{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T19:01:50Z","timestamp":1791054110134,"version":"4.1.0"},"reference-count":56,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy, Timisoara"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background\/Objectives: Viral respiratory tract infections (VRTIs) in patients with diabetes mellitus (DM) are characterized by a severity gap rather than an infection gap. This review synthesizes evidence from the 2023\u20132026 respiratory seasons to provide a post-pandemic framework for managing the synergistic metabolic and viral threats in this population. Materials and Methods: A scoping review of literature from PubMed, Scopus, and Embase (2023\u20132026) was conducted, focusing on clinical outcomes and mechanistic interactions between DM and emerging respiratory pathogens. Results: Recent data identify human Metapneumovirus (hMPV) and adenovirus as significant threats to diabetic hosts, with mortality risks equivalent to seasonal influenza (HR 1.00 for hMPV vs. influenza). The two-hit model combines a baseline of innate immune paralysis, characterized by impaired neutrophil chemo-taxis and mechanical SP-D dysfunction, with a cellular signaling environment primed for cytokine overreaction by epigenetic metabolic memory. The stress hyperglycemia ratio (SHR) has emerged as a promising predictor of mortality compared to absolute glucose or HbA1c, with a proposed threshold of \u22651.14 identifying patients at 3.5-fold increased risk for mechanical ventilation. Precision management should consider the prudent suspension of SGLT2 inhibitors to mitigate euglycemic DKA risks and considering the early use of GLP-1 receptor agonists for their hypothesized pulmonary anti-inflammatory properties. Conclusions: Closing the mortality gap may require a shift from generic viral care to a precision model that treats metabolic susceptibility with high clinical priority alongside the treatment of the viral pathogen.<\/jats:p>","DOI":"10.3390\/medicina62040770","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T07:37:19Z","timestamp":1776325039000},"page":"770","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Diabetes\u2013Viral Respiratory Syndemic: Pathophysiological Insights and Precision Management: A Scoping Review"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6508-928X","authenticated-orcid":false,"given":"Ana Maria","family":"Mihai","sequence":"first","affiliation":[{"name":"Doctoral School, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Infectious Diseases, Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1160-9164","authenticated-orcid":false,"given":"Monica","family":"Marc","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7865-9915","authenticated-orcid":false,"given":"Florina","family":"Lucaciu","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Infectious Diseases, Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9042-9924","authenticated-orcid":false,"given":"Alexandra","family":"Sima","sequence":"additional","affiliation":[{"name":"Department of Diabetes, \u201cPius Brinzeu\u201d Emergency Hospital, 300723 Timisoara, Romania"},{"name":"Second Department of Internal Medicine, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"126646","DOI":"10.1016\/j.vaccine.2024.126646","article-title":"Seasonal Influenza Vaccination Coverage and the Social Determinants of Influenza Vaccination among People over 50 with Diabetes in Europe: Analyzing Population-Based SHARE Data for the 2019\u20132020 and 2021\u20132022 Influenza Seasons","volume":"45","author":"Wang","year":"2025","journal-title":"Vaccine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S2213-2600(24)00255-8","article-title":"Respiratory Syncytial Virus Infections in Adults: A Narrative Review","volume":"12","author":"Wildenbeest","year":"2024","journal-title":"Lancet Respir. 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