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Nádasdi Á, Sinkovits G, Bobek I, Lakatos B, Förhécz Z, Prohászka ZZ, Réti M, Arató M, Cseh G, Masszi T, Merkely B, Ferdinandy P, Vályi-Nagy I, Prohászka Z, Firneisz G. Decreased circulating dipeptidyl peptidase-4 enzyme activity is prognostic for severe outcomes in COVID-19 inpatients. Biomark Med 2022; 16:317-330. [PMID: 35195023 PMCID: PMC8961475 DOI: 10.2217/bmm-2021-0717] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: To investigate the serum circulating DPP4 activity in patients with COVID-19 disease. Materials & methods: Serum samples from 102 hospitalized COVID-19 patients and 43 post-COVID-19 plasma donors and 39 SARS-CoV-2 naive controls and their medical data were used. Circulating DPP4 activities according to different COVID-19 disease peak severity (WHO) groups at sampling and at peak were assessed. Results: A significant decrease (p < 0.0001) in serum DPP4 activity was found in study groups of higher disease severity. When the circulating DPP4 activity was assessed as a prognostic marker, the logistic regression (p = 0.0023) indicated that the enzyme activity is a predictor of mortality (median 9.5 days before death) with receiver operating characteristic area under the curves of 73.33% (p[area = 0.5] < 0.0001) as single predictor and 83.45% (p[area = 0.5] < 0.0001) in combination with age among hospitalized patients with COVID-19. Conclusion: Decreased circulating DPP4 activity is associated with severe COVID-19 disease and is a strong prognostic biomarker of mortality.
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Affiliation(s)
| | - György Sinkovits
- Department of Internal Medicine & Haematology, Research Laboratory, Semmelweis University, Budapest, H-1088, Hungary
| | - Ilona Bobek
- Department of Anaesthesiology & Intensive Care Medicine, Central Hospital of Southern Pest, National Institute of Haematology & Infectious Diseases, Budapest, H-1097, Hungary
| | - Botond Lakatos
- Department of Infectology, Central Hospital of Southern Pest, National Institute of Haematology & Infectious Diseases, Budapest, H-1097, Hungary
| | - Zsolt Förhécz
- Department of Internal Medicine & Haematology, Semmelweis University, Budapest, H-1088, Hungary
| | - Zita Z Prohászka
- Department of Internal Medicine & Haematology, Research Laboratory, Semmelweis University, Budapest, H-1088, Hungary
| | - Marienn Réti
- Department of Haematology & Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Haematology & Infectious Diseases, Budapest, H-1097, Hungary
| | | | | | - Tamás Masszi
- Department of Internal Medicine & Haematology, Semmelweis University, Budapest, H-1088, Hungary
| | - Béla Merkely
- Semmelweis University, Budapest, H-1085, Hungary
| | - Péter Ferdinandy
- Department of Pharmacology & Pharmacotherapy, Semmelweis University, Budapest, H-1089, Hungary.,Semmelweis University, Budapest, H-1085, Hungary
| | - István Vályi-Nagy
- Central Hospital of Southern Pest, National Institute of Haematology & Infectious Diseases, Budapest, H-1097, Hungary
| | - Zoltán Prohászka
- Department of Internal Medicine & Haematology, Research Laboratory, Semmelweis University, Budapest, H-1088, Hungary
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Ning Q, Wu D, Wang X, Xi D, Chen T, Chen G, Wang H, Lu H, Wang M, Zhu L, Hu J, Liu T, Ma K, Han M, Luo X. The mechanism underlying extrapulmonary complications of the coronavirus disease 2019 and its therapeutic implication. Signal Transduct Target Ther 2022; 7:57. [PMID: 35197452 PMCID: PMC8863906 DOI: 10.1038/s41392-022-00907-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is a highly transmissible disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that poses a major threat to global public health. Although COVID-19 primarily affects the respiratory system, causing severe pneumonia and acute respiratory distress syndrome in severe cases, it can also result in multiple extrapulmonary complications. The pathogenesis of extrapulmonary damage in patients with COVID-19 is probably multifactorial, involving both the direct effects of SARS-CoV-2 and the indirect mechanisms associated with the host inflammatory response. Recognition of features and pathogenesis of extrapulmonary complications has clinical implications for identifying disease progression and designing therapeutic strategies. This review provides an overview of the extrapulmonary complications of COVID-19 from immunological and pathophysiologic perspectives and focuses on the pathogenesis and potential therapeutic targets for the management of COVID-19.
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Affiliation(s)
- Qin Ning
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Di Wu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojing Wang
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Xi
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Chen
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guang Chen
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongwu Wang
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiling Lu
- National Medical Center for Major Public Health Events, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Wang
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Zhu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junjian Hu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Liu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Ma
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meifang Han
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiaoping Luo
- National Medical Center for Major Public Health Events, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Abbasi F, Adatorwovor R, Davarpanah MA, Mansoori Y, Hajiani M, Azodi F, Sefidbakht S, Davoudi S, Rezaei F, Mohammadmoradi S, Asadipooya K. A Randomized Trial of Combination Therapy, Sitagliptin and Spironolactone, in Hospitalized Adult Patients with COVID-19. J Endocr Soc 2022; 6:bvac017. [PMID: 35261932 PMCID: PMC8898039 DOI: 10.1210/jendso/bvac017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
Context COVID-19 may cause respiratory distress syndrome and death. Treatment of COVID-19 to prevent complications remains a priority. Objective Our investigation sought to determine whether combination of spironolactone and sitagliptin could reduce mortality for inpatients with SARS-CoV-2 infection. Methods This single-blind, 4-arm, prospective randomized clinical trial was conducted at Shiraz and Bushehr University of Medical Sciences hospitals between December 2020 and April 2021. We randomized hospitalized adult patients with COVID-19 pneumonia into 4 groups: control, combination therapy, sitagliptin add-on, or spironolactone add-on. The primary outcome was the clinical improvement of the patients in the hospital as measured on an 8-point numerical scale. The secondary outcomes included intubation, ICU admission, end organ damages, CT findings, and paraclinical information. Results A total of 263 admitted patients were randomly assigned to control group (87 patients), combination group (60 patients), sitagliptin group (66 patients), and spironolactone group (50 patients). There were no significant differences in baseline characteristics, except for higher age in control group. The intervention groups, especially combination therapy, had better clinical outcomes (clinical score on fifth day of admission: 3.11 ± 2.45 for controls, 1.33 ± 0.50 for combination, 1.68 ± 1.02 for sitagliptin, and 1.64 ± 0.81 for spironolactone; P = 0.004). However, the mortality rate was lower in patients who received spironolactone (21.84% control, 13.33% combination, 13.64% sitagliptin, 10.00% spironolactone; P = 0.275). Our intervention reduced lung infiltration but not the area of involvement in lungs. Conclusion Sitagliptin and spironolactone can potentially improve clinical outcomes of hospitalized COVID-19 patients.
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Affiliation(s)
- Farhad Abbasi
- Department of Infectious Diseases, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | | | | | | | - Farzan Azodi
- Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sepideh Sefidbakht
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Shayan Mohammadmoradi
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA. Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Kamyar Asadipooya
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, USA
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Zein AFMZ, Raffaello WM. Dipeptidyl peptidase-4 (DPP-IV) inhibitor was associated with mortality reduction in COVID-19 - A systematic review and meta-analysis. Prim Care Diabetes 2022; 16:162-167. [PMID: 34952805 PMCID: PMC8666291 DOI: 10.1016/j.pcd.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis aimed to synthesize the latest evidence on the effect of dipeptidyl peptidase-4 (DPP-IV) inhibitor in patients with COVID-19. METHODS We performed a systematic literature search from the PubMed, Scopus, Embase, and Clinicaltrials.gov up until 15 July 2021. Studies that met the following criteria were included: prospective or retrospective observational studies or case series or randomized controlled trials (RCTs) reporting DPP-IV inhibitor use in patients with COVID-19 and mortality. The intervention group was patients receiving DPP-IV inhibitor. The control group was patients that did not receive DPP-IV inhibitor. The outcome was mortality reported as odds ratio (OR). RESULTS There were 11 studies consisting of 5950 patients in this meta-analysis. DPP-IV inhibitor use was associated with reduced mortality (OR 0.75 [0.56, 0.99], p = 0.043, I2: 42.9, p = 0.064) compared to those that did not receive DPP-IV inhibitor. Sensitivity analysis using the fixed-effect model (OR 0.75 [0.63, 0.88], p < 0.001, I2: 42.9, p = 0.064) also showed mortality benefit. The association between DPP-IV inhibitor and mortality was not significantly affected by age (p = 0.540), sex (p = 0.054), hypertension (p = 0.320), location (continent; p = 0.532), and retrospective/prospective nature of the study (p = 0.840). However, the association was affected by metformin (OR 1.03 [95% CI 1.01, 1.06], p = 0.010) and ACEI/ARB use (OR 1.06 [95% CI 1.02, 1.10], p = 0.004). CONCLUSION This meta-analysis showed that DPP-IV inhibitor was associated with reduced mortality in patients with COVID-19.
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Affiliation(s)
- Ahmad Fariz Malvi Zamzam Zein
- Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia; Department of Internal Medicine, Waled General Hospital, Cirebon, Indonesia.
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Khan A, Khan I, Halim SA, Rehman NU, Karim N, Ahmad W, Khan M, Csuk R, Al-Harrasi A. Anti-diabetic potential of β-boswellic acid and 11-keto-β-boswellic acid: Mechanistic insights from computational and biochemical approaches. Pharmacotherapy 2022; 147:112669. [PMID: 35121344 DOI: 10.1016/j.biopha.2022.112669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/27/2022]
Abstract
β-Boswellic acid (β-BA) and 11-keto-β-boswellic acid (β-KBA) are crucial bioactive compounds, mostly isolated from frankincense. These compounds are known for their potent anticancer and anti-inflammatory activities. Herein, we have explored the complete anti-diabetic potential of β-BA and β-KBA with detailed parameters. This research revealed that treatment with β-BA and β-KBA at a dose of 1, 2, and 10 mg/kg body weight for 21 days significantly improved body weight loss, water consumption, and specifically the concentration of blood glucose level (BGL) in diabetic animals, which indicated that the β-BA and β-KBA possess strong anti-diabetic activities. Serum total superoxide dismutase (SOD) and malondialdehyde (MDA) assays were also performed to evaluate the antioxidant effects. The biochemical analysis revealed that these compounds improve an abnormal level of several biochemical parameters like serum lipid values including total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) to a normal level and the high-density lipoprotein cholesterol level (HDL-C). To understand the mechanism of action of β-BA and β-KBA, their most probable biological targets were searched through the inverse docking approach. Our computational analysis reflects that among other probable targets, the Dipeptidyl peptidase 4 (DPP-4) enzyme could be one of the possible binders of β-BA and β-KBA to produce their anti-diabetic activities. These in-silico results were validated by an in-vitro experiment. It indicates that the anti-diabetic effects of β-BA and β-KBA are produced by the inhibition of DDP-4. Thus, these anti-diabetic, antioxidant, and anti-hyperlipidemic effects of β-BA and β-KBA suggest these compounds as potential therapeutics for diabetic conditions.
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Affiliation(s)
- Ajmal Khan
- Natural and Medical Sciences Research Center, University of Nizwa, P.O Box 33, Postal Code 616, Birkat Al Mauz, Nizwa, Sultanate of Oman
| | - Imran Khan
- Department of Pharmacy, University of Swabi, KPK, Pakistan
| | - Sobia Ahsan Halim
- Natural and Medical Sciences Research Center, University of Nizwa, P.O Box 33, Postal Code 616, Birkat Al Mauz, Nizwa, Sultanate of Oman
| | - Najeeb Ur Rehman
- Natural and Medical Sciences Research Center, University of Nizwa, P.O Box 33, Postal Code 616, Birkat Al Mauz, Nizwa, Sultanate of Oman
| | - Nasiara Karim
- Department of Pharmacy, University of Malakand, Chakdara 18800, KPK, Pakistan
| | - Waqar Ahmad
- Department of Pharmacy, University of Malakand, Chakdara 18800, KPK, Pakistan
| | - Majid Khan
- Natural and Medical Sciences Research Center, University of Nizwa, P.O Box 33, Postal Code 616, Birkat Al Mauz, Nizwa, Sultanate of Oman; H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Pakistan
| | - Rene Csuk
- Martin-Luther-University Halle-Wittenberg, Organic Chemistry, Kurt-Mothes-Str. 2, D-06120 Halle (Saale), Germany
| | - Ahmed Al-Harrasi
- Natural and Medical Sciences Research Center, University of Nizwa, P.O Box 33, Postal Code 616, Birkat Al Mauz, Nizwa, Sultanate of Oman.
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Wang W, Sun Y, Wang S, Sun Y. The Relationship Between Insulin Use And Increased Mortality In Patients With COVID-19 And Diabetes: A Meta-Analysis. Endocr Res 2022; 47:32-38. [PMID: 34409914 DOI: 10.1080/07435800.2021.1967376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study is to review observational studies on the effect of insulin use and mortality in patients with COVID-19 and diabetes. METHODS A systematic literature search was performed using the PubMed, Medline, EMBASE, and Cochrane Library databases. The meta-analysis was performed using a random effects model, and I2 was applied to evaluate heterogeneity. Sensitivity and subgroup analyses were also performed. RESULTS Overall, 1,338 patients over six studies were ultimately included. Insulin use was related to a higher risk of death in diabetic patients with COVID-19 compared to those who did not use insulin (odds ratio: 2.59, 95% confidence interval: 1.66-4.05; P < .0001; I2: 57%). CONCLUSIONS This meta-analysis revealed a correlation between insulin usage and increased mortality in diabetic patients with COVID-19. These results showed that insulin requirement in patients with COVID-19 and diabetes might indicate a poor prognosis.
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Affiliation(s)
- Wanteng Wang
- The Affiliated Hospital Of Qingdao University, Qingdao University, Qingdao, China
| | - Yu Sun
- The Affiliated Hospital Of Qingdao University, Qingdao University, Qingdao, China
| | - Shuai Wang
- The Affiliated Hospital Of Qingdao University, Qingdao University, Qingdao, China
| | - Yunbo Sun
- Department of Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, China
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Singh AK, Khunti K. COVID-19 and Diabetes. Annu Rev Med 2022. [DOI: https:/doi.org/10.1146/annurev-med-042220-011857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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.
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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
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Guardado-Mendoza R, Garcia-Magaña MA, Martínez-Navarro LJ, Macías-Cervantes HE, Aguilar-Guerrero R, Suárez-Pérez EL, Aguilar-García A. Effect of linagliptin plus insulin in comparison to insulin alone on metabolic control and prognosis in hospitalized patients with SARS-CoV-2 infection. Sci Rep 2022; 12:536. [PMID: 35017617 PMCID: PMC8752656 DOI: 10.1038/s41598-021-04511-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/07/2021] [Indexed: 01/08/2023] Open
Abstract
To evaluate the effect of the combination of linagliptin and insulin on metabolic control and prognosis in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hyperglycemia. A parallel double-blind randomized clinical trial including hospitalized patients with SARS-CoV-2 infection and hyperglycemia, randomized to receive 5 mg linagliptin + insulin (LI group) or insulin alone (I group) was performed. The main outcomes were the need for assisted mechanical ventilation and glucose levels during hospitalization. Subjects were screened for eligibility at hospital admission if they were not with assisted mechanical ventilation and presented hyperglycemia, and a total of 73 patients with SARS-CoV-2 infection and hyperglycemia were randomized to the LI group (n = 35) or I group (n = 38). The average hospital stay was 12 ± 1 vs 10 ± 1 days for the I and LI groups, respectively (p = 0.343). There were no baseline clinical differences between the study groups, but the percentage of males was higher in the LI group (26 vs 18, p = 0.030). The improvements in fasting and postprandial glucose levels were better in the LI group that the I group (122 ± 7 vs 149 ± 10, p = 0.033; and 137 ± 7 vs 173 ± 12, p = 0.017, respectively), and insulin requirements tended to be lower in the LI group than the I group. Three patients in the LI group and 12 in the I group required assisted mechanical ventilation (HR 0.258, CI 95% 0.092–0.719, p = 0.009); 2 patients in the LI group and 6 in the I group died after a follow-up of 30 days (p = 0.139). No major side effects were observed. The combination of linagliptin and insulin in hospitalized patients with SARS-CoV-2 infection and hyperglycemia reduced the relative risk of assisted mechanical ventilation by 74% and improved better pre and postprandial glucose levels with lower insulin requirements, and no higher risk of hypoglycemia. This study is registered at clinicaltrials.gov, number NCT04542213 on 09/03/2020.
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Affiliation(s)
- Rodolfo Guardado-Mendoza
- Research Department, Hospital Regional de Alta Especialidad del Bajío, and University of Guanajuato, Blvd.Milenio #130, Col. San Carlos la Roncha, CP 37660, León, Guanajuato, Mexico.
| | - Miguel Angel Garcia-Magaña
- Internal Medicine Department, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, Mexico
| | | | - Hilda Elizabeth Macías-Cervantes
- Internal Medicine Department, Unidad Médica de Alta Especialidad T1, Instituto Mexicano del Seguro Social, León, Guanajuato, Mexico
| | - Rodolfo Aguilar-Guerrero
- Internal Medicine Department, Unidad Médica de Alta Especialidad T1, Instituto Mexicano del Seguro Social, León, Guanajuato, Mexico
| | - Erick L Suárez-Pérez
- Department of Biostatistics and Epidemiology, Graduated School of Public Health, University of Puerto Rico, San Juan, USA
| | - Alberto Aguilar-García
- Endocrinology Department, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, Mexico
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Gao Q, Zhang W, Li T, Yang G, Zhu W, Chen N, Jin H. Interrelationship between 2019-nCov receptor DPP4 and diabetes mellitus targets based on protein interaction network. Sci Rep 2022; 12:188. [PMID: 34996987 PMCID: PMC8741798 DOI: 10.1038/s41598-021-03912-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/10/2021] [Indexed: 01/08/2023] Open
Abstract
Patients with diabetes are more likely to be infected with Coronavirus disease 2019 (COVID-19), and the risk of death is significantly higher than ordinary patients. Dipeptidyl peptidase-4 (DPP4) is one of the functional receptor of human coronavirus. Exploring the relationship between diabetes mellitus targets and DPP4 is particularly important for the management of patients with diabetes and COVID-19. We intend to study the protein interaction through the protein interaction network in order to find a new clue for the management of patients with diabetes with COVID-19. Diabetes mellitus targets were obtained from GeneCards database. Targets with a relevance score exceeding 20 were included, and DPP4 protein was added manually. The initial protein interaction network was obtained through String. The targets directly related to DPP4 were selected as the final analysis targets. Importing them into String again to obtain the protein interaction network. Module identification, gene ontology (GO) analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis were carried out respectively. The impact of DPP4 on the whole network was analyzed by scoring the module where it located. 43 DPP4-related proteins were finally selected from the diabetes mellitus targets and three functional modules were found by the cluster analysis. Module 1 was involved in insulin secretion and glucagon signaling pathway, module 2 and module 3 were involved in signaling receptor binding. The scoring results showed that LEP and apoB in module 1 were the highest, and the scores of INS, IL6 and ALB of cross module associated proteins of module 1 were the highest. DPP4 is widely associated with key proteins in diabetes mellitus. COVID-19 may affect DPP4 in patients with diabetes mellitus, leading to high mortality of diabetes mellitus combined with COVID-19. DPP4 inhibitors and IL-6 antagonists can be considered to reduce the effect of COVID-19 infection on patients with diabetes.
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Affiliation(s)
- Qian Gao
- Affiliated Hospital of Shaoxing University of Endocrine and Metabolism Department, Zhejiang, China.
| | - Wenjun Zhang
- Affiliated Hospital of Shaoxing University of Endocrine and Metabolism Department, Zhejiang, China
| | - Tingting Li
- Affiliated Hospital of Shaoxing University of Endocrine and Metabolism Department, Zhejiang, China
| | - Guojun Yang
- Affiliated Hospital of Shaoxing University of Endocrine and Metabolism Department, Zhejiang, China
| | - Wei Zhu
- Affiliated Hospital of Shaoxing University of Endocrine and Metabolism Department, Zhejiang, China
| | - Naijun Chen
- Affiliated Hospital of Shaoxing University of Endocrine and Metabolism Department, Zhejiang, China
| | - Huawei Jin
- Affiliated Hospital of Shaoxing University of Endocrine and Metabolism Department, Zhejiang, China
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de Sá-Ferreira CO, da Costa CHM, Guimarães JCW, Sampaio NS, Silva LDML, de Mascarenhas LP, Rodrigues NG, Dos Santos TL, Campos S, Young EC. Diabetic ketoacidosis and COVID-19: what have we learned so far? Am J Physiol Endocrinol Metab 2022; 322:E44-E53. [PMID: 34779657 PMCID: PMC8721947 DOI: 10.1152/ajpendo.00244.2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In December 2019, a pandemic emerged due to a new coronavirus that imposed various uncertainties and discoveries. It has been reported that diabetes is a risk factor for worst outcomes of COVID-19 and also that SARS-CoV-2 infection was correlated with the occurrence of diabetic ketoacidosis (DKA) in patients. The aim of this work is to discuss this correlation emphasizing the main case reports from 2020 while exploring the management of DKA during the course of COVID-19. Web of Science, PubMed, and Scopus databases were searched using two sets of Medical Subject Heading (MeSH) search terms or Title/Abstract words: Coronavirus Infections (Coronavirus Infections, Middle East Respiratory Syndrome, COVID-19) and Diabetic Ketoacidosis (Diabetic Ketoacidosis, Diabetic Acidosis, Diabetic Ketosis). There is a clear correlation between COVID-19 and DKA. The SARS-Cov-2 infection may precipitate both a hyperglycemic state and ketoacidosis occurrence in patients with diabetes and nondiabetic patients, which may lead to fatal outcomes. DKA in patients with COVID-19 may increase risk and worse outcomes. Hence, the SARS-Cov-2 infection presents a new perspective toward the management of glycemia and acidosis in patients with diabetes and nondiabetic patients, highlighting the need for rapid interventions to minimize the complications from COVID-19 while reducing its spreading.
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Affiliation(s)
| | | | | | - Nathasha Souza Sampaio
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | | | | | - Nicollas Garcia Rodrigues
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Talita Labonia Dos Santos
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Solange Campos
- Gaffrée e Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Esther Cytrynbaum Young
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
- Gaffrée e Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
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Kazakou P, Lambadiari V, Ikonomidis I, Kountouri A, Panagopoulos G, Athanasopoulos S, Korompoki E, Kalomenidis I, Dimopoulos MA, Mitrakou A. Diabetes and COVID-19; A Bidirectional Interplay. Front Endocrinol (Lausanne) 2022; 13:780663. [PMID: 35250853 PMCID: PMC8891603 DOI: 10.3389/fendo.2022.780663] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/11/2022] [Indexed: 01/08/2023] Open
Abstract
There seems to be a bidirectional interplay between Diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19). On the one hand, people with diabetes are at higher risk of fatal or critical care unit-treated COVID-19 as well as COVID-19 related health complications compared to individuals without diabetes. On the other hand, clinical data so far suggest that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in metabolic dysregulation and in impaired glucose homeostasis. In addition, emerging data on new onset DM in previously infected with SARS-CoV-2 patients, reinforce the hypothesis of a direct effect of SARS-CoV-2 on glucose metabolism. Attempting to find the culprit, we currently know that the pancreas and the endothelium have been found to express Angiotensin-converting enzyme 2 (ACE2) receptors, the main binding site of the virus. To move from bench to bedside, understanding the effects of COVID-19 on metabolism and glucose homeostasis is crucial to prevent and manage complications related to COVID-19 and support recovering patients. In this article we review the potential underlying pathophysiological mechanisms between COVID-19 and glucose dysregulation as well as the effects of antidiabetic treatment in patients with diabetes and COVID-19.
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Affiliation(s)
- Paraskevi Kazakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ignatios Ikonomidis
- Laboratory of Preventive Cardiology, Second Cardiology Department, Attikon University Hospital National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Panagopoulos
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Athanasopoulos
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kalomenidis
- 1 Department of Intensive Care, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Meletios A. Dimopoulos
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Asimina Mitrakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Asimina Mitrakou,
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Pelle MC, Zaffina I, Provenzano M, Moirano G, Arturi F. COVID-19 and diabetes-Two giants colliding: From pathophysiology to management. Front Endocrinol (Lausanne) 2022; 13:974540. [PMID: 36060943 PMCID: PMC9437522 DOI: 10.3389/fendo.2022.974540] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 01/08/2023] Open
Abstract
Since December 2019, a new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread around the world, causing the coronavirus 2019 (COVID-19) pandemic. From the beginning, SARS-CoV-2 has put a strain on the health system. In fact, many patients have had severe forms of the disease with the need for hospitalization due to respiratory failure. To contain the pandemic, the most widely used approach has been lockdowns. Social restrictions have been reduced thanks to the development of vaccines and targeted therapies. However, fatal events still occur among people at high risk of serious infection, such as patients with concomitant diabetes. Different mechanisms have been proposed to explain the poor prognosis of patients with diabetes and COVID-19, but the specific cause is unclear. It is now known that insulin resistance, inflammation, and cytokine storm are involved. Moreover, SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptors to enter cells. This receptor is expressed on pancreatic beta cells and, during infection, it appears that receptor involvement may induce hyperglycemia in patients with or without diabetes. In this study, we discuss the mechanisms underlying the poor prognosis in people with COVID-19 and diabetes and what may improve the outcome in these patients.
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Affiliation(s)
- Maria Chiara Pelle
- Department of Medical and Surgical Sciences, University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
| | - Isabella Zaffina
- Department of Medical and Surgical Sciences, University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
| | - Michele Provenzano
- Nephrology, Dialysis and Transplantation Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giovenale Moirano
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University ‘Magna Graecia’ of Catanzaro, Catanzaro, Italy
- *Correspondence: Franco Arturi,
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Chen Y, Lv X, Lin S, Arshad M, Dai M. The Association Between Antidiabetic Agents and Clinical Outcomes of COVID-19 Patients With Diabetes: A Bayesian Network Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:895458. [PMID: 35692410 PMCID: PMC9186017 DOI: 10.3389/fendo.2022.895458] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS This study aimed to assess the impact of different antidiabetic agents on individuals with diabetes and COVID-19. METHODS We searched PubMed, Web of Science, Embase, and Cochrane Library databases from inception to October 31, 2021 and included seven antidiabetic agents. The data were pooled via traditional pairwise meta-analysis and Bayesian network meta-analysis. RESULTS The pairwise meta-analysis included 35 studies. Metformin (odds ratio (OR), 0.74; P=0.001), dipeptidyl peptidase-4 inhibitors (DPP4i) (OR, 0.88; P=0.04), sodium-glucose cotransporter-2 inhibitors (SGLT2i) (OR, 0.82; P=0.001), and glucagon-like peptide-1 receptor agonists (GLP1RA) (OR, 0.91; P=0.02) treatment were associated with lower COVID-19 mortality in individuals with diabetes compared to respective non-users. However, insulin treatment resulted in higher mortality (OR, 1.8; P=0.001). Mortality did not significantly differ in sulfonylurea (OR, 0.97; P=0.56) and thiazolidinediones (TZDs) (OR, 1.00; P=0.96) users. Furthermore, due to limited data, we analyzed five antidiabetic agents (metformin, DPP4i, sulfonylurea, insulin, and SGLT2i) and found no association between them and severe disease risk (all P>0.05). The Bayesian network meta-analysis included 18 studies. GLP1RA and SGLT2i had the highest first and second rank probability (67.3% and 62.5%, respectively). Insulin showed the maximum probability of ranking seventh (97.0%). Metformin had the third and fourth highest rank probability of 44.8% and 38.9%, respectively. Meanwhile, DPP4i had the fifth-highest rank probability of 42.4%, followed by sulfonylurea at 45.1%. CONCLUSION Metformin, DPP4i, SGLT2i, and GLP1RA treatments were highly possible to reduced COVID-19 mortality risk in individuals with diabetes, while insulin might be related to increased mortality risk. Sulfonylurea and TZDs treatments were not associated with mortality. None of the antidiabetic agents studied were associated with the risk of severe disease. Additionally, GLP1RA probably had the most significant protective effect against death, followed by SGLT2i and metformin. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42021288200).
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Affiliation(s)
- Yidan Chen
- Department of Rheumatology & Immunology, West China Hospital of Sichuan University, Chengdu, China
| | - Xingfei Lv
- Department of Orthopedics, People’s Hospital of Zhongjiang County, Deyang, China
| | - Sang Lin
- Department of Rheumatology& Immunology, China-Japan Friendship Hospital, Beijing, China
| | - Mohammad Arshad
- Department of Pediatrics Surgery, Lok Nayak Hospital, New Delhi, India
| | - Mengjun Dai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Mengjun Dai,
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Mannucci F, Vitturi G, Benacchio L, Sbrogiò LG, Bano F, Lapolla A, Piarulli F, Giron MC, Avogaro A, Fadini GP. Infection Rates and Impact of Glucose Lowering Medications on the Clinical Course of COVID-19 in People with Type 2 Diabetes: A Retrospective Observational Study. Diabetes Metab Syndr Obes 2022; 15:3093-3101. [PMID: 36237966 PMCID: PMC9553236 DOI: 10.2147/dmso.s385646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Diabetes is a risk factor for COVID-19 severity, but the role played by glucose lowering medications (GLM) is still unclear. The aim of this study was to assess infection rates and outcomes of COVID-19 (hospitalization and mortality) in adults with diabetes assisted by the Local Health Unit of Padua (North-East Italy) according to the ongoing GLM. PATIENTS AND METHODS People with diabetes were identified using administrative claims, while those with SARS-CoV-2 infection were detected by cross referencing with the local COVID-19 surveillance registry. A multivariate logistic regression model was used to verify the association between GLM classes and the outcome. RESULTS SARS-CoV-2 infection rates were marginally but significantly higher in individuals with diabetes as compared to those without diabetes (RR 1.04, p = 0.043), though such relative 4% increase may be irrelevant from a clinical and epidemiological perspective. 1923 individuals with GLM-treated diabetes were diagnosed with COVID-19; 456 patients were hospitalized and 167 died. Those treated with insulin had a significantly higher risk of hospitalizations for COVID-19 (OR 1.48 p < 0.01) as were those treated with sulphonylureas/glinides (OR 1.34, p = 0.02). Insulin use was also significantly associated with higher mortality (OR 1.90, p < 0.01). Use of metformin was significantly associated with lower death rates (OR 0.62, p = 0.02). The association of other GLM classes with the outcome was not significant. CONCLUSION Diabetes does not appear to modify the risk of SARS-CoV-2 infection in a clinically meaningful way, but strongly increases the rates of hospitalization and death. Insulin use was associated with worse outcomes, whereas metformin use was associated with lower mortality.
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Affiliation(s)
| | - Giacomo Vitturi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | | | | | | | | | | | - Maria Cecilia Giron
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padua, Italy
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Padua, Italy
- Correspondence: Gian Paolo Fadini, Department of Medicine, University of Padova, Via Giustiniani 2, Padova, 35128, Italy, Tel +39 049 8214318, Fax +39 049 8212184, Email
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Abstract
COVID-19 brought a scientific revolution since its emergence in Wuhan, China, in December 2019. Initially, the SARS-CoV-2 virus came to attention through its effects on the respiratory system. However, its actions in many other organs also have been discovered almost daily. As enzymes are indispensable to uncountable biochemical reactions in the human body, it is not surprising that some enzymes are of relevance to COVID-19 pathophysiology. Past evidence from SARS-CoV and MERS-CoV outbreaks provided hints about the role of enzymes in SARS-CoV-2 infection. In this setting, ACE-2 is an enzyme of great importance since it is the cell entry receptor for SARS-CoV-2. Clinical data elucidate patterns of enzymatic alterations in COVID-19, which could be associated with organ damage, prognosis, and clinical complications. Further, viral mutations can create new disease behaviors, and these effects are related to the activity of enzymes. This review will discuss the main enzymes related to COVID-19, summarizing the findings on their role in viral entry mechanism, the consequences of their dysregulation, and the effects of SARS-CoV-2 mutations on them.
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Ali Kazem T, Zeylabi F, Filayih Hassan A, Paridar P, Pezeshki SP, Pezeshki SMS. Diabetes mellitus and COVID-19: review of a lethal interaction from the cellular and molecular level to the bedside. Expert Rev Endocrinol Metab 2022; 17:1-19. [PMID: 34781797 DOI: 10.1080/17446651.2022.2002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION While the main mode of transmission of coronavirus disease 2019 (COVID-19) is close contact with other individuals, the presence of chronic underlying diseases such as Diabetes Mellitus (DM) increases the chance of hospitalization and mortality rate due to infection. AREAS COVERED To investigate the effects of COVID-19 infection in DM patients, we reviewed literature from Google Scholar search engine and PubMed database from '2013 to 2020' using the terms "COVID-19; SARS-CoV-2; Diabetes mellitus; obesity; Angiotensin-converting enzyme 2; ACE2; Insulin and Metformin. Evidence suggests that COVID-19 exacerbates the course of diabetes. Presence of pro-inflammatory conditions, increased expression of receptors, and more difficult control of glucose levels in diabetics COVID-19 patients are some of the problems that diabetic patients may face. Also, psychological problems caused by the COVID-19 epidemic in diabetic patients is one of the most important problems in these patients, which is less covered. EXPERT OPINION DM is a strong and independent risk factor with a poor prognosis, which increases the risk of COVID-19 infection, the need for emergency services, the rate of hospitalization in the intensive care unit and also increases the mortality rate of COVID-19 patients.
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Affiliation(s)
| | - Fatemeh Zeylabi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Pouria Paridar
- Islamic Azad University, North-Tehran Branch, Tehran, Iran
| | - Seyedeh Pardis Pezeshki
- Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohammad Sadegh Pezeshki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Zhang T, Tong X, Zhang S, Wang D, Wang L, Wang Q, Fan H. The Roles of Dipeptidyl Peptidase 4 (DPP4) and DPP4 Inhibitors in Different Lung Diseases: New Evidence. Front Pharmacol 2021; 12:731453. [PMID: 34955820 PMCID: PMC8696080 DOI: 10.3389/fphar.2021.731453] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/25/2021] [Indexed: 02/05/2023] Open
Abstract
CD26/Dipeptidyl peptidase 4 (DPP4) is a type II transmembrane glycoprotein that is widely expressed in various organs and cells. It can also exist in body fluids in a soluble form. DPP4 participates in various physiological and pathological processes by regulating energy metabolism, inflammation, and immune function. DPP4 inhibitors have been approved by the Food and Drug Administration (FDA) for the treatment of type 2 diabetes mellitus. More evidence has shown the role of DPP4 in the pathogenesis of lung diseases, since it is highly expressed in the lung parenchyma and the surface of the epithelium, vascular endothelium, and fibroblasts of human bronchi. It is a potential biomarker and therapeutic target for various lung diseases. During the coronavirus disease-19 (COVID-19) global pandemic, DPP4 was found to be an important marker that may play a significant role in disease progression. Some clinical trials on DPP4 inhibitors in COVID-19 are ongoing. DPP4 also affects other infectious respiratory diseases such as Middle East respiratory syndrome and non-infectious lung diseases such as pulmonary fibrosis, lung cancer, chronic obstructive pulmonary disease (COPD), and asthma. This review aims to summarize the roles of DPP4 and its inhibitors in infectious lung diseases and non-infectious diseases to provide new insights for clinical physicians.
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Affiliation(s)
| | | | | | | | | | | | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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Julian DR, Kazakoff MA, Patel A, Jaynes J, Willis MS, Yates CC. Chemokine-Based Therapeutics for the Treatment of Inflammatory and Fibrotic Convergent Pathways in COVID-19. CURRENT PATHOBIOLOGY REPORTS 2021; 9:93-105. [PMID: 34900402 PMCID: PMC8651461 DOI: 10.1007/s40139-021-00226-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 02/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the SARS-CoV-2 betacoronavirus and has taken over 761,426 American lives as of the date of publication and will likely result in long-term, if not permanent, tissue damage for countless patients. COVID-19 presents with diverse and multisystemic pathologic processes, including a hyperinflammatory response, acute respiratory distress syndrome (ARDS), vascular injury, microangiopathy, tissue fibrosis, angiogenesis, and widespread thrombosis across multiple organs, including the lungs, heart, kidney, liver, and brain. C-X-C chemokines contribute to these pathologies by attracting inflammatory mediators, the disruption of endothelial cell integrity and function, and the initiation and propagation of the cytokine storm. Among these, CXCL10 is recognized as a critical contributor to the hyperinflammatory state and poor prognosis in COVID-19. CXCL10 is also known to regulate growth factor-induced fibrosis, and recent evidence suggests the CXCL10-CXCR3 signaling system may be vital in targeting convergent pro-inflammatory and pro-fibrotic pathways. This review will explore the mechanistic role of CXCL10 and related chemokines in fibrotic complications associated with COVID-19 and the potential of CXCL10-targeted therapeutics for early intervention and long-term treatment of COVID-19-induced fibrosis.
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Affiliation(s)
- Dana R Julian
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Bldg. 458A, Pittsburgh, PA 15261 USA.,McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Megan A Kazakoff
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Bldg. 458A, Pittsburgh, PA 15261 USA.,McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Akhil Patel
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Bldg. 458A, Pittsburgh, PA 15261 USA
| | - Jesse Jaynes
- College of Agriculture, Environment and Nutrition Sciences and College of Arts and Sciences, Tuskegee University, Tuskegee, AL 36088 USA
| | - Monte S Willis
- Pathology Institute, Allegheny Health Network, Pittsburgh, PA USA.,Department of Internal Medicine, Cardiology Section, Indiana University School of Medicine, Indianapolis, IN USA
| | - Cecelia C Yates
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Bldg. 458A, Pittsburgh, PA 15261 USA.,McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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Goodman KE, Magder LS, Baghdadi JD, Pineles L, Levine AR, Perencevich EN, Harris AD. Impact of Sex and Metabolic Comorbidities on Coronavirus Disease 2019 (COVID-19) Mortality Risk Across Age Groups: 66 646 Inpatients Across 613 U.S. Hospitals. Clin Infect Dis 2021; 73:e4113-e4123. [PMID: 33337474 PMCID: PMC7799326 DOI: 10.1093/cid/ciaa1787] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The relationship between common patient characteristics, such as sex and metabolic comorbidities, and mortality from coronavirus disease 2019 (COVID-19) remains incompletely understood. Emerging evidence suggests that metabolic risk factors may also vary by age. This study aimed to determine the association between common patient characteristics and mortality across age-groups among COVID-19 inpatients. METHODS We performed a retrospective cohort study of patients discharged from hospitals in the Premier Healthcare Database between April-June 2020. Inpatients were identified using COVID-19 ICD-10-CM diagnosis codes. A priori-defined exposures were sex and present-on-admission hypertension, diabetes, obesity, and interactions between age and these comorbidities. Controlling for additional confounders, we evaluated relationships between these variables and in-hospital mortality in a log-binomial model. RESULTS Among 66 646 (6.5%) admissions with a COVID-19 diagnosis, across 613 U.S. hospitals, 12 388 (18.6%) died in-hospital. In multivariable analysis, male sex was independently associated with 30% higher mortality risk (aRR, 1.30, 95% CI: 1.26-1.34). Diabetes without chronic complications was not a risk factor at any age (aRR 1.01, 95% CI: 0.96-1.06), and hypertension without chronic complications was a risk factor only in 20-39 year-olds (aRR, 1.68, 95% CI: 1.17-2.40). Diabetes with chronic complications, hypertension with chronic complications, and obesity were risk factors in most age-groups, with highest relative risks among 20-39 year-olds (respective aRRs 1.79, 2.33, 1.92; P-values ≤ .002). CONCLUSIONS Hospitalized men with COVID-19 are at increased risk of death across all ages. Hypertension, diabetes with chronic complications, and obesity demonstrated age-dependent effects, with the highest relative risks among adults aged 20-39.
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Affiliation(s)
- Katherine E Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan D Baghdadi
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea R Levine
- Department of Pulmonary & Critical Care Medicine, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eli N Perencevich
- Department of Internal Medicine and Epidemiology, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
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Pazoki M, Chichagi F, Hadadi A, Kafan S, Montazeri M, Kazemian S, Aminorroaya A, Ebrahimi M, Ashraf H, Hazaveh MM, Khajavi MR, Moharari RS, Sharifnia SH, Saleh SK, Rahimzadeh H, Goodarzi N, Heydarian P. Association of clinical characteristics, antidiabetic and cardiovascular agents with diabetes mellitus and COVID-19: a 7-month follow-up cohort study. J Diabetes Metab Disord 2021; 20:1545-1555. [PMID: 34778117 PMCID: PMC8573568 DOI: 10.1007/s40200-021-00901-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prognostic factors of long-term outcomes in hospitalized patients with diabetes mellitus and COVID-19 are lacking. METHODS In this retrospective cohort study, we evaluated patients aged ≥ 18-years-old with the COVID-19 diagnosis who were hospitalized between Feb 20 and Oct 29, 2020, in the Sina Hospital, Tehran, Iran. 1323 patients with COVID-19 entered in the final analysis, of whom 393 (29.7%) patients had diabetes. We followed up patients for incurring in-hospital death, severe COVID-19, in-hospital complications, and 7-month all-cause mortality. By doing univariate analysis, variables with unadjusted P-value < 0.1 in univariate analyses were regarded as the confounders to include in the logistic regression models. We made adjustments for possible clinical (model 1) and both clinical and laboratory (model 2) confounders. RESULTS After multivariable regression, it was revealed that preadmission use of sulfonylureas was associated with a borderline increased risk of severity in both models [model 1, OR (95% CI):1.83 (0.91-3.71), P-value: 0.092; model 2, 2.05 (0.87-4.79), P-value: 0.099] and major adverse events (MAE: each of the severe COVID-19, multi-organ damage, or in-hospital mortality) in model 1 [OR (95% CI): 1.86 (0.90-3.87), P-value: 0.094]. Preadmission use of ACEIs/ARBs was associated with borderline increased risk of MAE in the only model 1 [OR (95% CI):1.83 (0.96-3.48), P-value: 0.066]. CONCLUSIONS Preadmission use of sulfonylureas and ACEIs/ARBs were associated with borderline increased risk of in-hospital adverse outcomes. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40200-021-00901-4.
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Affiliation(s)
- Marzieh Pazoki
- Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Chichagi
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Hadadi
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Kafan
- Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Montazeri
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Kazemian
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Ebrahimi
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Khajavi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shariat Moharari
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahrokh Karbalai Saleh
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hormat Rahimzadeh
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Goodarzi
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Peimaneh Heydarian
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Endocrinology and Metabolism, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq., Tehran, 11367-46911 Iran
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Popovic DS, Papanas N, Pantea Stoian A, Rizvi AA, Janez A, Rizzo M. Use of Novel Antidiabetic Agents in Patients with Type 2 Diabetes and COVID-19: A Critical Review. Diabetes Ther 2021; 12:3037-3054. [PMID: 34699021 PMCID: PMC8546380 DOI: 10.1007/s13300-021-01170-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). The latter is a pandemic that has the potential of developing into a severe illness manifesting as systemic inflammatory response syndrome, acute respiratory distress syndrome, multi-organ involvement and shock. In addition, advanced age and male sex and certain underlying health conditions, like type 2 diabetes mellitus (T2DM), predispose to a higher risk of greater COVID-19 severity and mortality. This calls for an urgent identification of antidiabetic agents associated with more favourable COVID-19 outcomes among patients with T2DM, as well as recognition of their potential underlying mechanisms. It is crucial that individuals with T2DM be kept under very stringent glycaemic control in order to avoid developing various cardiovascular, renal and metabolic complications associated with more severe forms of COVID-19 that lead to increased mortality. The use of novel antidiabetic agents dipeptidyl peptidase 4 inhibitors (DPP4i), sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) in subjects with T2DM may have beneficial effects on COVID-19 outcomes. However, relevant studies either show inconsistent results (DPP4i) or are still too few (SGLT2i and GLP-1RAs). Further research is therefore needed to assess the impact of these agents on COVID-19 outcomes.
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Affiliation(s)
- Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Novi Sad, Serbia
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Anca Pantea Stoian
- Faculty of Medicine, Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Ali A Rizvi
- Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, GA, USA
- Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manfredi Rizzo
- Faculty of Medicine, Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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Memon B, Abdelalim EM. ACE2 function in the pancreatic islet: Implications for relationship between SARS-CoV-2 and diabetes. Acta Physiol (Oxf) 2021; 233:e13733. [PMID: 34561952 PMCID: PMC8646749 DOI: 10.1111/apha.13733] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023]
Abstract
The molecular link between SARS-CoV-2 infection and susceptibility is not well understood. Nonetheless, a bi-directional relationship between SARS-CoV-2 and diabetes has been proposed. The angiotensin-converting enzyme 2 (ACE2) is considered as the primary protein facilitating SARS-CoV and SARS-CoV-2 attachment and entry into the host cells. Studies suggested that ACE2 is expressed in the endocrine cells of the pancreas including beta cells, in addition to the lungs and other organs; however, its expression in the islets, particularly beta cells, has been met with some contradiction. Importantly, ACE2 plays a crucial role in glucose homoeostasis and insulin secretion by regulating beta cell physiology. Given the ability of SARS-CoV-2 to infect human pluripotent stem cell-derived pancreatic cells in vitro and the presence of SARS-CoV-2 in pancreatic samples from COVID-19 patients strongly hints that SARS-CoV-2 can invade the pancreas and directly cause pancreatic injury and diabetes. However, more studies are required to dissect the underpinning molecular mechanisms triggered in SARS-CoV-2-infected islets that lead to aggravation of diabetes. Regardless, it is important to understand the function of ACE2 in the pancreatic islets to design relevant therapeutic interventions in combatting the effects of SARS-CoV-2 on diabetes pathophysiology. Herein, we detail the function of ACE2 in pancreatic beta cells crucial for regulating insulin sensitivity, secretion, and glucose metabolism. Also, we discuss the potential role played by ACE2 in aiding SARS-COV-2 entry into the pancreas and the possibility of ACE2 cooperation with alternative entry factors as well as how that may be linked to diabetes pathogenesis.
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Affiliation(s)
- Bushra Memon
- College of Health and Life Sciences Hamad Bin Khalifa University (HBKU)Qatar Foundation Doha Qatar
- Diabetes Research Center Qatar Biomedical Research Institute (QBRI)Hamad Bin KhalifaUniversity (HBKU)Qatar Foundation (QF) Doha Qatar
| | - Essam M. Abdelalim
- College of Health and Life Sciences Hamad Bin Khalifa University (HBKU)Qatar Foundation Doha Qatar
- Diabetes Research Center Qatar Biomedical Research Institute (QBRI)Hamad Bin KhalifaUniversity (HBKU)Qatar Foundation (QF) Doha Qatar
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Nyland JE, Raja-Khan NT, Bettermann K, Haouzi PA, Leslie DL, Kraschnewski JL, Parent LJ, Grigson PS. Diabetes, Drug Treatment, and Mortality in COVID-19: A Multinational Retrospective Cohort Study. Diabetes 2021; 70:2903-2916. [PMID: 34580086 PMCID: PMC8660979 DOI: 10.2337/db21-0385] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
Patients with type 2 diabetes mellitus (T2DM) are at increased risk of severe coronavirus disease 2019 (COVID-19) outcomes possibly because of dysregulated inflammatory responses. Glucose-regulating medications, such as glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and pioglitazone, are known to have anti-inflammatory effects that may improve outcomes in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In a multinational retrospective cohort study, we used the TriNetX COVID-19 Research Network of 56 large health care organizations to examine these medications in relation to the incidence of hospital admissions, respiratory complications, and mortality within 28 days after a COVID-19 diagnosis. After matching for age, sex, race, ethnicity, BMI, and significant comorbidities, use of GLP-1R agonists and/or pioglitazone was associated with significant reductions in hospital admissions (GLP-1R: 15.7% vs. 23.5%, risk ratio [RR] 0.67 [95% CI 0.57-0.79; P < 0.001]; pioglitazone: 20.0% vs. 28.2%; RR 0.71 [95% CI 0.54-0.93; P = 0.01]). Use of GLP-1R agonists was also associated with reductions in respiratory complications (15.3% vs. 24.9%, RR 0.62 [95% CI 0.52-0.73]; P < 0.001) and incidence of mortality (1.9% vs. 3.3%, RR 0.58 [95% CI 0.35-0.97]; P = 0.04). Use of DPP-4 inhibitors was associated with a reduction in respiratory complications (24.0% vs. 29.2%, RR 0.82 [95% CI 0.74-0.90]; P < 0.001), and continued use of DPP-4 inhibitors after hospitalization was associated with a decrease in mortality compared with those who discontinued use (9% vs. 19%, RR 0.45 [95% CI 0.28-0.72]; P < 0.001). In conclusion, use of glucose-regulating medications, such as GLP-1R agonists, DPP-4 inhibitors, or pioglitazone, may improve COVID-19 outcomes for patients with T2DM; randomized clinical trials are needed to further investigate this possibility.
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Affiliation(s)
- Jennifer E Nyland
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
| | - Nazia T Raja-Khan
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
| | - Kerstin Bettermann
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
| | - Philippe A Haouzi
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
| | - Douglas L Leslie
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
| | | | - Leslie J Parent
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
| | - Patricia Sue Grigson
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
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Use of DPP4i reduced odds of clinical deterioration and hyperinflammatory syndrome in COVID-19 patients with type 2 diabetes: Propensity score analysis of a territory-wide cohort in Hong Kong. DIABETES & METABOLISM 2021; 48:101307. [PMID: 34863934 PMCID: PMC8632053 DOI: 10.1016/j.diabet.2021.101307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/21/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Type 2 diabetes mellitus (T2DM) patients with Coronavirus Disease 2019 (COVID-19) have poorer prognosis. Inconclusive evidence suggested dipeptidyl peptidase-4 inhibitors (DPP4i) might reduce inflammation and prevent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) entry, hence further evaluation on DPP4i is needed. METHODS 1214 Patients with T2DM were admitted with COVID-19 between 21st January 2020 and 31st January 2021 in Hong Kong. Exposure was DPP4i use within the 90 days prior to admission for COVID-19. Assessed outcomes included clinical deterioration, clinical improvement, low viral load, positive Immunoglobulin G (IgG) antibody, hyperinflammatory syndrome, proportion of IgG antibody, clinical status and length of hospitalization. Multivariable logistic and linear regression models were performed to estimate odds ratios (OR) and their 95% confidence intervals (CI) of event outcomes and continuous outcomes, respectively. RESULTS DPP4i users (N = 107) was associated with lower odds of clinical deterioration (OR=0.71, 95%CI 0.54 to 0.93, P = 0.013), hyperinflammatory syndrome (OR=0.56, 95%CI 0.45 to 0.69, P < 0.001), invasive mechanical ventilation (OR=0.30, 95%CI 0.21 to 0.42, P < 0.001), reduced length of hospitalization (-4.82 days, 95%CI -6.80 to -2.84, P < 0.001), proportion of positive IgG antibody on day-3 (13% vs 8%, p = 0.007) and day-7 (41% vs 26%, P < 0.001), despite lack of association between DPP4i use and in-hospital mortality. CONCLUSION DPP4i use was associated with reduced odds of clinical deterioration and hyperinflammatory syndrome. Prospective studies are warranted to elucidate the role of DPP4i in T2DM and COVID-19.
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Xie L, Zhang Z, Wang Q, Chen Y, Lu D, Wu W. COVID-19 and Diabetes: A Comprehensive Review of Angiotensin Converting Enzyme 2, Mutual Effects and Pharmacotherapy. Front Endocrinol (Lausanne) 2021; 12:772865. [PMID: 34867819 PMCID: PMC8639866 DOI: 10.3389/fendo.2021.772865] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
The potential relationship between diabetes and COVID-19 has been evaluated. However, new knowledge is rapidly emerging. In this study, we systematically reviewed the relationship between viral cell surface receptors (ACE2, AXL, CD147, DC-SIGN, L-SIGN and DPP4) and SARS-CoV-2 infection risk, and emphasized the implications of ACE2 on SARS-CoV-2 infection and COVID-19 pathogenesis. Besides, we updated on the two-way interactions between diabetes and COVID-19, as well as the treatment options for COVID-19 comorbid patients from the perspective of ACE2. The efficacies of various clinical chemotherapeutic options, including anti-diabetic drugs, renin-angiotensin-aldosterone system inhibitors, lipid-lowering drugs, anticoagulants, and glucocorticoids for COVID-19 positive diabetic patients were discussed. Moreover, we reviewed the significance of two different forms of ACE2 (mACE2 and sACE2) and gender on COVID-19 susceptibility and severity. This review summarizes COVID-19 pathophysiology and the best strategies for clinical management of diabetes patients with COVID-19.
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Affiliation(s)
| | | | | | | | | | - Weihua Wu
- Department of Endocrinology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China
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76
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Loretelli C, Abdelsalam A, D'Addio F, Ben Nasr M, Assi E, Usuelli V, Maestroni A, Seelam AJ, Ippolito E, Di Maggio S, Loreggian L, Radovanovic D, Vanetti C, Yang J, El Essawy B, Rossi A, Pastore I, Montefusco L, Lunati ME, Bolla AM, Biasin M, Antinori S, Santus P, Riva A, Zuccotti G, Galli M, Rusconi S, Fiorina P. PD-1 blockade counteracts post-COVID-19 immune abnormalities and stimulates the anti-SARS-CoV-2 immune response. JCI Insight 2021; 6:146701. [PMID: 34784300 PMCID: PMC8783674 DOI: 10.1172/jci.insight.146701] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
A substantial proportion of patients who have recovered from coronavirus disease-2019 (COVID-19) experience COVID-19–related symptoms even months after hospital discharge. We extensively immunologically characterized patients who recovered from COVID-19. In these patients, T cells were exhausted, with increased PD-1+ T cells, as compared with healthy controls. Plasma levels of IL-1β, IL-1RA, and IL-8, among others, were also increased in patients who recovered from COVID-19. This altered immunophenotype was mirrored by a reduced ex vivo T cell response to both nonspecific and specific stimulation, revealing a dysfunctional status of T cells, including a poor response to SARS-CoV-2 antigens. Altered levels of plasma soluble PD-L1, as well as of PD1 promoter methylation and PD1-targeting miR–15-5p, in CD8+ T cells were also observed, suggesting abnormal function of the PD-1/PD-L1 immune checkpoint axis. Notably, ex vivo blockade of PD-1 nearly normalized the aforementioned immunophenotype and restored T cell function, reverting the observed post–COVID-19 immune abnormalities; indeed, we also noted an increased T cell–mediated response to SARS-CoV-2 peptides. Finally, in a neutralization assay, PD-1 blockade did not alter the ability of T cells to neutralize SARS-CoV-2 spike pseudotyped lentivirus infection. Immune checkpoint blockade ameliorates post–COVID-19 immune abnormalities and stimulates an anti–SARS-CoV-2 immune response.
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Affiliation(s)
- Cristian Loretelli
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Ahmed Abdelsalam
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Francesca D'Addio
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Moufida Ben Nasr
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, United States of America
| | - Emma Assi
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Vera Usuelli
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Anna Maestroni
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Andy Joe Seelam
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Elio Ippolito
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Stefania Di Maggio
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Lara Loreggian
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Claudia Vanetti
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Jun Yang
- Institute of Organ Transplantation, Tongji Hospital and Medical College,, Wuhan, China
| | | | - Antonio Rossi
- Endocrinology Division, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ida Pastore
- Endocrinology Division, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Laura Montefusco
- Endocrinology Division, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Andrea M Bolla
- Endocrinology Division, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mara Biasin
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Science L. Sacco, Università di Milano, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Legnano General Hospital, ASST Ovest Milanese, Legnano, Italy
| | - Paolo Fiorina
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, United States of America
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Hegazy WAH, Rajab AAH, Abu Lila AS, Abbas HA. Anti-diabetics and antimicrobials: Harmony of mutual interplay. World J Diabetes 2021; 12:1832-1855. [PMID: 34888011 PMCID: PMC8613656 DOI: 10.4239/wjd.v12.i11.1832] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/26/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes is one of the four major non-communicable diseases, and appointed by the world health organization as the seventh leading cause of death worldwide. The scientists have turned over every rock in the corners of medical sciences in order to come up with better understanding and hence more effective treatments of diabetes. The continuous research on the subject has elucidated the role of immune disorders and inflammation as definitive factors in the trajectory of diabetes, assuring that blood glucose adjustments would result in a relief in the systemic stress leading to minimizing inflammation. On a parallel basis, microbial infections usually take advantage of immunity disorders and propagate creating a pro-inflammatory environment, all of which can be reversed by antimicrobial treatment. Standing at the crossroads between diabetes, immunity and infection, we aim in this review at projecting the interplay between immunity and diabetes, shedding the light on the overlapping playgrounds for the activity of some antimicrobial and anti-diabetic agents. Furthermore, we focused on the anti-diabetic drugs that can confer antimicrobial or anti-virulence activities.
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Affiliation(s)
- Wael A H Hegazy
- Department of Microbiology and Immunology, Zagazig University, Zagzig 44519, Egypt
| | - Azza A H Rajab
- Department of Microbiology and Immunology, Zagazig University, Zagzig 44519, Egypt
| | - Amr S Abu Lila
- Department of Pharmaceutics, Zagazig University, Faculty of Pharmacy, Zagzig 44519, Egypt
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 81442, Saudi Arabia
| | - Hisham A Abbas
- Department of Microbiology and Immunology, Zagazig University, Zagzig 44519, Egypt
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Kang SM, Park JH. Pleiotropic Benefits of DPP-4 Inhibitors Beyond Glycemic Control. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2021; 14:11795514211051698. [PMID: 34733107 PMCID: PMC8558587 DOI: 10.1177/11795514211051698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
Dipeptidyl peptidase (DPP)-4 inhibitors are oral anti-diabetic medications that block the activity of the ubiquitous enzyme DPP-4. Inhibition of this enzyme increases the level of circulating active glucagon-like peptide (GLP)-1 secreted from L-cells in the small intestine. GLP-1 increases the glucose level, dependent on insulin secretion from pancreatic β-cells; it also decreases the abnormally increased level of glucagon, eventually decreasing the blood glucose level in patients with type 2 diabetes. DPP-4 is involved in many physiological processes other than the degradation of GLP-1. Therefore, the inhibition of DPP-4 may have numerous effects beyond glucose control. In this article, we review the pleiotropic effects of DPP-4 inhibitors beyond glucose control, including their strong beneficial effects on the stress induced accelerated senescence of vascular cells, and the possible clinical implications of these effects.
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Affiliation(s)
- Seon Mee Kang
- Department of Internal Medicine, College of Medicine, Inje University, Busan, Republic of Korea.,Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | - Jeong Hyun Park
- Department of Internal Medicine, College of Medicine, Inje University, Busan, Republic of Korea.,Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
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Emral R, Haymana C, Demirci I, Tasci I, Sahin M, Cakal E, Ata N, Unluturk U, Demir T, Ertugrul D, Sahin I, Atmaca A, Celik O, Caglayan M, Arga KY, Dagdelen S, Salman S, Satman I, Sonmez A. Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study. Diabetes Ther 2021; 12:2857-2870. [PMID: 34398433 PMCID: PMC8365288 DOI: 10.1007/s13300-021-01133-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION To investigate the effect of preexisting treatment with dipeptidyl peptidase-4 inhibitors (DPP-4is) on COVID-19-related hospitalization and mortality in patients with type 2 diabetes mellitus (T2DM). METHODS A multicenter, retrospective cohort study was conducted using patient data extracted from the Turkish National Electronic Database. All patients who tested positive for COVID-19 (PCR test) between 11 March through to 30 May 2020 were screened for eligibility (n = 149,671). Following exclusion of patients based on pre-determined inclusion criteria, patients with T2DM using a DPP-4i or glucose-lowering medications other than a DPP-4i were compared for mortality and hospitalization. The propensity score method was used to match age, gender, micro- and macrovascular complications, and medications in the two groups. Independent associates of mortality were analyzed using multivariable analysis on the whole T2DM population. RESULTS A total of 33,478 patients with T2DM who tested postive for COVID-19 who met the inclusion criteria were included in the analysis. Median (interquartile range) age was 54 (22) years and 42.4% were male. Of these, 9100 patients using DPP-4is (n = 4550) or other glucose-lowering drugs (n = 4550) were matched in two groups. After matching, analysis revealed a lower mortality in the DPP-4i group (9.5 vs. 11.8%; p < 0.001). In the multivariable model, the use of DPP-4is (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35-0.91; p = 0.02) was associated with lower mortality in the whole sample, while age, male gender, computed tomography finding of COVID-19, obesity, low glomerular filtration rate, and an insulin-based regimen also predicted increased risk of death. There was no association between the preexisting treatment with DPP-4is and COVID-19-related hospitalization in the matched analysis or multivariate model. The rate of admission to the intensive care unit and/or mechanical ventilation favored the DPP-4i group (21.7 vs. 25.2%; p = 0.001), although this association became saturated in the multivariate analysis (OR 0.65, 95% CI 0.39-1.08; p = 0.099). CONCLUSIONS The results of this study demonstrate an association between DDP-4i use and reduced mortality in people with T2DM who tested PCR positive for COVID-19.
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Affiliation(s)
- Rifat Emral
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Cem Haymana
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ibrahim Demirci
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ilker Tasci
- Department of Internal Medicine, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Faculty of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Naim Ata
- Department of Strategy Development, Ministry of Health of the Republic of Turkey, Ankara, Turkey
| | - Ugur Unluturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Derun Ertugrul
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kecioren Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Aysegül Atmaca
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Osman Celik
- Public Hospitals General Directorate, Ministry of Health of the Republic of Turkey, Ankara, Turkey
| | | | - Kazim Yalcin Arga
- Department of Bioengineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
- Institute of Public Health and Chronic Diseases, The Health Institutes of Turkey, Istanbul, Turkey
| | - Selcuk Dagdelen
- Department of Endocrinology and Metabolism, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serpil Salman
- Department of Endocrinology and Metabolism, Medica Clinic, Istanbul, Turkey
| | - Ilhan Satman
- Institute of Public Health and Chronic Diseases, The Health Institutes of Turkey, Istanbul, Turkey
- Department of Endocrinology and Metabolism, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Katsiki N, Gómez‐Huelgas R, Mikhailidis DP, Pérez‐Martínez P. Narrative review on clinical considerations for patients with diabetes and COVID-19: More questions than answers. Int J Clin Pract 2021; 75:e14833. [PMID: 34510676 PMCID: PMC8646329 DOI: 10.1111/ijcp.14833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND-AIM Diabetes, obesity and hypertension are common comorbidities associated with increased severity and mortality rates from Corona Virus Disease (COVID)-19. METHODS In this narrative review (using the PubMed database), we discuss epidemiological data and pathophysiological links between diabetes and COVID-19. The potential effects of glycaemic control and antidiabetic drugs on the prevalence and outcomes of COVID-19 are also reviewed, as well as the role of telemedicine and diabetes self-management in the post-COVID-19 era. RESULTS Diabetes has been linked to COVID-19 morbidity and mortality, although further research is needed to elucidate this association. In the meantime, physicians should be aware of the potential rise in the prevalence of diabetes (due to unhealthy lifestyle changes during the pandemic), its severity and complications and focus on achieving optimal diabetes prevention and management. Telemedicine and diabetes self-management may help towards this direction. Dipeptidyl-peptidase 4 (DPP4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose transporter 2 (SGLT2) inhibitors may affect viral entry and infection, and thus COVID-19 outcomes, as shown in observational studies. CONCLUSION Diabetes has been associated with COVID-19 development and progression. Certain antidiabetic drugs may influence COVID-19 prevention and management. The results of ongoing randomized clinical trials will shed more light on this field.
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Affiliation(s)
- Niki Katsiki
- First Department of Internal MedicineDiabetes CenterDivision of Endocrinology and MetabolismAHEPA University HospitalThessalonikiGreece
| | - Ricardo Gómez‐Huelgas
- Internal Medicine DepartmentRegional University Hospital of MálagaInstituto de Investigación Biomédica de Málaga (IBIMA)Universidad de MalagaMalagaSpain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN)Instituto de Salud Carlos IIIMadridSpain
| | - Dimitri P. Mikhailidis
- Department of Clinical BiochemistryRoyal Free Hospital CampusUniversity College London Medical SchoolUniversity College London (UCL)LondonUK
| | - Pablo Pérez‐Martínez
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN)Instituto de Salud Carlos IIIMadridSpain
- Lipids and Atherosclerosis UnitDepartment of MedicineIMIBIC/Hospital Universitario Reina Sofía/Universidad de CordobaCordobaSpain
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Steenblock C, Schwarz PEH, Ludwig B, Linkermann A, Zimmet P, Kulebyakin K, Tkachuk VA, Markov AG, Lehnert H, de Angelis MH, Rietzsch H, Rodionov RN, Khunti K, Hopkins D, Birkenfeld AL, Boehm B, Holt RIG, Skyler JS, DeVries JH, Renard E, Eckel RH, Alberti KGMM, Geloneze B, Chan JC, Mbanya JC, Onyegbutulem HC, Ramachandran A, Basit A, Hassanein M, Bewick G, Spinas GA, Beuschlein F, Landgraf R, Rubino F, Mingrone G, Bornstein SR. COVID-19 and metabolic disease: mechanisms and clinical management. Lancet Diabetes Endocrinol 2021; 9:786-798. [PMID: 34619105 PMCID: PMC8489878 DOI: 10.1016/s2213-8587(21)00244-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
Up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders. Notably, there are many direct links between COVID-19 and the metabolic and endocrine systems. Thus, not only are patients with metabolic dysfunction (eg, obesity, hypertension, non-alcoholic fatty liver disease, and diabetes) at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders. In this Review, we provide an update on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Additionally, we update the practical recommendations and management of patients with COVID-19 and post-pandemic. Furthermore, we summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.
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Affiliation(s)
- Charlotte Steenblock
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter E H Schwarz
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden, Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Barbara Ludwig
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; DFG-Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden, Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; German Center for Diabetes Research, Neuherberg, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Linkermann
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Konstantin Kulebyakin
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia; Institute for Regenerative Medicine, Medical Research and Education Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Vsevolod A Tkachuk
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia; Institute for Regenerative Medicine, Medical Research and Education Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Alexander G Markov
- Department of General Physiology, St Petersburg State University, St Petersburg, Russia
| | | | - Martin Hrabě de Angelis
- German Center for Diabetes Research, Neuherberg, Germany; Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany; School of Life Sciences, Technische Universität München, Freising, Germany
| | - Hannes Rietzsch
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roman N Rodionov
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David Hopkins
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK
| | - Andreas L Birkenfeld
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK; Department of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany; Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Bernhard Boehm
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jay S Skyler
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, Netherlands; Profil Institute for Metabolic Research, Neuss, Germany
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Robert H Eckel
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Bruno Geloneze
- Obesity and Comorbidities Research Center, Universidade de Campinas, Campinas, Brazil
| | - Juliana C Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Science, Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaounde, Cameroon
| | - Henry C Onyegbutulem
- Endocrine, Diabetes and Metabolic Unit, Department of Internal Medicine, Nile University of Nigeria-Asokoro Hospital, Abuja, Nigeria
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Mohamed Hassanein
- Dubai Hospital, Dubai Health Authority and Gulf Medical University, Dubai, United Arab Emirates
| | - Gavin Bewick
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK
| | - Giatgen A Spinas
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | | | - Francesco Rubino
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK; Bariatric and Metabolic Surgery, King's College Hospital, London, UK
| | - Geltrude Mingrone
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden, Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; German Center for Diabetes Research, Neuherberg, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland; Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK.
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82
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Montefusco L, D'Addio F, Loretelli C, Ben Nasr M, Garziano M, Rossi A, Pastore I, Plebani L, Lunati ME, Bolla AM, Porta MD, Piuri G, Rocchio F, Abdelsalam A, Assi E, Barichella M, Maestroni A, Usuelli V, Loreggian L, Muzio F, Zuccotti GV, Cazzola R, Fiorina P. Anti-inflammatory effects of diet and caloric restriction in metabolic syndrome. J Endocrinol Invest 2021; 44:2407-2415. [PMID: 33686615 PMCID: PMC8502121 DOI: 10.1007/s40618-021-01547-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Weight loss in patients with metabolic syndrome has positive effects on cardiovascular and type 2 diabetes risks, but its effects on peripheral cytokines and lipid profiles in patients are still unclear. AIM To determine the effects of diet-induced weight loss on metabolic parameters, lipids and cytokine profiles. METHODS Eighteen adult males with metabolic syndrome (defined according to IDF 2009) and Body Mass Index (BMI) between 25 and 35 kg/m2 were subjected to a balanced hypocaloric diet for 6 months to reach at least a 5% body weight loss. RESULTS After weight loss, a significant improvement in BMI, waist circumference, insulin, fasting blood glucose and HOMA-IR (homeostasis model assessment of insulin resistance) was observed. The analysis of LDL (low-density lipoprotein cholesterol) and HDL (high-density lipoprotein cholesterol) lipoproteins showed a change in their composition with a massive transfer of triacylglycerols from HDL to LDL. This was associated with a significant reduction in peripheral pro-inflammatory cytokines such as IL-6, TNF-α, IL-8 and MIP-1β, leading to an overall decreased inflammatory score. An interesting positive correlation was also observed among peripheral cytokines levels after diet and peripheral levels of CETP (cholesteryl ester transfer protein), an enzyme with a key role in lipid change. CONCLUSION Weight loss through caloric restriction is associated with an improvement in peripheral lipid and cytokine profiles that may play a major role in improving cardiovascular risk.
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Affiliation(s)
- L Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - F D'Addio
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - C Loretelli
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - M Ben Nasr
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - M Garziano
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - A Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - I Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - L Plebani
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - M E Lunati
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - A M Bolla
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - M D Porta
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - G Piuri
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - F Rocchio
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - A Abdelsalam
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
- Department of Biochemistry and Biotechnology, Heliopolis University, Cairo, Egypt
| | - E Assi
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - M Barichella
- Clinical Nutrition Unit, Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | - A Maestroni
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - V Usuelli
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - L Loreggian
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy
| | - F Muzio
- Clinical Nutrition and Dietetic Unit, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - G V Zuccotti
- Department of Pediatrics, V. Buzzi Childrens' Hospital and Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Degli Studi Di Milano, Milan, Italy
| | - R Cazzola
- Department of Biomedical and Clinical Sciences, "L. Sacco", Università Di Milano, Milan, Italy
| | - P Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy.
- International Center for T1D, Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC L. Sacco, Università Di Milano, Milan, Italy.
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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83
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Avogaro A, Bonora B, Fadini GP. Managing diabetes in diabetic patients with COVID: where do we start from? Acta Diabetol 2021; 58:1441-1450. [PMID: 34173070 PMCID: PMC8231743 DOI: 10.1007/s00592-021-01739-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022]
Abstract
AIMS COVID-19 has and still is sweeping away the national health systems worldwide. In this review, we sought to determine the evidence base proofs on the antidiabetic treatment capable to reduce the risk of COVID-19-related mortality. METHODS We have performed a systematic search of published articles using PubMed, and EMBASE from March 2020 to March 31st, 2021. We excluded editorials, commentary, letters to the editor, reviews, and studies that did not have mortality as an outcome. For metformin and insulin only, we performed a meta-analysis using Cochrane RevMan 5.2. RESULTS Among antidiabetic drugs, metformin was the only drug associated with a reduced risk of mortality. Conversely, insulin appears associated with an increased risk. The other classes of drugs were neutral. CONCLUSIONS The totality of articles reports retrospective data strongly affected by "channeling bias" so that most of the existing results on each class of drugs are driven by the phenotype of patients likely to receive that specific drug by prescription.
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Affiliation(s)
- Angelo Avogaro
- Department of Medicine, Unit of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Benedetta Bonora
- Department of Medicine, Unit of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Gian Paolo Fadini
- Department of Medicine, Unit of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
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84
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Rizza S, Nucera A, Chiocchi M, Bellia A, Mereu D, Ferrazza G, Ballanti M, Davato F, Di Cola G, Buonomo CO, Coppeta L, Vanni G, Gervasi R, Cardellini M, Lauro D, Federici M. Metabolic characteristics in patients with COVID-19 and no-COVID-19 interstitial pneumonia with mild-to-moderate symptoms and similar radiological severity. Nutr Metab Cardiovasc Dis 2021; 31:3227-3235. [PMID: 34629249 PMCID: PMC8372447 DOI: 10.1016/j.numecd.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS It is known that the highest COVID-19 mortality rates are among patients who develop severe COVID-19 pneumonia. However, despite the high sensitivity of chest CT scans for diagnosing COVID-19 in a screening population, the appearance of a chest CT is thought to have low diagnostic specificity. The aim of this retrospective case-control study is based on evaluation of clinical and radiological characteristics in patients with COVID-19 (n = 41) and no-COVID-19 interstitial pneumonia (n = 48) with mild-to-moderate symptoms. METHODS AND RESULTS To this purpose we compared radiological, clinical, biochemical, inflammatory, and metabolic characteristics, as well as clinical outcomes, between the two groups. Notably, we found similar radiological severity of pneumonia, which we quantified using a disease score based on a high-resolution computed tomography scan (COVID-19 = 18.6 ± 14.5 vs n-COVID-19 = 23.2 ± 15.2, p = 0.289), and comparable biochemical and inflammatory characteristics. However, among patients without diabetes, we observed that COVID-19 patients had significantly higher levels of HbA1c than n-COVID-19 patients (COVID-19 = 41.5 ± 2.6 vs n-COVID-19 = 38.4 ± 5.1, p = 0.012). After adjusting for age, sex, and BMI, we found that HbA1c levels were significantly associated with the risk of COVID-19 pneumonia (odds ratio = 1.234 [95%CI = 1.051-1.449], p = 0.010). CONCLUSIONS In this retrospective case-control study, we found similar radiological and clinical characteristics in patients with COVID-19 and n-COVID-19 pneumonia with mild-to-moderate symptoms. However, among patients without diabetes HbA1c levels were higher in COVID-19 patients than in no-COVID-19 individuals. Future studies should assess whether reducing transient hyperglycemia in individuals without overt diabetes may lower the risk of SARS-CoV-2 infection.
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Affiliation(s)
- Stefano Rizza
- Department of Systems Medicine, University of Rome Tor Vergata, Italy.
| | - Alessandro Nucera
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Daniele Mereu
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | | | - Marta Ballanti
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Francesca Davato
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Giovanni Di Cola
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Claudio O Buonomo
- Department of Surgical Science, University of Rome Tor Vergata, Italy
| | - Luca Coppeta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Gianluca Vanni
- Department of Surgical Science, University of Rome Tor Vergata, Italy
| | - Romualdo Gervasi
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
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Hattori S. Ten-year follow-up of sitagliptin treatment in patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2021; 13:117. [PMID: 34689790 PMCID: PMC8542356 DOI: 10.1186/s13098-021-00735-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early and effective intervention with a dipeptidyl peptidase 4 inhibitor (DPP4i) before the development of advanced atherosclerosis in type 2 diabetes mellitus (T2DM) patients without a history of cardiovascular disease (CVD) is reported to increase the chance of significant reductions in not only microvascular disease, but also CVD. METHOD This study aimed to investigate whether sitagliptin is effective and tolerated for glycemic control and whether renoprotective effects and β-cell function are preserved for as long as ten years in Japanese patients with T2DM without a history of CVD. RESULTS The situation is equivalent to improving glycemic control as assessed by hemoglobin A1c both in a sitagliptin group [sitagliptin 50 mg as either monotherapy or combination therapy with other oral glucose-lowering drugs (n = 17)] or a control group [placebo as either monotherapy or combination therapy with other glucose-lowering drugs (n = 9)], while anti-inflammatory effects as assessed by high-sensitivity C-reactive peptide in the sitagliptin group were superior to those in the control group. In the sitagliptin group, mean urinary albumin excretion (measured as urinary albumin-to-creatinine ratio) was markedly decreased, but no changes in estimated glomerular filtration rate were seen throughout the study. Beta-cell function as evaluated by homeostatic model assessment of β-cell function values was reduced at baseline in both groups, improved significantly in the sitagliptin group, and continued unchanged in the control group during the study. CONCLUSION These observations suggest that early intervention with sitagliptin in patients with T2DM may have long-lasting renoprotective and islet-protective effects. TRIAL REGISTRATION UMIN Clinical Registry (UMIN000038459). Registered 01 November (retrospectively registered): https://upload.umin.ac.jp/UMIN000038459.
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Affiliation(s)
- Sachiko Hattori
- Department of Endocrinology and Metabolism, Tohto Clinic, 4-1 Kioi-Cho, Chiyoda-Ku, Tokyo, 102-0094, Japan.
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86
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Luk AOY, Yip TCF, Zhang X, Kong APS, Wong VWS, Ma RCW, Wong GLH. Glucose-lowering drugs and outcome from COVID-19 among patients with type 2 diabetes mellitus: a population-wide analysis in Hong Kong. BMJ Open 2021; 11:e052310. [PMID: 34670765 PMCID: PMC8529616 DOI: 10.1136/bmjopen-2021-052310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To investigate the association between baseline use of glucose-lowering drugs and serious clinical outcome among patients with type 2 diabetes. DESIGN Territory-wide retrospective cohort of confirmed cases of COVID-19 between January 2020 and February 2021. SETTING All public health facilities in Hong Kong. PARTICIPANTS 1220 patients with diabetes who were admitted for confirmed COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES Composite clinical endpoint of intensive care unit admission, requirement of invasive mechanical ventilation and/or in-hospital death. RESULTS In this cohort (median age 65.3 years, 54.3% men), 737 (60.4%) patients were treated with metformin, 385 (31.6%) with sulphonylureas, 199 (16.3%) with dipeptidyl peptidase-4 (DPP-4) inhibitors and 273 (22.4%) with insulin prior to admission. In multivariate Cox regression, use of metformin and DPP-4 inhibitors was associated with reduced incidence of the composite endpoint relative to non-use, with respective HRs of 0.51 (95% CI 0.34 to 0.77, p=0.001) and 0.46 (95% CI 0.29 to 0.71, p<0.001), adjusted for age, sex, diabetes duration, glycated haemoglobin (HbA1c), smoking, comorbidities and drugs. Use of sulphonylureas (HR 1.55, 95% CI 1.07 to 2.24, p=0.022) and insulin (HR 6.34, 95% CI 3.72 to 10.78, p<0.001) were both associated with increased hazards of the composite endpoint. CONCLUSIONS Users of metformin and DPP-4 inhibitors had fewer adverse outcomes from COVID-19 compared with non-users, whereas insulin and sulphonylurea might predict a worse prognosis.
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Affiliation(s)
- Andrea On Yan Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Terry C F Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, People's Republic of China
| | - Xinge Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice Pik Shan Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, People's Republic of China
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SARS-CoV-2 and diabetes: A potential therapeutic effect of dipeptidyl peptidase 4 inhibitors in diabetic patients diagnosed with COVID-19. Metabol Open 2021; 12:100134. [PMID: 34661092 PMCID: PMC8511553 DOI: 10.1016/j.metop.2021.100134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 and has become an urgent economic and health challenge. Dipeptidyl peptidase 4 (DPP4), also mentioned as a cluster of differentiation 26 (CD26) is a serine exopeptidase found in two arrangements: a soluble form (sDPP-4) and a plasma membrane-bound form. Because other coronaviruses enter the cells by binding to DPP-4, it has been speculated that DPP-4 inhibitors may exert activity against COVID-19. Therefore, this review aimed to summarize the potential therapeutic effect of dipeptidyl peptidase 4 inhibitors in diabetic patients diagnosed with COVID-19. To include different studies, publications related to Dipeptidyl peptidase-4 inhibitor use and clinical outcomes from COVID-19 were searched from the databases such as Web of Science, PubMed, Medline, Elsevier, Google Scholar, and SCOPUS, via English key terms. A direct engrossment of DPP4 in COVID-19 needs to be elucidated, there is also evidence confirming that DPP4 inhibitors exert anti-fibrotic and modulate inflammation activity. Thus, the use of DPP-4 inhibitors could reduce mortality due to COVID-19 or improve the progression of COVID-19; this evidence may support the management of diabetic patients diagnosed with COVID-19; however more well-designed investigation is urgently required.
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88
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Maiorino MI, Longo M, Scappaticcio L, Bellastella G, Chiodini P, Esposito K, Giugliano D. Improvement of glycemic control and reduction of major cardiovascular events in 18 cardiovascular outcome trials: an updated meta-regression. Cardiovasc Diabetol 2021; 20:210. [PMID: 34663316 PMCID: PMC8522255 DOI: 10.1186/s12933-021-01401-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Besides providing reassurance about cardiovascular (CV) safety of newer diabetes drugs, cardiovascular outcome trials (CVOTs) have also shown encouraging benefits on some CV endpoints. The contribution of the better glycemic control in the reduction of major cardiovascular events (MACE) remains an open question. The aim of this study is to evaluate the associations between the reduction of HbA1c and risk of MACE, MACE components, hospitalization for heart failure (HF) and all-cause death in CVOTs. METHODS An electronic search up to July 2021 was conducted to determine eligible trials. Systematic review identified eighteen CVOTs reporting prespecified CV outcomes. Pooled summary estimates and 95% confidence intervals (CI) were calculated according to the random effects model using the Paule-Mandel method; restricted maximum likelihood estimators were used to estimate model parameters in the metaregression. RESULTS The eighteen CVOTs evaluated 161,156 patients and included four trials with dipeptidyl-peptidase-4 inhibitors (DPP-4i), eight trials with glucagon-like peptide-1 receptor agonists (GLP-1RA) and six trials with sodium-glucose cotransporter-2 inhibitors (SGLT-2i). Random-effects model meta-analysis showed an association between treatment and risk of MACE (hazard ratio [HR] 0.90; 95% CI 0.86, 0.94, P < 0.001), with significant heterogeneity between studies (I2 = 45.2%, Q statistic P = 0.040). In meta-regression, there was an association between the reduction in HbA1c at the end of the trial and the HR reduction for MACE (beta = - 0.298, P = 0.007), with significant heterogeneity (I2 = 40%, Q statistic P = 0.04); this association was totally driven by the risk reduction of non-fatal stroke, which explained 100% of between-study variance (beta = - 0.531, R2 = 100%), without heterogeneity (I2 = 24%, Q statistic P = 0.206). There was no association between the reduction in HbA1c and the HR for heart failure or all-cause death. CONCLUSIONS The reduction of HbA1c in eighteen CVOTs was significantly associated with reduction of non-fatal stroke, explaining all (R2 = 100%) of the between-study variance. While the contribution of glucose lowering in some CV benefits of newer agents does not influence their indications for the patient with type 2 diabetes, it may hopefully facilitate their use.
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Affiliation(s)
- Maria Ida Maiorino
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Miriam Longo
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Scappaticcio
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Prieto Santamaría L, Díaz Uzquiano M, Ugarte Carro E, Ortiz-Roldán N, Pérez Gallardo Y, Rodríguez-González A. Integrating heterogeneous data to facilitate COVID-19 drug repurposing. Drug Discov Today 2021; 27:558-566. [PMID: 34666181 PMCID: PMC8520166 DOI: 10.1016/j.drudis.2021.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 01/03/2023]
Abstract
In the COVID-19 pandemic, drug repositioning has presented itself as an alternative to the time-consuming process of generating new drugs. This review describes a drug repurposing process that is based on a new data-driven approach: we put forward five information paths that associate COVID-19-related genes and COVID-19 symptoms with drugs that directly target these gene products, that target the symptoms or that treat diseases that are symptomatically or genetically similar to COVID-19. The intersection of the five information paths results in a list of 13 drugs that we suggest as potential candidates against COVID-19. In addition, we have found information in published studies and in clinical trials that support the therapeutic potential of the drugs in our final list.
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Affiliation(s)
- Lucía Prieto Santamaría
- ETS Ingenieros Informáticos, Universidad Politécnica de Madrid, 28660 Boadilla del Monte, Madrid, Spain; Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28660 Boadilla del Monte, Madrid, Spain; Ezeris Networks Global Services S.L., 28028 Madrid, Spain
| | - Marina Díaz Uzquiano
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28660 Boadilla del Monte, Madrid, Spain
| | - Esther Ugarte Carro
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28660 Boadilla del Monte, Madrid, Spain
| | - Nieves Ortiz-Roldán
- Facultativo Especialista Área (FEA), Anestesiología y Reanimación, Hospital Sierrallana, Servicio Cántabro de Salud, 39300 Torrelavega, Cantabria, Spain
| | | | - Alejandro Rodríguez-González
- ETS Ingenieros Informáticos, Universidad Politécnica de Madrid, 28660 Boadilla del Monte, Madrid, Spain; Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28660 Boadilla del Monte, Madrid, Spain.
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90
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Hebbard C, Lee B, Katare R, Garikipati VNS. Diabetes, Heart Failure, and COVID-19: An Update. Front Physiol 2021; 12:706185. [PMID: 34721055 PMCID: PMC8554151 DOI: 10.3389/fphys.2021.706185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the WHO in March 2020. As of August 2021, more than 220 countries have been affected, accounting for 211,844,613 confirmed cases and 4,432,802 deaths worldwide. A new delta variant wave is sweeping through the globe. While previous reports consistently have demonstrated worse prognoses for patients with existing cardiovascular disease than for those without, new studies are showing a possible link between SARS-CoV-2 infection and an increased incidence of new-onset heart disease and diabetes, regardless of disease severity. If this trend is true, with hundreds of millions infected, the disease burden could portend a potentially troubling increase in heart disease and diabetes in the future. Focusing on heart failure in this review, we discuss the current data at the intersection of COVID, heart failure, and diabetes, from clinical findings to potential mechanisms of how SARS-CoV-2 infection could increase the incidence of those pathologies. Additionally, we posit questions for future research areas regarding the significance for patient care.
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Affiliation(s)
- Carleigh Hebbard
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Brooke Lee
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rajesh Katare
- Department of Physiology–HeartOtago, University of Otago, Dunedin, New Zealand
| | - Venkata Naga Srikanth Garikipati
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Abstract
Uncontrolled diabetes and/or hyperglycemia is associated with severe COVID-19 disease and increased mortality. It is now known that poor glucose control before hospital admission can be associated with a high risk of in-hospital death. By achieving and maintaining glycemic control, primary care physicians (PCPs) play a critical role in limiting this potentially devastating outcome. Further, despite the hope that mass vaccination will help control the pandemic, genetic variants of the virus are causing surges in some countries. As such, PCPs will treat an increasing number of patients with diabetes who have symptoms of post-COVID-19 infection, or even have new-onset type 2 diabetes as a result of COVID-19 infection. However, much of the literature published focuses on the effects of COVID-19 in hospitalized patients, with few publications providing information and advice to those caring for people with diabetes in the primary care setting. This manuscript reviews the current knowledge of the risk and outcomes of individuals with diabetes who are infected with COVID-19 and provides information for PCPs on the importance of glucose control, appropriate treatment, and use of telemedicine and online prescription delivery systems to limit the potentially devastating effects of COVID-19 in people with hyperglycemia.
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Affiliation(s)
- Jeremy Pettus
- University of California, School of Medicine, San Diego, CA, USA
| | - Neil Skolnik
- Family Medicine Residency Program, Abington-Jefferson Health, Abington, PA, USA
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92
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Elibol A, Eren D, Erdoğan MD, Elmaağaç M, Dizdar OS, Çelik İ, Günal Aİ. Factors influencing on development of COVID-19 pneumonia and association with oral anti-diabetic drugs in hospitalized patients with diabetes mellitus. Prim Care Diabetes 2021; 15:806-812. [PMID: 34376379 PMCID: PMC8332925 DOI: 10.1016/j.pcd.2021.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/24/2021] [Accepted: 08/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) increases mortality and morbidity in patients with coronavirus disease (COVID-19). In this study, it was aimed to assess factors influencing on COVID-19 pneumonia in hospitalized patients with diabetes and association with oral anti-diabetic drugs. MATERIALS AND METHODS This cross-sectional study included 432 patients with type 2 diabetes mellitus diagnosed with COVID-19. Data regarding clinical characteristics, demographic characteristics, intensive care unit (ICU) rate in patients admitted to ICU, laboratory results on day 1 and 7, thoracic computed tomography (CT) findings and oral anti-diabetic drugs used were extracted from medical records. In all patients, 75-days mortality was recorded. Data were assessed independently. RESULTS There was pneumonia in 386 (89.4%) of 432 patients with diabetes. The risk for pneumonia was markedly higher in patients on DPP-4 inhibitors; however, there was no significant among other oral anti-diabetic groups and subgroups. In addition, elevated CRP was linked to the increased risk for pneumonia. Only patients in the pneumonia group had SGLT-2 inhibitor use. During follow-up, 91 patients died. In Cox regression analysis, low Glasgow Coma Scale score, and increased lactate dehydrogenase levels were identified as significant independent risk factors for mortality. CONCLUSION The study indicated that DPP-4 inhibitor used and elevated CRP level were associated with pneumonia development. Only patients in the pneumonia group had SGLT-2 inhibitor use. No oral anti-diabetics was found to be associated with COVID-19 related death.
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Affiliation(s)
- Ayça Elibol
- University of Health Sciences Kayseri City Training and Research Hospital, Department of Internal Medicine, Kayseri, Turkey
| | - Didem Eren
- University of Health Sciences Kayseri City Training and Research Hospital, Department of Internal Medicine, Kayseri, Turkey
| | - Macide Deniz Erdoğan
- University of Health Sciences Kayseri City Training and Research Hospital, Department of Internal Medicine, Kayseri, Turkey
| | - Merve Elmaağaç
- University of Health Sciences Kayseri City Training and Research Hospital, Department of Internal Medicine, Kayseri, Turkey
| | - Oguzhan Sıtkı Dizdar
- University of Health Sciences Kayseri City Training and Research Hospital, Department of Internal Medicine, Kayseri, Turkey.
| | - İlhami Çelik
- University of Health Sciences Kayseri City Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkey
| | - Ali İhsan Günal
- University of Health Sciences Kayseri City Training and Research Hospital, Department of Nephrology, Kayseri, Turkey
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93
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Czupryniak L, Dicker D, Lehmann R, Prázný M, Schernthaner G. The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence? Cardiovasc Diabetol 2021; 20:198. [PMID: 34598700 PMCID: PMC8485772 DOI: 10.1186/s12933-021-01389-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available—but currently limited—evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care.
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Dror Dicker
- Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Centre, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roger Lehmann
- Department of Endocrinology, Diabetes and Nutrition, University Hospital Zürich, Zürich, Switzerland
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Guntram Schernthaner
- Department of Medicine I, Rudolfstiftung Hospital Vienna, 1030, Vienna, Austria. .,Medical University of Vienna, Vienna, Austria.
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Giorda CB, Picariello R, Tartaglino B, Nada E, Doglio M, Romeo F, Costa G, Gnavi R. From swab testing to health outcomes within the T2DM population: Impact of diabetes background on COVID19 progression. Diabetes Res Clin Pract 2021; 180:109021. [PMID: 34437941 PMCID: PMC8381620 DOI: 10.1016/j.diabres.2021.109021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/30/2021] [Accepted: 08/19/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND We aimed to study the impact of diabetes background on COVID-19 progression from swab testing to health outcomes in type 2 diabetes (T2DM). METHODS From the database of the diabetes units of Piedmont-Italy we extracted records of T2DM patients, which were linked with the swab-testing-database, and the database of hospital discharges. Five outcomes (PCR testing, PCR testing positivity, hospitalization, Intensive Care Unit (ICU), death) were evaluated using robust Poisson models. RESULTS Among 125,021 T2DM patients, 1882 had a positive PCR test. Of these patients, 49.4% were hospitalized within 30 days, 11.8% were admitted to an ICU, and 27.1% died. Greater probability of death was associated with age, male sex, liver and renal impairment, Hba1c above 8%, and former smoking. Hospitalization and ICU admission were mainly affected by age, male sex, hypertension, and metabolic control. Notably, ICU admissions were reduced in very elderly people. No outcomes were associated with educational level. CONCLUSIONS Hospitalization and ICU admission are heavily affected by age and local triage policy. A key finding was that men who were > 75 years old and poorly compensated were highly vulnerable patients. Renal and/or hepatic impairment are additional factors. This information may be useful for addressing intervention priorities.
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Affiliation(s)
| | | | | | - Elisa Nada
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Marella Doglio
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Francesco Romeo
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy; Department of Public Health, University of Torino, Torino, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy
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95
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Tarlovskaya EI, Arutyunov AG, Konradi AO, Lopatin YM, Rebrov AP, Tereshchenko SN, Chesnikova AI, Hayrapetyan HG, Babin AP, Bakulin IG, Bakulina NV, Balykova LA, Blagonravova AS, Boldina MV, Vaisberg AR, Galyavich AS, Gomonova VV, Grigorieva NY, Gubareva IV, Demko IV, Evzerikhina AV, Zharkov AV, Kamilova UK, Kim ZF, Kuznetsova TY, Lareva NV, Makarova EV, Malchikova SV, Nedogoda SV, Petrova MM, Pochinka IG, Protasov KV, Protsenko DN, Ruzanau DY, Sayganov SA, Sarybaev AS, Selezneva NM, Sugraliev AB, Fomin IV, Khlynova OV, Chizhova OY, Shaposhnik II, Shсukarev DA, Abdrahmanova AK, Avetisian SA, Avoyan HG, Azarian KK, Aimakhanova GT, Ayipova DA, Akunov AC, Alieva MK, Aparkina AV, Aruslanova OR, Ashina EY, Badina OY, Barisheva OY, Batchayeva AS, Bitieva AM, Bikhteyev IU, Borodulina NA, Bragin MV, Budu AM, Burygina LA, Bykova GA, Vagapova KR, Varlamova DD, Vezikova NN, Verbitskaya EA, Vilkova OE, Vinnikova EA, Vustina VV, Gаlova EA, Genkel VV, Gorshenina EI, Gostishev RV, Grigorieva EV, Gubareva EY, Dabylova GM, Demchenko AI, Dolgikh OY, Duyshobayev MY, Evdokimov DS, Egorova KE, Ermilova AN, Zheldybayeva AE, Zarechnova NV, Zimina YD, Ivanova SY, Ivanchenko EY, Ilina MV, Kazakovtseva MV, Kazymova EV, Kalinina YS, Kamardina NA, Karachenova AM, Karetnikov IA, Karoli NA, Karpov OV, Karsiev MK, Кaskaeva DS, Kasymova KF, Kerimbekova ZB, Kerimova AS, Kim ES, Kiseleva NV, Klimenko DA, Klimova AV, Kovalishena OV, Kolmakova EV, Kolchinskaya TP, Kolyadich MI, Kondriakova OV, Konoval MP, Konstantinov DY, Konstantinova EA, Kordukova VA, Koroleva EV, Kraposhina AY, Kriukova TV, Kuznetsova AS, Kuzmina TY, Kuzmichev KV, Kulchoroeva CK, Kuprina TV, Kouranova IM, Kurenkova LV, Kurchugina NY, Kushubakova NA, Levankova VI, Levin MЕ, Lyubavina NA, Magdeyeva NA, Mazalov KV, Majseenko VI, Makarova AS, Maripov AM, Marusina AA, Melnikov ES, Moiseenko NB, Muradova FN, Muradyan RG, Myshak AO, Nikitina NM, Ogurlieva BB, Odegova AA, Omarova YM, Omurzakova NA, Ospanova SO, Pahomova EV, Petrov LD, Plastinina SS, Pogrebetskaya VA, Polyakov DS, Ponomarenko EV, Popova LL, Prokofeva NA, Pudova IA, Rakov NA, Rakhimov AN, Rozanova NA, Serikbolkyzy S, Simonov AA, Skachkova VV, Soloveva DV, Soloveva IA, Sokhova FM, Subbotin AK, Sukhomlinova IM, Sushilova AG, Tagayeva DR, Titojkina YV, Tikhonova EP, Tokmin DS, Tolmacheva AA, Torgunakova MS, Trenogina KV, Trostianetckaia NA, Trofimov DA, Tulichev AA, Tursunova AT, Ulanova ND, Fatenkov OV, Fedorishina OV, Fil TS, Fomina IY, Fominova IS, Frolova IA, Tsvinger SM, Tsoma VV, Cholponbaeva MB, Chudinovskikh TI, Shevchenko OA, Sheshina TV, Shishkina EA, Shishkov KY, Sherbakov SY, Yausheva EA, Musaelian SN, Belenkov YN, Arutyunov GP. Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2»). ACTA ACUST UNITED AC 2021; 61:20-32. [PMID: 34713782 DOI: 10.18087/cardio.2021.9.n1680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022]
Abstract
Aim To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.
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Affiliation(s)
- E I Tarlovskaya
- Eurasian Association of Therapists, Moscow; Privolzhsky Research Medical University, Nizhny Novgorod
| | - A G Arutyunov
- Eurasian Association of Therapists, Moscow; N. I. Pirogov Russian National Research Medical University, Moscow
| | - A O Konradi
- V. A. Almazov National Medical Research Center, St. Peterburg
| | | | - A P Rebrov
- V. I. Razumovsky Saratov State Medical University, Saratov
| | | | | | - H G Hayrapetyan
- Erebouni Medical Center, Cardiology and Cardiac Surgery Clinic, Erevan
| | - A P Babin
- Nikolae Testemitanu Sate University of Medicine and Pharmacy, Kishinev
| | - I G Bakulin
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - N V Bakulina
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - L A Balykova
- N. P. Ogarev National Research Mordovia State University, Saransk
| | | | - M V Boldina
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - A R Vaisberg
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - A S Galyavich
- Interregional Clinical Diagnostic Center, Kazan; Kazan State Medical University, Kazan
| | - V V Gomonova
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - N Yu Grigorieva
- N. I. Lobachevsky National Research State University of Nizhny Novgorod, Nizhny Novgorod
| | | | - I V Demko
- Krasnoyarsk Regional Clinical Hospital, Krasnoyarsk
| | | | | | - U K Kamilova
- National Specialized Science and Practice Medical Center for Therapy and Medical Rehabilitation, Tashkent
| | - Z F Kim
- Kazan Municipal Clinical Hospital №7, Kazan
| | | | | | - E V Makarova
- Privolzhsky Research Medical University, Nizhny Novgorod
| | | | | | - M M Petrova
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | - I G Pochinka
- Privolzhsky Research Medical University, Nizhny Novgorod; Municipal Clinical Hospital #13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod
| | - K V Protasov
- Irkutsk State Medical Academy of Postgraduate Education, Branch of the Russian Medical Academy of Continuing Professional Education, Irkutsk
| | | | | | - S A Sayganov
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - A S Sarybaev
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | - N M Selezneva
- N. P. Ogarev National Research Mordovia State University, Saransk
| | - A B Sugraliev
- S. D. Asfendiyarov Kazakh National Medical University, Alma-Ata
| | - I V Fomin
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - O V Khlynova
- Akademician E. A. Vagner Perm State Medical University, Perm
| | - O Yu Chizhova
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | | | | | - A K Abdrahmanova
- Kazakh Medical University of Continuous Education, Alma-Ata; I. Zhekenova Municipal Clinical Hospital for Infectious Diseases, Alma-Ata
| | - S A Avetisian
- Erebouni Medical Center, Cardiology and Cardiac Surgery Clinic, Erevan
| | - H G Avoyan
- Erebouni Medical Center, Cardiology and Cardiac Surgery Clinic, Erevan
| | - K K Azarian
- Erebouni Medical Center, Cardiology and Cardiac Surgery Clinic, Erevan
| | - G T Aimakhanova
- S. D. Asfendiyarov Kazakh National Medical University, Alma-Ata
| | - D A Ayipova
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | - A Ch Akunov
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | - M K Alieva
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - A V Aparkina
- V. I. Razumovsky Saratov State Medical University, Saratov
| | | | - E Yu Ashina
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - O Yu Badina
- Privolzhsky District Medical Center, Nizhny Novgorod
| | | | - A S Batchayeva
- N. I. Pirogov Russian National Research Medical University, Moscow
| | - A M Bitieva
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - I U Bikhteyev
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | | | - M V Bragin
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - A M Budu
- Municipal Clinical Hospital №1, Kishinev
| | - L A Burygina
- P. B. Gannushkin Psychiatric Clinical Hospital №4, Moscow
| | - G A Bykova
- Akademician E. A. Vagner Perm State Medical University, Perm
| | - K R Vagapova
- Polyclinic №1 at the Administrative Department of the President of the Russian Federation, Moscow
| | | | | | - E A Verbitskaya
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | - O E Vilkova
- N. I. Lobachevsky National Research State University of Nizhny Novgorod, Nizhny Novgorod
| | - E A Vinnikova
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | | | - E A Gаlova
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - V V Genkel
- South Ural State Medical University, Chelyabinsk
| | - E I Gorshenina
- N. P. Ogarev National Research Mordovia State University, Saransk
| | | | - E V Grigorieva
- V. I. Razumovsky Saratov State Medical University, Saratov
| | | | - G M Dabylova
- S. D. Asfendiyarov Kazakh National Medical University, Alma-Ata
| | | | | | - M Y Duyshobayev
- S. D. Asfendiyarov Kazakh National Medical University, Alma-Ata
| | - D S Evdokimov
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - K E Egorova
- V. A Baranov Karelia Republic Hospital, Petrozavodsk
| | - A N Ermilova
- Eurasian Association of Therapists, Moscow; V. P. Serbsky National Medical Research Center of Psychiatry and Narcology, Moscow
| | | | | | - Yu D Zimina
- Municipal Clinical Hospital №25, Novosibirsk
| | | | | | - M V Ilina
- Kirovsk Inter-District Hospital, outpatient department, Kirovsk
| | | | - E V Kazymova
- Clinical Hospital at the Samara Station "Russian Railways Medicine", Samara
| | - Yu S Kalinina
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | - N A Kamardina
- Privolzhsky District Medical Center, Nizhny Novgorod
| | | | - I A Karetnikov
- Irkutsk Regional Clinical Hospital, recipient of the "Badge of Honor" award, Irkutsk
| | - N A Karoli
- V. I. Razumovsky Saratov State Medical University, Saratov
| | - O V Karpov
- P. B. Gannushkin Psychiatric Clinical Hospital #4, Moscow
| | - M Kh Karsiev
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - D S Кaskaeva
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | - K F Kasymova
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | - Zh B Kerimbekova
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | | | - E S Kim
- Kazan State Medical University, Kazan; Kazan Municipal Clinical Hospital №7, Kazan
| | - N V Kiseleva
- Privolzhsky Research Medical University, Nizhny Novgorod
| | | | - A V Klimova
- N. I. Pirogov Russian National Research Medical University, Moscow; Municipal Polyclinic №134, Moscow
| | | | - E V Kolmakova
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | | | - M I Kolyadich
- South Ural State Medical University, Chelyabinsk; Chelyabinsk Municipal Clinical Hospital №1, Chelyabinsk
| | | | - M P Konoval
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | | | | | - V A Kordukova
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - E V Koroleva
- Municipal Clinical Hospital №5 of the Nizhny Novgorod Nizhegorodsky District, Nizhny Novgorod
| | - A Yu Kraposhina
- Krasnoyarsk Regional Clinical Hospital, Krasnoyarsk; Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | | | | | - T Yu Kuzmina
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | - K V Kuzmichev
- Municipal Clinical Hospital №13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod
| | - Ch K Kulchoroeva
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | | | | | | | | | - N A Kushubakova
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | | | - M Е Levin
- P. B. Gannushkin Psychiatric Clinical Hospital №4, Moscow
| | - N A Lyubavina
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - N A Magdeyeva
- V. I. Razumovsky Saratov State Medical University, Saratov
| | - K V Mazalov
- Privolzhsky District Medical Center, Nizhny Novgorod
| | | | - A S Makarova
- Irkutsk State Medical Academy of Postgraduate Education, Branch of the Russian Medical Academy of Continuing Professional Education, Irkutsk
| | - A M Maripov
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | - A A Marusina
- Kirovsk Inter-District Hospital, outpatient department, Kirovsk
| | - E S Melnikov
- Eurasian Association of Therapists, Moscow; I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - N B Moiseenko
- N. I. Lobachevsky National Research State University of Nizhny Novgorod, Nizhny Novgorod
| | - F N Muradova
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - R G Muradyan
- Global Medical System Clinics and Hospitals, Moscow
| | | | - N M Nikitina
- V. I. Razumovsky Saratov State Medical University, Saratov
| | - B B Ogurlieva
- N. I. Pirogov Russian National Research Medical University, Moscow; Municipal Clinical Hospital №4, Moscow
| | | | - Yu M Omarova
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - N A Omurzakova
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | - Sh O Ospanova
- S. D. Asfendiyarov Kazakh National Medical University, Alma-Ata
| | - E V Pahomova
- GBUZ RK "Republican tuberculosis dispensary", Petrozavodsk
| | | | - S S Plastinina
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - V A Pogrebetskaya
- Municipal Clinical Hospital №38 of the Nizhny Novgorod Nizhegorodsky District, Nizhny Novgorod
| | - D S Polyakov
- Privolzhsky Research Medical University, Nizhny Novgorod
| | | | | | - N A Prokofeva
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - I A Pudova
- Privolzhsky Research Medical University, Nizhny Novgorod; Municipal Polyclinic №4 of the Nizhny Novgorod Kanavinsky District, Nizhny Novgorod
| | - N A Rakov
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - A N Rakhimov
- 21 National Specialized Science and Practice Medical Center for Therapy and Medical Rehabilitation, Tashkent
| | | | - S Serikbolkyzy
- S. D. Asfendiyarov Kazakh National Medical University, Alma-Ata
| | - A A Simonov
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | | | - D V Soloveva
- Privolzhsky Research Medical University, Nizhny Novgorod
| | - I A Soloveva
- Krasnoyarsk Regional Clinical Hospital, Krasnoyarsk; Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | - F M Sokhova
- P. B. Gannushkin Psychiatric Clinical Hospital №4, Moscow
| | - A K Subbotin
- Privolzhsky District Medical Center, Nizhny Novgorod
| | | | - A G Sushilova
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - D R Tagayeva
- National Specialized Science and Practice Medical Center for Therapy and Medical Rehabilitation, Tashkent
| | - Yu V Titojkina
- N. P. Ogarev National Research Mordovia State University, Saransk
| | - E P Tikhonova
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | | | - A A Tolmacheva
- Novosibirsk State Medical University, Novosibirsk; Clinical Consultative and Diagnostic Polyclinic №27, Novosibirsk
| | - M S Torgunakova
- Prof. V. F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
| | | | | | - D A Trofimov
- Kazan State Medical University, Kazan; Kazan Municipal Clinical Hospital №7, Kazan
| | - A A Tulichev
- Privolzhsky Research Medical University, Nizhny Novgorod; Municipal Clinical Hospital №3, Nizhny Novgorod
| | - A T Tursunova
- S. D. Asfendiyarov Kazakh National Medical University, Alma-Ata
| | - N D Ulanova
- Municipal Clinical Hospital #13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod
| | | | - O V Fedorishina
- Irkutsk State Medical Academy of Postgraduate Education, Branch of the Russian Medical Academy of Continuing Professional Education, Irkutsk
| | - T S Fil
- I. I. Mechnikov North-Western State Medical University, St. Petersburg
| | - I Yu Fomina
- Privolzhsky Research Medical University, Nizhny Novgorod; Municipal Polyclinic #1, Nizhny Novgorod
| | - I S Fominova
- N. P. Ogarev National Research Mordovia State University, Saransk
| | - I A Frolova
- Privolzhsky District Medical Center, Nizhny Novgorod
| | | | - V V Tsoma
- Volgograd State Medical University, Volgograd
| | - M B Cholponbaeva
- M. M. Mirrakhimov National Center of Cardiology and Therapy, Bishkek
| | | | | | - T V Sheshina
- N. I. Lobachevsky National Research State University of Nizhny Novgorod, Nizhny Novgorod
| | - E A Shishkina
- Akademician E. A. Vagner Perm State Medical University, Perm
| | | | - S Yu Sherbakov
- Kazan State Medical Academy, Branch of the Russian Medical Academy of Continuing Professional Education, Kazan
| | - E A Yausheva
- N. P. Ogarev National Research Mordovia State University, Saransk
| | | | - Yu N Belenkov
- The First Moscow state medical University I. M. Sechenov
| | - G P Arutyunov
- Eurasian Association of Therapists, Moscow; N. I. Pirogov Russian National Research Medical University, Moscow
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96
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Kan C, Zhang Y, Han F, Xu Q, Ye T, Hou N, Sun X. Mortality Risk of Antidiabetic Agents for Type 2 Diabetes With COVID-19: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:708494. [PMID: 34603199 PMCID: PMC8481667 DOI: 10.3389/fendo.2021.708494] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/30/2021] [Indexed: 02/05/2023] Open
Abstract
Aims We conducted a systematic review and meta-analysis to assess various antidiabetic agents' association with mortality in patients with type 2 diabetes (T2DM) who have coronavirus disease 2019 (COVID-19). Methods We performed comprehensive literature retrieval from the date of inception until February 2, 2021, in medical databases (PubMed, Web of Science, Embase, and Cochrane Library), regarding mortality outcomes in patients with T2DM who have COVID-19. Pooled OR and 95% CI data were used to assess relationships between antidiabetic agents and mortality. Results Eighteen studies with 17,338 patients were included in the meta-analysis. Metformin (pooled OR, 0.69; P=0.001) and sulfonylurea (pooled OR, 0.80; P=0.016) were associated with lower mortality risk in patients with T2DM who had COVID-19. However, patients with T2DM who had COVID-19 and received insulin exhibited greater mortality (pooled OR, 2.20; P=0.002). Mortality did not significantly differ (pooled OR, 0.72; P=0.057) between DPP-4 inhibitor users and non-users. Conclusions Metformin and sulfonylurea could be associated with reduced mortality risk in patients with T2DM who have COVID-19. Furthermore, insulin use could be associated with greater mortality, while DPP-4 inhibitor use could not be. The effects of antidiabetic agents in patients with T2DM who have COVID-19 require further exploration. Systematic Review Registration PROSPERO (identifier, CRD42021242898).
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Affiliation(s)
- Chengxia Kan
- Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yang Zhang
- Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Fang Han
- Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Qian Xu
- Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Tongtong Ye
- Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ningning Hou
- Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xiaodong Sun
- Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
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97
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Klonoff DC, Messler J, Valk T, Jagannathan R, Pasquel FJ, Umpierrez GE. Clinical Trials of COVID-19 Therapies Should Account for Diabetes and Hyperglycemia. J Diabetes Sci Technol 2021; 15:1181-1187. [PMID: 34159841 PMCID: PMC8442178 DOI: 10.1177/19322968211013369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Complications of Coronavirus Disease 2019 (COVID-19) occur with increased frequency in people admitted to the hospital with diabetes or hyperglycemia. The increased risk for COVID-19 infections in the presence of these metabolic conditions is in part due to overlapping pathophysiologic features of COVID-19, diabetes, and glucose control. Various antiviral treatments are being tested in COVID-19 patients. We believe that in these trials, it will be useful to evaluate treatment effect differences in patients stratified according to whether they have diabetes or hyperglycemia. In this way, it will be possible to better facilitate development of antiviral treatments that are most specifically beneficial for the large subset of COVID-19 patients who have diabetes or hyperglycemia.
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Affiliation(s)
- David C. Klonoff
- Mills-Peninsula Medical Center, San
Mateo, CA, USA
- David C. Klonoff, M.D., FACP, FRCP (Edin),
Fellow AIMBE, Medical Director, Diabetes Research Institute, Mills-Peninsula
Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, CA 94401, USA.
| | | | - Timothy Valk
- Admetsys Corporation, Research
Division, Winter Park, FL, USA
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98
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Al-Kuraishy HM, Al-Gareeb AI, Qusty N, Alexiou A, Batiha GES. Impact of Sitagliptin in Non-Diabetic Covid-19 Patients. Curr Mol Pharmacol 2021; 15:683-692. [PMID: 34477540 DOI: 10.2174/1874467214666210902115650] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/09/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In Coronavirus disease 2019 (Covid-19), SARS-CoV-2 may use dipeptidyl peptidase 4 (DPP4) as an entry-point in different tissues expressing these receptors. DPP4 inhibitors (DPP4Is), also named gliptins like sitagliptin, have anti-inflammatory and antioxidant effects; thereby lessen inflammatory and oxidative stress in diabetic Covid-19 patients. Therefore, the present study aimed to illustrate the potential beneficial effect of sitagliptin in managing Covid-19 in non-diabetic patients. METHODS A total number of 89 patients with Covid-19 were recruited from a single-center at the time of diagnosis. The recruited patients were assigned according to the standard therapy for Covid-19 and our interventional therapy into two groups; Group A: Covid-19 patients on the standard therapy (n=40) and Group B: Covid-19 patients on the standard therapy plus sitagliptin (n=49). The duration of this interventional study was 28 days according to the guideline in management patients with Covid-19. Routine laboratory investigations, serological tests, complete blood count (CBC), C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), and serum ferritin were measured to observed Covid-19 severity and complications. Lung computed tomography (CT) and clinical scores were evaluated. RESULTS The present study illustrated that sitagliptin add-on standard therapy improved clinical outcomes, radiological scores, and inflammatory biomarkers than standard therapy alone in non-diabetic patients with Covid-19 (P<0.01). CONCLUSIONS Sitagliptin add-on standard therapy in managing non-diabetic Covid-19 patients may have a robust beneficial effect by modulating inflammatory cytokines with subsequent good clinical outcomes.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, Baghdad. Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, Baghdad. Iraq
| | - Naeem Qusty
- Medical Laboratories Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca. Saudi Arabia
| | | | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, AlBeheira, Egypt
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99
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Ealey KN, Phillips J, Sung HK. COVID-19 and obesity: fighting two pandemics with intermittent fasting. Trends Endocrinol Metab 2021; 32:706-720. [PMID: 34275726 PMCID: PMC8226104 DOI: 10.1016/j.tem.2021.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Obesity is strongly and independently associated with an increased risk of severe illness and death from coronavirus disease 2019 (COVID-19). The pathophysiological changes that result from elevated body weight lead to metabolic dysfunction, chronic inflammation, impaired immunological responses, and multisystem disorders, which increase vulnerability to severe illness from COVID-19. While vaccination strategies are under way across the world, the second and third waves of the pandemic, along with the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains, continue to threaten the stability of medical systems worldwide. Furthermore, evidence from previous pandemics suggests that vaccines are less effective in obese individuals than in their healthy-weight counterparts over the long term. Therefore, a consideration of lifestyle changes that can boost metabolic health and immunity is critical to reduce the risk of complications and severe illness from viral infection. In this review, we discuss the potential mechanisms linking excess body weight with COVID-19 morbidity. We also present evidence that intermittent fasting (IF), a dietary program that has gained popularity in recent years, may be an effective strategy to improve metabolic health and immunity and thus reduce the impact of obesity on COVID-19 morbidity and mortality.
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Affiliation(s)
- Kafi N Ealey
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Joy Phillips
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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100
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Asfour HZ, Alhakamy NA, Eljaaly K, Alaofi AL, Tantawy MA, Hussein KS, Aldarmahi AA, Elfaky MA. Molecular docking studies of HIV TAT and sitagliptin nano-formula as potential therapeutic targeting SARS-CoV2 protease. J INDIAN CHEM SOC 2021. [PMCID: PMC8349443 DOI: 10.1016/j.jics.2021.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The outbreak of COVID-19 pandemic regarded as a major health/economic hazard. The importance of coming up with mechanisms for preventing or treating SARS-CoV-2infection has been felt across the world. This work aimed at examining the efficiency of Sitagliptin (SIT) and human immunodeficiency virus type 1 (HIV-1) trans-activator transcription peptide (TAT) against SARS-CoV-2 virus. 3CL-protease inhibition activity and docking studies were examined. According to the results, the prepared complex's formula was as follows 1: 1 SIT: TAT molar ratio, whereas zeta potential and particle size values were at 34.17 mV and 97.19 nm, respectively. This combination did exhibit its antiviral potentiality against SARS-CoV-2 via IC50 values of 9.083 5.415, and 16.14 μM for TAT, SIT-TAT, and SIT, respectively. In addition, the complex SIT-TAT showed a significant (P < 0.001) viral-3CL-protease inhibitory effect. This was further confirmed via in silico study. Molecular docking investigation has shown promising binding affinity of the formula components towards SARS-CoV-2 main protease (3-CL).
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