Bidirectional impact of covid-19, type II diabetes, and chronic kidney disease: A systematic review and its implications for metabolic control

From the perspective of clinical epidemiology, current evidence consolidates the existence of a bidirectional and synergistic relationship between COVID-19, Type 2 Diabetes Mellitus (T2DM), and chronic kidney disease (CKD). These comorbidities not only represent independent risk factors for the development of severe COVID-19, acute respiratory distress syndrome, and mortality (with significantly elevated odds ratios, as shown in international records), but SARS-CoV-2 infection also acts as a destabilizing factor, precipitating severe glycemic dysregulation, acute kidney injury, and accelerating the progression of both chronic conditions through direct pathophysiological mechanisms (linked to the high expression of ACE2 in the pancreas and kidneys, facilitating viral entry and cellular dysfunction) and indirect mechanisms (cytokine storm, hypercoagulability, and RAAS dysregulation).

This review, conducted using the PRISMA methodology and including 21 studies, highlights the urgent need for a comprehensive clinical management approach that prioritizes strict metabolic control and renal function monitoring—not only as baseline therapeutic goals but also as risk mitigation strategies against infection. It also emphasizes the importance of strengthening health systems to maintain continuity of chronic care during pandemics, given the profound prognostic impact this interaction has on patient morbidity and survival.