COVID-19 associated CKM syndrome progression in diabetic patients is linked to pancreatic beta cell dysfunction, rather than RASi use: a retrospective cohort study

COVID-19 exacerbates CKM progression in diabetic patients, but this is not driven by RASi therapy itself. RASi use should be interpreted as a "marker of severity" for baseline comorbidities, rather than a pathogenic factor. Mechanistically, viral infection may cause the failure of compensatory mechanisms in pancreatic β-cell function (manifested as low C-peptide and spurious low HOMA-IR).