1
|
|
Singh AK, Singh R, Misra A. Oral semaglutide in type 2 diabetes mellitus: Comprehensive review, critical appraisal and clinical consideration of its use in India. Diabetes Metab Syndr 2022; 16:102436. [PMID: 35245858 DOI: 10.1016/j.dsx.2022.102436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Oral semaglutide is the first glucagon-like petide-1 receptor agonist (GLP-1RA) approved for oral use in the treatment of type 2 diabetes mellitus (T2DM). We aim to conduct a comprehensive review of literature to find out the efficacy and safety of oral semaglutide in T2DM, to lay out a clinical consideration for its use in India. METHODS We searched the electronic database of PubMed and Google Scholar from inception until January 31, 2022, using several MeSH keywords and retrieved all available granular details of phase 1, 2 and 3 randomized controlled trials (RCTs) of oral semaglutide. Subsequently, we reviewed the results critically to lay down the clinical recommendation of its use. RESULTS Ten phase 3 randomized, placebo- and or active-controlled studies of oral semaglutide (PIONEER programs) are currently published. Seven global trials of oral semaglutide (PIONEER 1-5, 7 and 8) that exclusively studied the efficacy (lowering of HbA1c and body weight, achieving target of HbA1c <7% and other composites of HbA1c and weight) outcomes, found 14 mg oral semaglutide to be superior to placebo or active comparators (empagliflozin, sitagliptin and liraglutide). Efficacy was similar in Asians, although no separate data exists for Indians due to the low number of participants. Expectedly, gastrointestinal intolerance were the most commonly observed side effects with oral semaglutide and the main reason for drug discontinuation. CONCLUSION Oral semaglutide 14 mg is an effective agent in the treatment of T2DM. Real-world studies of semaglutide are clearly needed in India in absence of meaningful data from RCTs in Indians.
Collapse
|
2
|
|
Singh AK, Phatak SR, Singh R, Bhattacharjee K, Singh NK, Gupta A, Sharma A. Humoral antibody kinetics with ChAdOx1-nCOV (Covishield™) and BBV-152 (Covaxin™) vaccine among Indian Healthcare workers: A 6-month longitudinal cross-sectional Coronavirus Vaccine-induced antibody titre (COVAT) study. Diabetes Metab Syndr 2022; 16:102424. [PMID: 35150961 DOI: 10.1016/j.dsx.2022.102424] [Citation(s) in RCA: 8] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and aims There is limited data available on longitudinal humoral antibody dynamics following two doses of ChAdOx1-nCOV (Covishield™) and BBV-152 (Covaxin™) vaccine against SARS-CoV-2 among Indians. Methods We conducted a 6-month longitudinal study in vaccinated healthcare workers by serially measuring quantitative anti-spike antibody at 3-weeks, 3-months and 6-months after the completion of second dose. Geometric mean titer (GMT) and linear mixed models were used to assess the dynamics of antibody levels at 6 months. Results Of the 481 participants, GMT of anti-spike antibody decreased by 56% at 6-months regardless of age, gender, blood group, body-mass index and comorbidities in 360 SARS-CoV-2 naive individuals but significantly more in hypertensives. Participants with past infection had significantly higher GMT at all time points compared to the naive individuals. Among SARS-CoV-2 naive cohorts, a significantly higher GMT was noted amongst the Covishield recipients at all time points, but there was a 44% decline in GMT at 6-month compared to the peak titer period. Decline in GMT was insignificant (8%) in Covaxin recipients at 6-month despite a lower GMT at all time points vs. Covishield. There was 5.6-fold decrease in seropositivity rate at 6-month with both vaccines. Participants with type 2 diabetes mellitus have a lower seropositivity rate at all the time points. Seropositivity rate was significantly higher with Covishield vs. Covaxin at all time points except at 6-month where Covaxin recipients had a higher seropositivity rate but no difference noted in propensity-matched analysis. Conclusions There is waning humoral antibody response following two doses of either vaccine at six months. Covishield recipients had a higher anti-spike antibody GMT compared with Covaxin at all-time points, however a significant decline in antibody titers was seen with Covishield but not with Covaxin at 6-months.
Collapse
|
3
|
|
Abstract
The prevalence of diabetes in people with coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has varied worldwide. Most of the available evidence suggests a significant increase in severity and mortality of COVID-19 in people with either type 1 (T1DM) or type 2 diabetes mellitus (T2DM), especially in association with poor glycemic control. While new-onset hyperglycemia and new-onset diabetes (both T1DM and T2DM) have been increasingly recognized in the context of COVID-19 and have been associated with worse outcome, no conclusive evidence yet suggests direct tropism of SARS-CoV-2 on the β cells of pancreatic islets. While all approved oral antidiabetic agents appear to be safe in people with T2DM having COVID-19, no conclusive data are yet available to indicate a mortality benefit with any class of these drugs, in the absence of large randomized controlled trials.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes and Endocrinology, G.D. Hospital and Diabetes Institute, Kolkata 700014, India
| | - Kamlesh Khunti
- Department of Primary Care Diabetes and Vascular Medicine, Leicester Diabetes Research Centre, Leicester LE5 4PW, United Kingdom
| |
Collapse
|
4
|
|
Singh AK, Singh A, Singh R, Misra A. An updated practical guideline on use of molnupiravir and comparison with agents having emergency use authorization for treatment of COVID-19. Diabetes Metab Syndr 2022; 16:102396. [PMID: 35051686 DOI: 10.1016/j.dsx.2022.102396] [Citation(s) in RCA: 26] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background and aims Molnupiravir is a newer oral antiviral drug that has recently received emergency use authorization (EUA) in USA, UK and India. We aim to conduct an update on our previous systematic review to provide practical clinical guideline for using molnupiravir in patients with COVID-19. Methods We systematically searched the electronic database of PubMed, MedRxiv and Google Scholar until January 5, 2022, using key MeSH keywords. Results Final result of phase 3 study in 1433 non-hospitalized COVID-19 patients showed a significant reduction in composite risk of hospital admission or death (absolute risk difference, −3.0% [95% confidence interval {CI}, −5.9 to −0.1%]; 1-sided P = 0.02) although with a non-significant 31% relative risk reduction (RRR). RRR for death alone was 89% (95% CI, 14 to 99; P-value not reported). Number needed to treat to prevent 1 death or 1 hospitalization or death composite appears to be closely competitive to other agents having EUA in people with COVID-19. However, cost-wise molnupiravir is comparatively cheaper compared to all other agents. Conclusion Molnupiravir could be a useful agent in non-pregnant unvaccinated adults with COVID-19 who are at increased risk of severity including hospitalization. However, it is effective only when used within 5-days of onset of symptoms. A 5-days course seems to be safe without any obvious short-term side effects.
Collapse
Affiliation(s)
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
| |
Collapse
|
5
|
|
Joshi R, Singla R, Mishra A, Kumar M, Singh RS, Singh A, Bansal S, Sharma AR, Sarma P, Prakash A, Medhi B. A systematic review on SARS-CoV-2 remission: an Emerging challenge for its management, treatment, immunization strategies and post-treatment guidelines. New Microbes New Infect 2022;:100949. [PMID: 35018221 DOI: 10.1016/j.nmni.2022.100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 disease caused by severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2) has posed as a major health concern for people all across the globe. Along with the increasing confirmed patients being readmitted with complaints for fever, cough, cold, the effective monitoring of 'relapse' of the SARS-CoV-2 virus in the previously discharged patients have become the next area of focus. However, availability of limited data on reactivation of SARS-CoV-2 makes the disease prognosis as well as the effective control of re-infection an immense challenge. Prompted by these challenges, we assessed the possibility of re-infection in discharged patients and the risk of the transmission, proficiency of RT-PCR results and approximate period required for the quarantine and the real challenges for the development of vaccine. In the present review, the published literature on all the possible cases of re-infection from February to July were reported, thereby selected 142 studies from a hub of overall 669 studies after full text screening. The incomplete virus clearance, poor sensitivity of the present diagnostic testing, emergence of mutant strains, insufficient mucus collection from the throat swab etc. are some of the possible causes of re-infection. The new protocols for management of COVID-19 discharged patients should be revised in the guidelines.
Collapse
Affiliation(s)
- Rupa Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Rubal Singla
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Abhishek Mishra
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Mukesh Kumar
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Rahul Soloman Singh
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Ashutosh Singh
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Seema Bansal
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Amit Raj Sharma
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Phulen Sarma
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Ajay Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| |
Collapse
|
6
|
|
Singh AK, Singh R. Letter by Awadhesh Kumar Singh Regarding Article, “Cardiovascular Outcomes Comparison of Dipeptidyl Peptidase-4 Inhibitors Versus Sulfonylurea as Add-on Therapy for Type 2 Diabetes Mellitus: a Meta-Analysis”. J Lipid Atheroscler 2022; 11:84. [PMID: 35118024 DOI: 10.12997/jla.2022.11.1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| |
Collapse
|
7
|
|
Gupta R, Kesavadev J, Krishnan G, Agarwal S, Saboo B, Shah M, Mittal A, Durani S, Luthra A, Singhal A, Rasheed M, Rao GVS, Tripathi V, Jha A, Ghosh A, Mohan V, Singh AK, Phatak S, Panicker J, Bhadada SK, Joshi S, Pal R, Mithal A, Vikram N, Misra A. COVID-19 associated mucormycosis: A Descriptive Multisite Study from India. Diabetes Metab Syndr 2021; 15:102322. [PMID: 34717135 DOI: 10.1016/j.dsx.2021.102322] [Citation(s) in RCA: 5] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Mucormycosis is an invasive fungal infection and carries a significant morbidity and mortality. A number of cases of mucormycosis have been reported in association with COVID-19. In this study, a consortium of clinicians from various parts of India studied clinical profile of COVID-19 associated mucormycosis (CAM) and this analysis is presented here. METHODS Investigators from multiple sites in India were involved in this study. Clinical details included the treatment and severity of COVID-19, associated morbidities, as well as the diagnosis, treatment and prognosis of mucormycosis. These data were collected using google spreadsheet at one centre. Descriptive analysis was done. RESULTS There were 115 patients with CAM. Importantly, all patients had received corticosteroids. Diabetes was present in 85.2% of patients and 13.9% of patients had newly detected diabetes. The most common site of involvement was rhino-orbital. Mortality occurred in 25 (21.7%) patients. On logistic regression analysis, CT scan-based score for severity of lung involvement was associated with mortality. CONCLUSION Universal administration of corticosteroids in our patients is notable. A large majority of patients had diabetes, while mortality was seen in ∼1/5th of patients, lower as compared to recently published data.
Collapse
Affiliation(s)
| | | | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | | | | | | | - Atul Mittal
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Suhail Durani
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Atul Luthra
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Anuj Singhal
- Fortis Escorts Heart Institute, New Delhi, India
| | | | - G V S Rao
- Dr Rao's ENT Centre, Hyderabad, Telangana, India
| | | | - Alka Jha
- Fortis Rajan Dhall Hospital, New Delhi, India
| | | | - V Mohan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamilnadu, India
| | | | | | | | | | | | - Rimesh Pal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Naval Vikram
- All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
8
|
|
Singh AK, Phatak SR, Singh R, Bhattacharjee K, Singh NK, Gupta A, Sharma A. Antibody response after first and second-dose of ChAdOx1-nCOV (Covishield TM®) and BBV-152 (Covaxin TM®) among health care workers in India: The final results of cross-sectional coronavirus vaccine-induced antibody titre (COVAT) study. Vaccine 2021; 39:6492-509. [PMID: 34600747 DOI: 10.1016/j.vaccine.2021.09.055] [Citation(s) in RCA: 53] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background We assessed the humoral immune response of both ChAdOx1-nCOV (CovishieldTM) and BBV-152 (CovaxinTM) vaccines in Indian health care workers (HCW). Methods A Pan-India, Cross-sectional, Coronavirus Vaccine-induced Antibody Titre (COVAT) study was conducted that measured SARS-CoV-2 anti-spike binding antibody quantitatively, 21 days or more after the first and second dose of two vaccines in both severe acute respiratory syndrome (SARS-CoV-2) naïve and recovered HCW. Primary aim was to analyze antibody response (seropositivity rate, Geometric Mean Titre [GMT] and 95% Confidence Interval [CI]) following each dose of both vaccines and its correlation to age, sex, blood group, body mass index (BMI) and comorbidities. Here we report the results of anti-spike antibody response after first and two completed doses. Results Among the 515 HCW (305 Male, 210 Female) who took two doses of both vaccines, 95.0% showed seropositivity to anti-spike antibody. However, both seropositivity rate and GMT (95% CI) of anti-spike antibody was significantly higher in Covishield vs. Covaxin recipients (98.1 vs. 80.0%; 129.3 vs. 48.3 AU/mL; both p < 0.001). This difference persisted in 457 SARS-CoV-2 naïve and propensity-matched (age, sex and BMI) analysis of 116 participants. Age > 60-years, males, people with any comorbidities, and history of hypertension (HTN) had a significantly less anti-spike antibody GMT compared to age ≤ 60 years, females, no comorbidities and no HTN respectively, after the completion of two doses of either vaccine. Gender, presence of comorbidities, and vaccine type were independent predictors of antibody seropositivity rate and anti-spike antibody titre levels in multiple logistic and log transformed linear regression analysis. Both vaccine recipients had similar solicited mild to moderate adverse events and none had severe or unsolicited side effects. Conclusions Both vaccines elicited good immune response after two doses, although seropositivity rates and GMT of anti-spike antibody titre was significantly higher in Covishield compared to Covaxin recipients.
Collapse
|
9
|
|
Nanditha A, Raghavan A, Misra A, Saboo B, Singh AK, Joshi SR, Agarwal S, Tandon N, Tiwaskar M, Aravind SR, Ramachandran A. Management of Hyperglycemia in COVID-19 and Post-COVID-19 Syndrome - Proposed Guidelines for India. J Assoc Physicians India 2021; 69:11-2. [PMID: 34585892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
SARS-CoV-2 virus spread rapidly all over the globe in 2020 and the second wave has taken our nation, India by storm. The pandemic has posed unique challenges in people with metabolic disorders, including diabetes, hypertension, obesity, pulmonary, cardiovascular, kidney and non-alcoholic fatty liver disease. Uncontrolled diabetes, in conjunction with endocrine, inflammatory and metabolic effects of the infection itself has made management of hyperglycemia in COVID-19 infection particularly challenging. Furthermore, the post-COVID-19 syndrome has also emerged as a sequela in COVID-19 survivors, increasing the risk of death, complications and adding further burden on the health care system. With more than a year of experience, we have gained substantial insight; and now provide practical recommendations on the management of hyperglycemia in COVID-19 as well as post COVID-19 syndrome.
Collapse
Affiliation(s)
- Arun Nanditha
- Director, Consultant Diabetologist, India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Arun Raghavan
- Director, Consultant Diabetologist, India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), President, Diabetes Foundation (India) (DFI), New Delhi
| | - Banshi Saboo
- Chief Diabetologist Chairman, Diabetes Care Hormone Clinic, Ahmedabad, Gujarat
| | - Awadhesh Kumar Singh
- Senior Consultant Endocrinologist, G.D Hospital Diabetes Institute, Kolkata, West Bengal
| | - Shashank R Joshi
- Senior Consultant Endocrinologist, Lilavati Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Sanjay Agarwal
- Director - Aegle Clinic for Diabetes Care, Head of Dept. Medicine Diabetes, Ruby Hall Clinic. Senior Consultant Diabetes Medicine, Jehangir Hospital, Pune, Maharashtra
| | - Nikhil Tandon
- Professor Head, Department of Endocrinology Metabolism, All India Institute of Medical Sciences, New Delhi
| | - Mangesh Tiwaskar
- Consultant Physician Diabetologist, Shilpa Medical Research Centre, Mumbai, Maharashtra
| | - Sosale R Aravind
- Director, Diacon Hospital, Bangalore, Karnataka; 10President, India Diabetes Research Foundation, Chairman, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Ambady Ramachandran
- President, India Diabetes Research Foundation, Chairman, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| |
Collapse
|
10
|
|
Singh AK, Singh R. Do SGLT-2 inhibitors exhibit similar cardiovascular benefit in patients having reduced ejection fraction heart failure with type 2 diabetes, prediabetes and normoglycemia? Diabetes Metab Syndr 2021; 15:102282. [PMID: 34562869 DOI: 10.1016/j.dsx.2021.102282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS We aimed to know whether SGLT-2 inhibitors (SGLT-2I) exhibit similar cardiovascular (CV) benefit in patients having reduced ejection fraction heart failure (HFrEF) with varying degree of glycemia. METHOD We meta-analyzed the trial-level hazard ratio and 95% confidence interval of randomized trials that reported the CV outcomes stratified in to three subgroups of normoglycemia, prediabetes and diabetes. RESULTS This meta-analysis found a significant and similar CV risk reduction in patients with HFrEF without any significant interaction between three subgroups (PIntercation = 0.98). CONCLUSIONS SGLT-2I exhibit similar CV risk reduction in HFrEF, regardless of baseline glycemic status. However, this finding is limited to pooled data from only 2 studies in people without T2DM.
Collapse
|
11
|
|
Singh AK, Singh R. Comments on: Rise of the phoenix: Mucormycosis in COVID-19 times. Indian J Ophthalmol 2021; 69:2552. [PMID: 34427273 DOI: 10.4103/ijo.IJO_1423_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Awadhesh K Singh
- Department of Diabetes and Endocrinology, G. D Hospital and Diabetes Institute, Kolkata, India
| | - Ritu Singh
- Department of Diabetes and Endocrinology, G. D Hospital and Diabetes Institute, Kolkata, India
| |
Collapse
|
12
|
|
Abstract
Step-wise addition of antihyperglycemic agents (AHA) after the initiation of metformin monotherapy has been the traditional approach for the treatment of type 2 diabetes mellitus (T2DM) world-wide. Emerging evidence increasingly suggests that metformin-based combination therapy, especially with the newer AHA that lowers HbA1c glucose-dependently and do not potentiate hypoglycemia, could be a potentially better option for durable glycemic control with good tolerability compared to diabetes monotherapy. In this review, we descriptively analyzed the evidence available from the systematic reviews and meta-analyses of randomized head-to-head trials that reported the efficacy and safety outcomes of diabetes monotherapy, metformin-based combination therapies, and monotherapy versus metformin-based combination therapies.
Collapse
Affiliation(s)
- Awadhesh K Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | | |
Collapse
|
13
|
|
Abstract
Highlights The beneficial cardiovascular (CV) effects of SGLT-2 inhibitors (SGLT-2i) in patients with heart failure are already known. Whether SGLT-2i exert similar CV effects in heart failure with reduced or preserved ejection fraction is not known. This meta-analysis showed SGLT-2i exert similar CV benefits irrespective of the types of heart failure. Future trials will confirm or refute the CV effects of SGLT-2i in patients with heart failure with preserved ejection fraction.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Anoop Misra
- Department of Diabetes, Fortis-CDOC hospital for Diabetes & Allied Science, New Delhi, India
| |
Collapse
|
14
|
|
Saboo B, Agarwal S, Singh AK, Makkar B, Chawla R, Ghosh S, Viswanathan V, Gupta S, Kumar V, Maheshwari A. Diabetes Mellitus and Heart Failure: A Consensus Statement. Int J Diabetes Dev Ctries 2021; 41:1-41. [DOI: 10.1007/s13410-021-00956-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
15
|
|
Abstract
BACKGROUND AND AIMS There are increasing case reports of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19), especially from India. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. We aim to conduct a systematic review of literature to find out the patient's characteristics having mucormycosis and COVID-19. METHODS We searched the electronic database of PubMed and Google Scholar from inception until May 13, 2021 using keywords. We retrieved all the granular details of case reports/series of patients with mucormycosis, and COVID-19 reported world-wide. Subsequently we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, use of steroids and its outcome in people with COVID-19. RESULTS Overall, 101 cases of mucormycosis in people with COVID-19 have been reported, of which 82 cases were from India and 19 from the rest of the world. Mucormycosis was predominantly seen in males (78.9%), both in people who were active (59.4%) or recovered (40.6%) from COVID-19. Pre-existing diabetes mellitus (DM) was present in 80% of cases, while concomitant diabetic ketoacidosis (DKA) was present in 14.9%. Corticosteroid intake for the treatment of COVID-19 was recorded in 76.3% of cases. Mucormycosis involving nose and sinuses (88.9%) was most common followed by rhino-orbital (56.7%). Mortality was noted in 30.7% of the cases. CONCLUSION An unholy trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. All efforts should be made to maintain optimal glucose and only judicious use of corticosteroids in patients with COVID-19.
Collapse
|
16
|
|
Singh AK, Singh R. Effect of background insulin therapy on cardiovascular outcomes with SGLT-2 inhibitors in type 2 diabetes: A meta-analysis of cardiovascular outcome trials. Diabetes Res Clin Pract 2021; 172:108648. [PMID: 33421444 DOI: 10.1016/j.diabres.2021.108648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 02/08/2023]
Abstract
Cardiovascular (CV) benefits of SGLT-2 inhibitors (SGLT-2i) have been consistent in type 2 diabetes mellitus (T2DM). To find whether SGLT-2i show similar CV effects with insulin therapy in T2DM, we conducted a trial-level meta-analysis of CV outcome trials. This meta-analysis found SGLT-2i exert CV benefit, irrespective of background insulin therapy.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| |
Collapse
|
17
|
|
Singh AK, Singh R. Does background metformin therapy influence the cardiovascular outcomes with SGLT-2 inhibitors in type 2 diabetes? Diabetes Res Clin Pract 2021; 172:108536. [PMID: 33181201 DOI: 10.1016/j.diabres.2020.108536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 02/05/2023]
Abstract
Metformin has been recommended as a first-line antidiabetic drug (ADD) for all patients with type 2 diabetes even in the presence of high cardiovascular (CV) risk by American Diabetes Association. In contrast, European Society of Cardiology recommends either a sodium-glucose co-transporter-2 inhibitors (SGLT-2i) or a glucagon-like peptide-1 receptor agonists as a first-line ADD, in presence of high CV risk. While this discordant recommendation has created a debate, we sought to find whether background metformin therapy influences the CV outcomes with SGLT-2i. We pooled the hazard ratio and 95% confidence interval of three-point composite major adverse cardiovascular events (3P-MACE) of 3 CV outcome trials (CVOTs) from the subgroup analysis based on outcomes with or without background metformin therapy. Subsequently, we conducted a meta-analysis by applying the inverse variance-weighted averages of pooled logarithmic hazard ratio, using a random-effects analysis. While this meta-analysis found a significant reduction in 3P-MACE with SGLT-2i without background metformin therapy (N = 7,233; HR 0.79; 95% CI, 0.69-0.90; p < 0.01; I2 = 0.0%), no significant reduction in 3P-MACE was observed with SGLT-2i in presence of background metformin therapy (N = 27,081; HR 0.94; 95% CI, 0.86-1.02; p = 0.13; I2 = 0.0%) with a significant Pheterogenity of 0.03 between the two groups. Similar finding was observed from the pooled results from 4 CVOTs. This may suggest that background metformin therapy may undermine the 3P-MACE benefit of SGLT-2i. However, no such interaction was observed in a recent meta-analysis of SGLT-2i, with or without background metformin therapy. Future research is warranted to understand the CV interaction of metformin with SGLT-2i.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| |
Collapse
|
18
|
|
Singh AK, Singh R. Similarities and differences in cardio-renal outcome trials with SGLT-2 inhibitors: call for pharmacogenomic studies? Pharmacogenet Res Per Med 2021; 0:0-0. [DOI: 10.21037/prpm-22-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
19
|
|
Abstract
BACKGROUND AND AIMS Molnupiravir is a newer oral antiviral drug that has recently been tested in COVID-19. We aim to conduct a systematic review of literature to find out the efficacy and safety of molnupiravir in patients with COVID-19. METHODS We systematically searched the electronic database of PubMed, MedRxiv and Google Scholar from inception until October 15, 2021, using MeSH keywords. Ongoing trials of molnupiravir in COVID-19 were additionally searched from the ClinicalTrials.Gov and ctri.nic.in/Clinicaltrials. We retrieved all the available granular details of phase 1 to 3 studies of molnupiravir in COVID-19. Subsequently we reviewed the results narratively. RESULTS Two phase 1 double-blind, randomized, placebo-controlled (DBRPC) studies of molnupiravir showed that 1600 mg daily dose is safe and tolerable, without any serious adverse events up to 5.5 days. One phase 2 DBPRC study found significantly lower time to clearance (RNA negativity) with molnupiravir 800 mg twice daily compared to the placebo (log-rank p value = 0.013) in mild to moderate COVID-19. Interim report of one phase 3 DBRPC study in non-hospitalized COVID-19 found a significant reduction in the risk of hospital admission or death by 50% (p = 0.0012). However, no significant benefit was observed with molnupiravir in the later stage of moderate to severe COVID-19. CONCLUSION Molnupiravir is first oral antiviral drug to demonstrate a significant benefit in reducing hospitalization or death in mild COVID-19 and could be an important weapon in the battle against SARS-CoV-2. However, its role in moderate to severe COVID-19 is questionable and more studies are needed.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India,Corresponding author. G. D Hospital & Diabetes Institute, Kolkata, 700013, India
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India,National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India,Diabetes Foundation (India), New Delhi, India
| |
Collapse
|
20
|
|
Singh AK, Singh R. Cardiovascular Outcomes with SGLT-2 inhibitors in patients with heart failure with or without type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndr 2021; 15:351-9. [PMID: 33503584 DOI: 10.1016/j.dsx.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| |
Collapse
|
21
|
|
Singh AK, Singh R, Saboo B, Misra A. Non-insulin anti-diabetic agents in patients with type 2 diabetes and COVID-19: A Critical Appraisal of Literature. Diabetes Metab Syndr 2021; 15:159-67. [PMID: 33352455 DOI: 10.1016/j.dsx.2020.12.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Several observational studies have recently reported the outcomes of non-insulin anti-diabetic agents (ADA) in patients with T2DM and coronavirus disease 2019 (COVID-19). We sought to review the literature to appraise the clinicians on these outcomes. METHODS A literature search using the specific keywords was carried out in the database of PubMed, MedRxiv and Google Scholar up till December 11, 2020 applying Boolean method. Full text of all the relevant articles that reported the outcomes of ADA in patients with T2DM and COVID-19 were retrieved. Subsequently, an appraisal of literature report was narratively presented. RESULTS Available studies that reported the outcomes of ADA are either case series or retrospective cohorts or prospective observational studies, in absence of the randomized controlled trials (RCTs). Results from these observational studies suggest that amongst all the non-insulin ADA, metformin users prior to the hospitalization had improved outcomes compared to the non-users. Data for dipeptidyl-peptidase-4 inhibitors (DPP-4i) are encouraging although inconsistent. No documentation of any harm or benefit has been observed for sulfonylureas (SUs), sodium glucose co-transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide receptor agonists (GLP-1RAs). No data is yet available for pioglitazone. CONCLUSION Metformin and DPP-4i should be continued in patients with T2DM until hospitalization or unless contraindicated. No evidence of harm suggests that SUs, SGLT-2i or GLP-1RAs may not be stopped unless very sick, hospitalized or contraindicated. The results from RCTs are needed to claim any meaningful benefit with either metformin or DPP-4i in patients with T2DM and COVID-19.
Collapse
|
22
|
|
Singh AK, Singh R. When is pharmacotherapy necessary for gestational diabetes? Expert Opin Pharmacother 2021; 22:2079-81. [PMID: 33300823 DOI: 10.1080/14656566.2020.1858052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Ritu Singh
- Department of Gynecology & Obstetrics, G.D Hospital & Diabetes Institute, Kolkata, India
| |
Collapse
|
23
|
|
Singh AK, Singh R, Khunti K. Comment on Gan et al. Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2020;43:1948-1957. Diabetes Care 2020; 43:e200-1. [PMID: 33218984 DOI: 10.2337/dc20-1950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Awadhesh Kumar Singh
- GD Hospital & Diabetes Institute, Kolkata, India .,Sun Valley Hospital & Diabetes Research Centre, Guwahati, India
| | - Ritu Singh
- GD Hospital & Diabetes Institute, Kolkata, India
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| |
Collapse
|
24
|
|
Singh AK, Gillies CL, Singh R, Singh A, Chudasama Y, Coles B, Seidu S, Zaccardi F, Davies MJ, Khunti K. Prevalence of co-morbidities and their association with mortality in patients with COVID-19: A systematic review and meta-analysis. Diabetes Obes Metab 2020; 22:1915-24. [PMID: 32573903 DOI: 10.1111/dom.14124] [Citation(s) in RCA: 231] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023]
Abstract
AIM To estimate the prevalence of both cardiometabolic and other co-morbidities in patients with COVID-19, and to estimate the increased risk of severity of disease and mortality in people with co-morbidities. MATERIALS AND METHODS Medline, Scopus and the World Health Organization website were searched for global research on COVID-19 conducted from January 2019 up to 23 April 2020. Study inclusion was restricted to English language publications, original articles that reported the prevalence of co-morbidities in individuals with COVID-19, and case series including more than 10 patients. Eighteen studies were selected for inclusion. Data were analysed using random effects meta-analysis models. RESULTS Eighteen studies with a total of 14 558 individuals were identified. The pooled prevalence for co-morbidities in patients with COVID-19 disease was 22.9% (95% CI: 15.8 to 29.9) for hypertension, 11.5% (9.7 to 13.4) for diabetes, and 9.7% (6.8 to 12.6) for cardiovascular disease (CVD). For chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), cerebrovascular disease and cancer, the pooled prevalences were all less than 4%. With the exception of cerebrovascular disease, all the other co-morbidities presented a significantly increased risk for having severe COVID-19. In addition, the risk of mortality was significantly increased in individuals with CVD, COPD, CKD, cerebrovascular disease and cancer. CONCLUSIONS In individuals with COVID-19, the presence of co-morbidities (both cardiometabolic and other) is associated with a higher risk of severe COVID-19 and mortality. These findings have important implications for public health with regard to risk stratification and future planning.
Collapse
Affiliation(s)
| | - Clare L. Gillies
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Ritu Singh
- GD Hospital & Diabetes InstituteKolkataIndia
| | - Akriti Singh
- College of Medicine and JNM HospitalKalyani, NadiaWest BengalIndia
| | - Yogini Chudasama
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Briana Coles
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
| | - Sam Seidu
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Francesco Zaccardi
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Melanie J. Davies
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| |
Collapse
|
25
|
|
Singh AK, Gupta R, Misra A. Reply to the letter of Mahajan and Gaur in response to the article: Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers (Singh et al.). Diabetes Metab Syndr 2020; 14:729. [PMID: 32473904 DOI: 10.1016/j.dsx.2020.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
26
|
|
Singh A, Shaikh A, Singh R, Singh AK. Letter in response to letter to the editor by Singh and Dhibar regarding the article "COVID-19: From bench to bedside" (Singh et al.). Diabetes Metab Syndr 2020; 14:865. [PMID: 32562863 DOI: 10.1016/j.dsx.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
27
|
|
Sharma AR, Batra G, Kumar M, Mishra A, Singla R, Singh A, Singh RS, Medhi B. BCG as a game-changer to prevent the infection and severity of COVID-19 pandemic? Allergol Immunopathol (Madr) 2020; 48:507-17. [PMID: 32653224 DOI: 10.1016/j.aller.2020.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023]
Abstract
The impact of COVID-19 is changing with country wise and depend on universal immunization policies. COVID-19 badly affects countries that did not have universal immunization policies or having them only for the selective population of countries (highly prominent population) like Italy, USA, UK, Netherland, etc. Universal immunization of BCG can provide great protection against the COVID-19 infection because the BCG vaccine gives broad protection against respiratory infections. BCG vaccine induces expressions of the gene that are involved in the antiviral innate immune response against viral infections with long-term maintenance of BCG vaccine-induced cellular immunity. COVID-19 cases are reported very much less in the countries with universal BCG vaccination policies such as India, Afghanistan, Nepal, Bhutan, Bangladesh, Israel, Japan, etc. as compared to without BCG implemented countries such as the USA, Italy, Spain, Canada, UK, etc. BCG vaccine provides protection for 50–60 years of immunization, so the elderly population needs to be revaccinated with BCG. Several countries started clinical trials of the BCG vaccine for health care workers and elderly people. BCG can be uses as a prophylactic treatment until the availability of the COVID-19 vaccine.
Collapse
Affiliation(s)
- A R Sharma
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Neurology, India
| | - G Batra
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Neurology, India
| | - M Kumar
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Pharmacology, India
| | - A Mishra
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Pharmacology, India
| | - R Singla
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Pharmacology, India
| | - A Singh
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Pharmacology, India
| | - R S Singh
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Pharmacology, India
| | - B Medhi
- Post Graduate Institute for Medical Education and Research (PGIMER), Chandigarh, India; Department of Pharmacology, India.
| |
Collapse
|
28
|
|
Abstract
Hyperglycemia with or without blood glucose in diabetes range is an emerging finding not uncommonly encountered in patients with COVID-19. Increasingly, all evidence currently available hints that both new-onset hyperglycemia without diabetes and new-onset diabetes in COVID-19 is associated with a poorer outcome compared with normoglycemic individuals and people with pre-existing diabetes.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| |
Collapse
|
29
|
|
Singh AK, Singh R. At-admission hyperglycemia is consistently associated with poor prognosis and early intervention can improve outcomes in patients with COVID-19. Diabetes Metab Syndr 2020; 14:1641-4. [PMID: 32896795 DOI: 10.1016/j.dsx.2020.08.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 02/05/2023]
Abstract
Background & Aims At-admission hyperglycemia have been associated with poorer outcome during critical illnesses. At-admission hyperglycemia in previously unknown diabetes is not uncommonly encountered entity in patients with COVID-19. We sought to find out the outcomes of at-admission hyperglycemia and effect of early intervention to achieve optimal glycemic control in relation to COVID-19 patients. Methods We searched the PubMed and Google Scholar database up till August 20, 2020 using specific keywords related to our aims and objectives. Results All currently available evidences clearly hint that at-admission hyperglycemia in patients with COVID-19 is associated with a poorer outcome, compared with normoglycemic individuals. Fortunately, early intervention by achieving an optimal glycemic control has also been associated with a significant improvement in the outcomes in patients with COVID-19. Conclusion At-admission hyperglycemia should be taken seriously by all clinicians treating patients with COVID-19. All efforts should be made towards an optimal glycemic control in patients with COVID-19, even in absence of pre-existing diabetes. At-admission hyperglycemia is associated with poor outcomes in patients with COVID-19. Early intervention and optimal glycemic control improve the outcomes in patients with COVID-19. All efforts should be made to achieve reasonable glycemic control in patients with COVID-19.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| |
Collapse
|
30
|
|
Singh AK, Misra A. Impact of COVID-19 and comorbidities on health and economics: Focus on developing countries and India. Diabetes Metab Syndr 2020; 14:1625-30. [PMID: 32891011 DOI: 10.1016/j.dsx.2020.08.032] [Citation(s) in RCA: 50] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 02/08/2023]
Abstract
Background and aims Presence of comorbidities in patients with Coronavirus disease 2019 (COVID-19) have often been associated with increased in-hospital complications and mortality. Intriguingly, several developed countries with a higher quality of life have relatively higher mortality with COVID-19, compared to the middle- or low-income countries. Moreover, certain ethnic groups have shown a higher predilection to contract COVID-19, with heightened mortality. We sought to review the available literature with regards to impact of COVID-19 and comorbidities on the health and economics, especially in context to the developing countries including India. Methods A Boolean search was carried out in PubMed, MedRxiv and Google Scholar databases up till August 23, 2020 using the specific keywords, to find the prevalence of comorbidities and its outcome in patients with COVID-19. Results All available evidence consistently suggests that presence of comorbidities is associated with a poor outcome in patients with COVID-19. Diabetes prevalence is highest in Indian COVID-19 patients, compared to other countries. Majority of the patients with COVID-19 are asymptomatic ranging from 26 to 76%. Conclusions Universal masking is the need of hour during unlock period. Low-income countries such as India, Brazil and Africa with less resources and an average socio-economic background, must adopt a strict policy for an affordable testing programs to trace, test, identify and home quarantine of asymptomatic cases. Despite the huge number of COVID-19 patients, India still has low volume research at the moment. Comorbidities in patients with COVID-19 is often associated with a poor prognosis. Diabetes prevalence is highest in Indian COVID-19 patients compared to other countries. Increasing number of asymptomatic COVID-19 cases are currently being reported world-wide. Universal masking is the best available option to prevent COVID-19 during the unlock period. Despite the huge number of COVID-19 patients, India still has low volume research at the moment.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Anoop Misra
- Fortis-C-DOC Center of Excellence for Diabetes, Metabolic Disease and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
| |
Collapse
|
31
|
|
Seidu S, Gillies C, Zaccardi F, Kunutsor SK, Hartmann-Boyce J, Yates T, Singh AK, Davies MJ, Khunti K. The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis. Endocrinol Diabetes Metab 2020;:e00176. [PMID: 32904932 DOI: 10.1002/edm2.176] [Citation(s) in RCA: 48] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 02/05/2023]
Abstract
Background Obesity accompanied by excess ectopic fat storage has been postulated as a risk factor for severe disease in people with SARS-CoV-2 through the stimulation of inflammation, functional immunologic deficit and a pro-thrombotic disseminated intravascular coagulation with associated high rates of venous thromboembolism. Methods Observational studies in COVID-19 patients reporting data on raised body mass index at admission and associated clinical outcomes were identified from MEDLINE, Embase, Web of Science and the Cochrane Library up to 16 May 2020. Mean differences and relative risks (RR) with 95% confidence intervals (CIs) were aggregated using random effects models. Results Eight retrospective cohort studies and one cohort prospective cohort study with data on of 4,920 patients with COVID-19 were eligible. Comparing BMI ≥ 25 vs <25 kg/m2, the RRs (95% CIs) of severe illness and mortality were 2.35 (1.43-3.86) and 3.52 (1.32-9.42), respectively. In a pooled analysis of three studies, the RR (95% CI) of severe illness comparing BMI > 35 vs <25 kg/m2 was 7.04 (2.72-18.20). High levels of statistical heterogeneity were partly explained by age; BMI ≥ 25 kg/m2 was associated with an increased risk of severe illness in older age groups (≥60 years), whereas the association was weaker in younger age groups (<60 years). Conclusions Excess adiposity is a risk factor for severe disease and mortality in people with SARS-CoV-2 infection. This was particularly pronounced in people 60 and older. The increased risk of worse outcomes from SARS-CoV-2 infection in people with excess adiposity should be taken into account when considering individual and population risks and when deciding on which groups to target for public health messaging on prevention and detection measures. Systematic review registration: PROSPERO 2020: CRD42020179783.
Collapse
Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre Leicester General Hospital University of Leicester Leicester UK.,The NIHR Applied Research Collaboration (ARC) East Midlands Leicester General Hospital University of Leicester Leicester UK
| | - Clare Gillies
- Diabetes Research Centre Leicester General Hospital University of Leicester Leicester UK.,The NIHR Applied Research Collaboration (ARC) East Midlands Leicester General Hospital University of Leicester Leicester UK
| | - Francesco Zaccardi
- Diabetes Research Centre Leicester General Hospital University of Leicester Leicester UK.,The NIHR Applied Research Collaboration (ARC) East Midlands Leicester General Hospital University of Leicester Leicester UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust University of Bristol Bristol UK.,Musculoskeletal Research Unit Translational Health Sciences Bristol Medical School Southmead Hospital University of Bristol Bristol UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences Centre for Evidence-Based Medicine University of Oxford Oxford UK
| | - Thomas Yates
- Diabetes Research Centre Leicester General Hospital University of Leicester Leicester UK.,NIHR Leicester Biomedical Research Centre A Collaboration between University Hospitals of Leicester NHS Trust University of Leicester Leicester UK
| | | | - Melanie J Davies
- Diabetes Research Centre Leicester General Hospital University of Leicester Leicester UK.,NIHR Leicester Biomedical Research Centre A Collaboration between University Hospitals of Leicester NHS Trust University of Leicester Leicester UK
| | - Kamlesh Khunti
- Diabetes Research Centre Leicester General Hospital University of Leicester Leicester UK.,The NIHR Applied Research Collaboration (ARC) East Midlands Leicester General Hospital University of Leicester Leicester UK
| |
Collapse
|
32
|
|
Singh AK, Khunti K. Assessment of risk, severity, mortality, glycemic control and antidiabetic agents in patients with diabetes and COVID-19: A narrative review. Diabetes Res Clin Pract 2020; 165:108266. [PMID: 32533989 DOI: 10.1016/j.diabres.2020.108266] [Citation(s) in RCA: 48] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 02/08/2023]
Abstract
AIMS Rising prevalence of non-communicable diseases world-wide has made diabetes an important comorbidity in patients with coronavirus disease-19 (COVID-19). We sought to review the risk, severity and mortality in COVID-19 and its relation to the glycemic control, and role of anti-diabetic agents in patients with diabetes. METHODS A Boolean search was made in PubMed, MedRxiv and Google Scholar database until May 10, 2020 and full articles with supplementary appendix were retrieved using the specific key words related to the topic. RESULTS There is a high prevalence of diabetes in patients with COVID-19. Patients with diabetes had a significantly more severe variety of COVID-19 and increased mortality, compared to the groups without diabetes. Moreover, poor glycemic control is associated with a significantly higher severe COVID-19 and increased mortality, compared to the well-controlled glycemic groups. No data currently available for or against any anti-diabetic agents in COVID-19. CONCLUSIONS Diabetes, in particular poorly-controlled group is associated with a significantly higher risk of severe COVID-19 and mortality. This calls for an optimal glycemic control and an increased emphasis on future preventative therapies including the vaccination programs for these groups in addition to the traditional risk prevention such as social distancing and self-isolation.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Kamlesh Khunti
- Leicester Diabetes Research Centre, Leicester LE5 4PW, UK.
| |
Collapse
|
33
|
|
Singh A, Shaikh A, Singh R, Singh AK. COVID-19: From bench to bed side. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2020; 14:277-81. [DOI: 10.1016/j.dsx.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
34
|
|
Singh AK, Singh R. Is metformin ahead in the race as a repurposed host-directed therapy for patients with diabetes and COVID-19? Diabetes Res Clin Pract 2020; 165:108268. [PMID: 32533990 DOI: 10.1016/j.diabres.2020.108268] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| |
Collapse
|
35
|
|
Singh AK. COVID-19 experience in Kuwait: A high prevalence of asymptomatic cases and increased mortality in smokers. EClinicalMedicine 2020; 24:100462. [PMID: 32695964 DOI: 10.1016/j.eclinm.2020.100462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| |
Collapse
|
36
|
|
Singh AK, Singh R. Reply to Sodium-glucose co-transporter-2 inhibitors, cardiovascular outcomes and the impact of gender: Class effect or statistical play of chance? Diabetes Metab Syndr 2020; 14:335. [PMID: 32302947 DOI: 10.1016/j.dsx.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|