\title{Association and treatment of diabetes in patients affected by Covid-19}
\author{Syed~Yasir~Afaque\textsuperscript{*}~\\[5pt]{Department of Research and Development, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra {\textendash} 442001, India}}

\begin{abstract}
In December 2019, a unique coronavirus infection, SARS-CoV-2, was first identified in the province of Wuhan in China. Since then, it spread rapidly all over the world and has been responsible for a large number of morbidity and mortality among humans. According to a latest study, Diabetes mellitus, heart diseases, Hypertension etc. are being considered important risk factors for the development of this infection and is also associated with unfavorable outcomes in these patients. There is little evidence concerning the trail back of these patients possibly because of a small number of participants and people who experienced primary composite outcomes (such as admission in the ICU, usage of machine-driven ventilation or even fatality of these patients). Until now, there are no academic findings that have proven independent prognostic value of diabetes on death in the novel Coronavirus patients. However, there are several conjectures linking Diabetes with the impact as well as progression of COVID-19 in these patients. The aim of this review is to acknowledge about the association amongst Diabetes and the novel Coronavirus and the result of the infection in such patients.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Coronavirus,\newline Covid-19,\newline Diabetes,\newline Association,\newline Risk Factors,\newline Outcome
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Syed~Yasir~Afaque~\\ Phone:\ 9172995883~\\  Email:\  yasirafaque1262@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
        \textsc{DOI:}\ \href{https://doi.org/10.26452/\@journalDoi}{\textcolor{blue}{\underline{\smash{https://doi.org/10.26452/\@journalDoi}}}}\par%
        \vspace*{-11pt}\hrulefill\\{\fontsize{9.12}{10.12}\selectfont Production and Hosted by}\par{IJRPS |~\href{www.ijrps.com}{www.ijrps.com}}\par%
        \vspace*{-2pt}{\fontsize{9.12}{10.12}\selectfont\textcopyright\ \@copyrightYear\ $|$ All rights reserved.}\par%
        \vspace*{-11pt}\rule{\linewidth}{1.2pt}
        \makeatother
        
    
\section{Introduction}
A case of Severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 was first identified in Wuhan, China in December 2019. Subsequently, this infection spread rapidly across the globe. Until 15\ensuremath{^{th}} August 2020, over 25 million cases have been confirmed all over the world and over 2.5 million cases in India. There have been over 765,000 deaths all over the world until now. The pandemic started in Wuhan, China and therefore, most of the primary data is from China. These studies show that Hypertension, Diabetes, Cardiovascular diseases and COPD are very common comorbidities associated with COVID-19.

So far there has been no evidence to prove the association of the virus with the outcome of patients suffering from conditions like Diabetes Mellitus but there are many speculations about the association of the Covid-19 virus with Diabetes and conditions associated with high morbidity and mortality like Diabetes, Hypertension etc. However, these conclusions are being considered unreliable due to the fact that they and more epidemiological rather than analytical.

Moreover, a large part of these findings does not analyze the relationship between COVID-19 and factors like age, sex and obesity. Therefore, interpretation of data should be done with care and understanding \unskip~\citep{906210:20560277}. The aim of this review article is to summarize the current knowledge and available data and establish the relationship between Covid-19 and its outcome in these patients.
    
\section{Materials and Methods}
A search was made on the online research portal PUBMED using the terms COVID-19, SARS-CoV2, Diabetes up to 10\ensuremath{^{th}} August 2020. Full articles were accessed and analyzed.
    
\section{Results and Discussion}
Recent studies prove that there is increased incidence of COVID-19 in patients with Diabetes Mellitus. The outcome may differ in these patients as well and may even be worse than compared with the general population. Therefore, control of diabetes is crucial for patients not only infected with COVID-19 but also in patients who are not infected with the virus. Online portals, posters, telemedicine, webinars etc. are new innovations that are useful in treating these patients.

\textbf{General characteristics of SARS-CoV-19}

The period of incubation of COVID-19 has been approximated to be 2-14 days. This period is defined as the time of infection to the onset of illness. During a research conducted in about 1099 confirmed COVID-19 cases in China, it was established that the median incubatory period was 4 days. A different research involving 181 patients stated an average incubation period of 5 days. The Centre of disease control (CDC), has suggested a time period of 2-14 days for occurrence of symptoms of the infection. Therefore, keeping this mind, 14 days had been applied internationally as the standard period for quarantine for observing and limiting the movement of healthy individuals \unskip~\citep{906210:20560270}.

\textbf{Mode of transmission}

Initial studies show that the root cause of the COVID-19 infection was from a seafood and wildlife market in Wuhan, China thereby, insinuating zoonotic exposure to be the key cause of transmission. Majority of patients in China had either direct or immediate contact history with this area. Some findings suggest that SARS-CoV-2 and Bat Coronavirus (Bat CoV) may have been actually related but there is no definite proof of the same. Later, many more cases of the virus were reported amongst health care experts however, they had connection with the wildlife or seafood market. Therefore, now it is deemed that the virus is primarily transmitted by direct diffusion of droplets, immediate contact and aerosols. Droplet contact occurs when respiratory secretions are released when a person coughs or sneezes and when these secretions are ingested or inhaled by others within the range of 6 feet. According to recent studies, a person may also get infected by touching a surface or object that has been contaminated. It has been experimentally shown that these secretions may remain on the object for a period of up to 3 hours. Infection can also spread through medical procedures like Endotracheal intubation, Bronchosopy, Tracheostomy etc. Viable virus has been isolated by rectal and faecal swabs, but faeco-oral route is not being considered as a mode of spread of the virus.

\textbf{Demography and clinical characteristics of COVID-19}

No age group is safe from being infected by SARS-Cov-2. However, the average age group that is the most susceptible of being affected appears to be between 47 and 59 years. There is no specific gender predisposition as of yet, but it has been shown that males contribute a higher number of cases than females. Fewer cases have been recognized amongst infants and kids. According to a study done in China, amongst 72,314 patients of COVID-19, only 2\% of these patients were less than 20 years of age.

The clinical features of the infection seem to be very heterogenous with most adults and younger individuals presenting symptoms alike flu. Certain patients may however acquire acute respiratory distress syndrome (ARDS), multi-organ dysfunction syndrome (MODS), arrhythmias, acute cardiac damage, respiratory failure, shock, or even death. Majority of the COVID-19 symptoms are fever, cough with or without expectoration, fatigue and difficulty in breathing. Nevertheless, symptoms such as headache, upper respiratory symptoms (eg: Pharyngitis and Rhinorrhea) and gastrointestinal symptoms (e.g.: nausea, vomiting and diarrhea) may transpire as well. A Chinese study also showed patients to have altered taste and smell sensations \unskip~\citep{906210:20560276}.

Laboratory tests show majority of patients with either normal or reduced WBC counts, in particular lymphocytopenia. Nevertheless, in critical patients, neutrophil counts, markers of inflammation, urea and creatinine levels are greater in addition to reduced lymphocyte count. A CT scan of the chest frequently showed ground glass opacities with or without consolidation, which are generally bilateral and have a peripheral distribution involving the lower lobes. Certain patients might even have no abnormal findings on the CT Chest \unskip~\citep{906210:20560274}.

\textbf{Diagnosis}

SARS CoV 2 or COVID-19 is diagnosed by microbiologic analysis. Patients who are symptomatic or have any kind of travel history to a severely stricken COVID country or city have to be tested for the virus. Additionally, other causes like Influenza, Respiratory Syncytial virus should also be ruled out. The standard diagnostic method as of now is Reverse transcription polymerase chain reaction, long for RT-PCR. The specimens for the test include nasopharyngeal swabs, sputum samples and secretion of the lower tract \unskip~\citep{906210:20560275}.

\textbf{Criteria for suspicion and testing}



\begin{itemize}
  \item \relax People with sudden onset of fever and/or cough, dyspnea or individuals with symptoms of lower respiratory infection with no defined origin as well as no history of contact with a COVID-19 positive patient.
  \item \relax Individuals with new onset symptoms who have been in contact with a confirmed case of the infection.
  \item \relax Patients who have a travel history of more than 14 days to a location where community spread of COVID-19 has occurred. 
  \item \relax Patients more than 60 years of age with underlying comorbidities like hypertension, diabetes, renal disease, cancer, immuno compromising situations who have developed new onset fever and cough etc.
  \item \relax A healthcare professional who has directly dealt with an infected COVID-19 patient without being in proper gear i.e., personal protective equipment (PPE) \unskip~\citep{906210:20560272}.
\end{itemize}
  \textbf{Association of diabetes with COVID-19}

Diabetes mellitus has become one of the major reasons of morbidity and mortality across the globe. This ailment is linked with numerous micro vascular as well as macro vascular complications which majorly affect a patient's health. These complications have a major impact on the patients' health and survival. The link between Diabetes and COVID-19 can be associated and related to other common infections like Influenza and Pneumonia which tend to be more frequent and serious in older patients. The association of COVID-19 with diabetes however, remains controversial whether if it actually affects the patient. Uncontrolled diabetes has often been reported to be a significant marker of severity and mortality in patients infected by other diseases such as H1N1, SARS-Cov, MERS-CoV. 

There is little data to support the association of COVID-19 with the development of complications of Diabetes in these patients. A person infected by COVID-19 may perhaps be more vulnerable to developing diabetic complications because of a possible higher stress condition that is created which can thereby, result in the release of higher hyperglycemic hormones like Glucocorticoids and Catecholamines, that result in a surge to blood sugar levels. A study in Wuhan showed that about 10\% of the patients of Type II Diabetes mellitus suffered at least one episode of hypoglycemia. Hypoglycemia in these patients has proved to stabilize pro-inflammatory monocytes and intensify reactivity of platelets that has shown to decrease cardiovascular deaths in patients with Diabetes mellitus. However, episodes of hyper/hypoglycemia still remain nonspecific to COVID-19 or to its virulence. Furthermore, the commonly used oral anti-hypoglycemic drugs have nonspecific effect on the outcome of these patients \unskip~\citep{906210:20560271}.

\textbf{Aspects of COVID-19 pathogenesis and potential management options for patients with COVID-19 and diabetes}

All Coronaviruses on entering the host cells, bind to the cells via Spike Proteins that adhere to the cell and oozes out particular receptors. Subsequently, the host cell Protease enzyme conjoins the spike which moreover sanctions the virus to enter and reproduce. The Angiotensin Converting enzyme or ACE has been known to be bounded to most receptors in infections caused by SARS-CoV and SARS-CoV-2. The ACE receptor is widely found in the gastrointestinal tract, kidneys, heart, neurons in the brain, intestines, endothelium of vessels, immune cells and pancreas. According to a research conducted in China, 39 COVID-19 confirmed patients with history of diabetes were compared with 39 healthy individuals without diabetes. The research exhibited that 20 out of the 39 healthy individuals acquired diabetes when hospitalization. It had been proposed that SARS-CoV may have possibly impaired the pancreatic islets and may have caused acute insulin dependent Diabetes mellitus. However, additional investigations as well as evidence is required to support this study.

Previous studies have shown that patients with pneumonia who have undergone endotracheal intubation and were on continued use of ACE inhibitors and Angiotensin receptor blockers (ARB) have been linked with decreased death possibility. These drugs have their own immuno modulatory effects and produce pulmonary and systemic inflammatory responses by diminishing inflammatory mediators like Cytokines. Both these classes of drugs are commonly utilized by patients of Diabetes and Hypertension and therefore their effect in patients of COVID-19 are highly debated. 

Some researchers have said that ACEi and ARBs might as well be beneficial as they might be able to reduce the SARS-CoV spike proteins ACE2 expression. A retrospective study done on 112 COVID-19 infected patients did not display a considerable variance with ACEi/ARB medications amongst the survivors and non-survivors. Moreover, ACEi, ARBs, Ibuprofen and Thiazolidinediones may lead to increase levels of ACE2, thereby questioning the safety of these medications in SARS-CoV patients. 

Although, Diabetes have been connected with worse outcomes in COVID-19 patients however, the vulnerability of these patients is pretty much comparable with non-diabetic patients. The occurrence of diabetes in patients of COVID-19 is about the same as the general population. Furthermore, it has also been revealed that DPP-4 (Dipeptidyl peptidase 4) is the prime receptor in MERS-CoV. DPP-4 inhibitors are frequently used across the globe as a cure for Diabetes and therefore, these drugs could be used in the treatment of Diabetic patients infected with COVID-19.

At present, no drug or vaccine is specifically available for the treatment of SARS-CoV-2. Several clinical trials are being done across the world in order to assess the efficacy of various drugs like Remdesivir, Tocilizumab, Lopinavir/Ritonavir, Ribavirin, Interferon, Chloroquine etc. Remdesivir and Tocilizumab are currently being used in India for severe cases of SARS-CoV-2.

Antimalarial drugs such as Chloroquine, Hydroxychloroquine, has been proved to be useful in treating COVID-19 infected patients but the efficacy still remains indeterminate. According to a study, Chloroquine was successful in regulating the infection in vitro owing to its immunomodulatory and anti-inflammatory effect. It has been effective in shortening the course of the disease and furthermore, Hydroxychloroquine has been also shown to improve glycemic control in severe and refractory diabetic patients.

It is unfortunate that there is not enough data available for the appropriate treatment of diabetic patients infected with Covid-19. Therefore, the mainstay of treatment would be rigorous monitoring, glycemic control, dietary modifications, careful surveillance of drug interactions and side effects. The management of these patients should be by a multidisciplinary approach by endocrinologists, pulmonologists, psychiatrists, nutritionist etc. More consideration should be given to diabetic patients with complications like nephropathy, retinopathy, cardiovascular complications etc. Finally, close monitoring and vigilance of these patients with proper care during hospitalization has a positive impact on these patients and on their outcomes.
    
\section{Conclusion}
Since the rapid spread of COVID-19 from Wuhan to all over the world, it has become extremely difficult to manage the situation with thousands of deaths occurring every day. Therefore, early recognition, monitoring and isolation can contribute to a better and faster control of the pandemic. Furthermore, there should be increased vigilance and care taken by the general population to further stop the spread. Further researches should be urgently done to control morbidity and mortality associated with COVID-19. 

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.
    

\bibliographystyle{pharmascope_apa-custom}

\bibliography{\jobname}
\end{document}
