Response to: Is newly diagnosed diabetes a stronger risk factor than pre-existing diabetes for COVID-19 severity?

Although obtaining a timely diagnosis of diabetes mellitus is in the management of SARS-CoV-2 infections, however, temporarily uncontrolled hyperglycemia, and not just newly onset diabetes mellitus, may be the real contributing factor influencing disease severity in these patients. Therefore, we recommend strict blood glucose monitoring in all patients diagnosed with SARS-CoV-2 infection rather than measuring HbA1c, which would only reflect glucose homeostasis over the previous 2-4 months. In fact the potential mechanisms explaining the association between hyperglycaemia and unfavourable progression of COVID-19 include metabolic abnormalities, impairment of host immune response, hyper-inflammation, enhanced risk of thrombosis, higher vulnerability to secondary infections and abnormal glycosylation of SARS-CoV-2 and ACE, responsible for immune escape or optimized binding and increased cell penetration.