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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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Jacobs J, Johnson AK, Boshara A, Hunt B, Khouri C, Cruz J, Glick N. COVID-19 health inequities and association with mechanical ventilation and prolonged length of stay at an urban safety-net health system in Chicago. PLoS One 2021; 16:e0258243. [PMID: 34644327 PMCID: PMC8513837 DOI: 10.1371/journal.pone.0258243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023] Open
Abstract
Millions of Americans have been infected with COVID-19 and communities of color have been disproportionately burdened. We investigated the relationship between demographic characteristics and COVID-19 positivity, and comorbidities and severe COVID-19 illness (use of mechanical ventilation and length of stay) within a racial/ethnic minority population. Patients tested for COVID-19 between March 2020 and January 2021 (N = 14171) were 49.9% (n = 7072) female; 50.1% (n = 7104) non-Hispanic Black; 33.2% (n = 4698) Hispanic; and 23.6% (n = 3348) aged 65+. Overall COVID-19 positivity was 16.1% (n = 2286). Compared to females, males were 1.1 times more likely to test positive (p = 0.014). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic persons were 1.4 (p = 0.003) and 2.4 (p<0.001) times more likely, respectively, to test positive. Compared to persons ages 18-24, the odds of testing positive were statistically significantly higher for every age group except 25-34, and those aged 65+ were 2.8 times more likely to test positive (p<0.001). Adjusted for race, sex, and age, COVID-positive patients with chronic obstructive pulmonary disease were 1.9 times more likely to require a ventilator compared to those without chronic obstructive pulmonary disease (p = 0.001). Length of stay was not statistically significantly associated with any of the comorbidity variables. Our findings emphasize the importance of documenting COVID-19 disparities in marginalized populations.
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Affiliation(s)
- Jacquelyn Jacobs
- Sinai Urban Health Institute, Sinai Health System, Chicago, Illinois, United States of America
| | - Amy K. Johnson
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Arianna Boshara
- Sinai Urban Health Institute, Sinai Health System, Chicago, Illinois, United States of America
| | - Bijou Hunt
- Sinai Urban Health Institute, Sinai Health System, Chicago, Illinois, United States of America
- Sinai Infectious Disease Center, Chicago, Illinois, United States of America
| | - Christina Khouri
- Chicago Medical School at Rosalind Franklin University, North Chicago, Illinois, United States of America
| | - Javier Cruz
- Chicago Medical School at Rosalind Franklin University, North Chicago, Illinois, United States of America
| | - Nancy Glick
- Sinai Infectious Disease Center, Chicago, Illinois, United States of America
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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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204
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Xu Y, Yang X, Bian H, Xia M. Metabolic dysfunction associated fatty liver disease and coronavirus disease 2019: clinical relationship and current management. Lipids Health Dis 2021; 20:126. [PMID: 34602072 PMCID: PMC8487451 DOI: 10.1186/s12944-021-01564-z] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). At present, the COVID-19 has been prevalent worldwide for more than a year and caused more than four million deaths. Liver injury was frequently observed in patients with COVID-19. Recently, a new definition of metabolic dysfunction associated fatty liver disease (MAFLD) was proposed by a panel of international experts, and the relationship between MAFLD and COVID-19 has been actively investigated. Several previous studies indicated that the patients with MAFLD had a higher prevalence of COVID-19 and a tendency to develop severe type of respiratory infection, and others indicated that liver injury would be exacerbated in the patients with MAFLD once infected with COVID-19. The mechanism underlying the relationship between MAFLD and COVID-19 infection has not been thoroughly investigated, and recent studies indicated that multifactorial mechanisms, such as altered host angiotensin converting enzyme 2 (ACE2) receptor expression, direct viral attack, disruption of cholangiocyte function, systemic inflammatory reaction, drug-induced liver injury, hepatic ischemic and hypoxic injury, and MAFLD-related glucose and lipid metabolic disorders, might jointly contribute to both of the adverse hepatic and respiratory outcomes. In this review, we discussed the relationship between MAFLD and COVID-19 based on current available literature, and summarized the recommendations for clinical management of MAFLD patients during the pandemic of COVID-19.
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Affiliation(s)
- Yanlan Xu
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Department of Geriatrics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, 201700, China
| | - Xinyu Yang
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hua Bian
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Fudan Institute for Metabolic Diseases, Shanghai, 200032, China.
| | - Mingfeng Xia
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Fudan Institute for Metabolic Diseases, Shanghai, 200032, China.
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Lim S, Kong APS, Tuomilehto J. Influence of COVID-19 pandemic and related quarantine procedures on metabolic risk. Prim Care Diabetes 2021; 15:745-750. [PMID: 34312109 PMCID: PMC8286866 DOI: 10.1016/j.pcd.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has changed the lives of many people across the globe. In addition to the effect of the virus on the biological functions in those infected individuals, many countries have launched government policy with additional impact of these quarantine procedures on the metabolic health of many people worldwide. This mini-review aimed to highlight current evidence regarding the influence of metabolic health due to these quarantine procedures including decrease in physical activity, changes in unhealthy eating habits, increase in stress, and provide recommendations of healthy lifestyle during COVID-19 pandemic.
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Affiliation(s)
- Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Alice Pik-Shan Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland; Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
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206
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Jacob E, Avery A. Energy-restricted interventions are effective for the remission of newly diagnosed type 2 diabetes: A systematic review of the evidence base. Obes Sci Pract 2021; 7:606-618. [PMID: 34631138 PMCID: PMC8488441 DOI: 10.1002/osp4.504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a chronic, progressive disease. Caloric restriction and subsequent weight loss have been associated with both improvements and, in some cases, remission of T2D. AIM To systematically review the safety and effectiveness of calorie-restricted diets on weight change and the remission of T2D. METHODS Electronic databases were searched. Intervention trials including a calorie restriction, published between 2010 and 2020, evaluating the remission of T2D (HbA1c <6.5% without diabetes medication) were selected. Risk of bias was assessed. RESULTS Eight trials met inclusion criteria including four randomized controlled and four single-arm trials. Three controlled trials found greater remission in the calorie-restricted arm (p < 0.05). A recent diagnosis of diabetes was associated with higher remission rates (75%-80%) with an inverse association between duration of diabetes and rate of remission (r = -0.94). A higher level of remission was observed with greater calorie restriction in non-new diagnosis studies. Greater weight loss was associated with increasing rates of remission (r = 0.83). No reported adverse events led to withdrawal from trials. There was great heterogeneity in study design. CONCLUSION Remission rate of T2D achieved through calorie restriction is high and similar to that reported in the bariatric surgery literature. Remission should be the aim at diagnosis and calorie restriction could be used to achieve this. The target weight loss should be >10% body weight in people with obesity. More research is needed into the optimum level of calorie restriction and the support required for long-term remission. National guidelines should be updated to reflect recent evidence.
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Affiliation(s)
| | - Amanda Avery
- Faculty of ScienceThe University of NottinghamNottinghamUK
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207
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Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic. DIABETES EPIDEMIOLOGY AND MANAGEMENT 2021; 4:100022. [PMID: 35072135 PMCID: PMC8556094 DOI: 10.1016/j.deman.2021.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023]
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment. Methods The ISACS-STEMI COVID-19 registry retrospectively assessed STEMI patients treated with primary percutaneous coronary intervention (PPCI) in March/June 2019 and 2020 in 109 European high-volume primary PCI centers. This subanalysis assessed the prognostic impact of chronic RASI therapy at admission on mortality and SARS-CoV2 infection among diabetic patients. Results Our population is represented by 3812 diabetic STEMI patients undergoing mechanical reperfusion, 2038 in 2019 and 1774 in 2020. Among 3761 patients with available data on chronic RASI therapy, between those ones with and without treatment there were several differences in baseline characteristics, (similar in both periods) but no difference in the prevalence of SARS-CoV2 infection (1.6% vs 1.3%, respectively, p = 0.786). Considering in-hospital medication, RASI therapy was overall associated with a significantly lower in-hospital mortality (3.3% vs 15.8%, p < 0.0001), consistently both in 2019 and in 2010. Conclusions This is first study to investigate the impact of RASI therapy on prognosis and SARS-CoV2 infection of diabetic patients experiencing STEMI and undergoing PPCI during the COVID-19 pandemic. Both pre-admission chronic RASI therapy and in-hospital RASI did not negatively affected patients’ survival during the hospitalization, neither increased the risk of SARS-CoV2 infection. Trial registration number NCT 04412655
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208
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Abstract
This article summarizes clinical observations and management strategies in pediatric type 1 diabetes (T1D) during the coronavirus disease 2019 (COVID-19) pandemic. Despite initial fears that children with diabetes would, similar to adults with diabetes, be at risk for severe COVID-19, most pediatric patients with a history of T1D who developed COVID-19 had mild disease or were asymptomatic similar to their peers without diabetes. The article also summarizes the use of telemedicine to provide ongoing care for pediatric patients with T1D during the COVID-19 pandemic. Finally, the article highlights important lessons learned about management of pediatric diabetes during the COVID-19 pandemic.
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209
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Xie W, Wu N, Wang B, Xu Y, Zhang Y, Xiang Y, Zhang W, Chen Z, Yuan Z, Li C, Jia X, Shan Y, Xu B, Bai L, Zhong L, Li Y. Fasting plasma glucose and glucose fluctuation are associated with COVID-19 prognosis regardless of pre-existing diabetes. Diabetes Res Clin Pract 2021; 180:109041. [PMID: 34500004 PMCID: PMC8420085 DOI: 10.1016/j.diabres.2021.109041] [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: 06/25/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
AIMS We aimed to investigate the role of Fasting Plasma Glucose (FPG) and glucose fluctuation in the prognosis of COVID-19 patients stratified by pre-existing diabetes. METHODS The associations of FPG and glucose fluctuation indexes with prognosis of COVID-19 in 2,642 patients were investigated by multivariate Cox regression analysis. The primary outcome was in-hospital mortality; the secondary outcome was disease progression. The longitudinal changes of FPG over time were analyzed by the latent growth curve model in COVID-19 patients stratified by diabetes and severity of COVID-19. RESULTS We found FPG as an independent prognostic factor of overall survival after adjustment for age, sex, diabetes and severity of COVID-19 at admission (HR: 1.15, 95% CI: 1.06-1.25, P = 1.02 × 10-3). Multivariate logistic regression analysis indicated that the standard deviation of blood glucose (SDBG) and largest amplitude of glycemic excursions (LAGE) were also independent risk factors of COVID-19 progression (P = 0.03 and 0.04, respectively). The growth trajectory of FPG over the first 3 days of hospitalization was steeper in patients with critical COVID-19 in comparison to moderate patients. CONCLUSIONS Hyperglycemia and glucose fluctuation were adverse prognostic factors of COVID-19 regardless of pre-existing diabetes. This stresses the importance of glycemic control in addition to other therapeutic management.
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Affiliation(s)
- Weijia Xie
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Na Wu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Bin Wang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of The Army Medical University, Chongqing 401120, People's Republic of China
| | - Yu Xu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of The Army Medical University, Chongqing 401120, People's Republic of China
| | - Yao Zhang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Ying Xiang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Wenjing Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of The Army Medical University, Chongqing 401120, People's Republic of China
| | - Zheng Chen
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Zhiquan Yuan
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Chengying Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Xiaoyue Jia
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Yifan Shan
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Bin Xu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China
| | - Li Bai
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of The Army Medical University, Chongqing 401120, People's Republic of China
| | - Li Zhong
- Cardiovascular Disease Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, People's Republic of China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 401120, People's Republic of China.
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Impact of Metabolic Syndrome in the Clinical Outcome of Disease by SARS-COV-2. Arch Med Res 2021; 52:738-745. [PMID: 33926762 PMCID: PMC8041184 DOI: 10.1016/j.arcmed.2021.04.001] [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] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/14/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND It has been observed that subjects with comorbidities related to metabolic syndrome (MetS) as hypertension, obesity, cardiovascular disease (CVD), and diabetes mellitus (DM2) show severe cases and a higher mortality by COVID-19. To date, there is little information available on the impact of the interaction between these comorbidities in the risk of death by COVID-19. AIM OF THE STUDY To evaluate the impact of the combinations of MetS components in overall survival (OS) and risk of death among COVID-19 patients. METHODS Using public data of the Ministry of Health, suspected, and confirmed COVID-19 cases from February 25-June 6, 2020 was analyzed. Mortality odds ratio (OR) was calculated with a univariate analysis (95% CI) and attributable risk. Interactions between components and survival curves were analyzed and a multivariate logistics regression analysis was conducted. RESULTS The analysis included 528,651 cases out of which 202,951 were confirmed for COVID-19. Probabilities of OS among confirmed patients were 0.93, 0.89, 0.87, 0.86, and 0.83 while the OR of multivariate analysis was 1.83 (1.77-1.89), 2.58 (2.48-2.69), 2.83 (2.66-3.01), and 3.36 (2.83-3.99) for zero, one, two, three, and four MetS components, respectively. The combination with the highest risk was DM2 + hypertension at 2.22 (2.15-2.28), and the attributable risk for any component was 9.35% (9.21-9.49). Only the combination obesity + CVD showed no significant interaction. CONCLUSION The presence of one MetS component doubles the risk of death by COVID-19, which was higher among patients with DM2 + hypertension. Only obesity and CVD do not interact significantly.
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Coronavirus induces diabetic macrophage-mediated inflammation via SETDB2. Proc Natl Acad Sci U S A 2021; 118:2101071118. [PMID: 34479991 PMCID: PMC8463849 DOI: 10.1073/pnas.2101071118] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has disproportionately affected patients with comorbidities, namely, obesity and type 2 diabetes. Macrophages (Mφs) are a key innate immune cell primarily responsible for the harmful, hyperinflammatory “cytokine storm” in patients that develop severe COVID-19. We describe a mechanism for this Mφ-mediated cytokine storm in response to coronavirus. In response to coronavirus infection, expression of the chromatin-modifying enzyme, SETDB2, decreases in Mφs, leading to increased transcription of inflammatory cytokines. Further, we find SETDB2 is regulated by an interferon beta (IFNβ)/JaK/STAT3 mechanism, and that exogenous administration of IFNβ can reverse inflammation, particularly in diabetic Mφs via an increase in SETDB2. Together, these results suggest therapeutic targeting of the IFNβ/SETDB2 axis in diabetic patients with COVID-19 may decrease pathologic inflammation. COVID-19 induces a robust, extended inflammatory “cytokine storm” that contributes to an increased morbidity and mortality, particularly in patients with type 2 diabetes (T2D). Macrophages are a key innate immune cell population responsible for the cytokine storm that has been shown, in T2D, to promote excess inflammation in response to infection. Using peripheral monocytes and sera from human patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and a murine hepatitis coronavirus (MHV-A59) (an established murine model of SARS), we identified that coronavirus induces an increased Mφ-mediated inflammatory response due to a coronavirus-induced decrease in the histone methyltransferase, SETDB2. This decrease in SETDB2 upon coronavirus infection results in a decrease of the repressive trimethylation of histone 3 lysine 9 (H3K9me3) at NFkB binding sites on inflammatory gene promoters, effectively increasing inflammation. Mφs isolated from mice with a myeloid-specific deletion of SETDB2 displayed increased pathologic inflammation following coronavirus infection. Further, IFNβ directly regulates SETDB2 in Mφs via JaK1/STAT3 signaling, as blockade of this pathway altered SETDB2 and the inflammatory response to coronavirus infection. Importantly, we also found that loss of SETDB2 mediates an increased inflammatory response in diabetic Mϕs in response to coronavirus infection. Treatment of coronavirus-infected diabetic Mφs with IFNβ reversed the inflammatory cytokine production via up-regulation of SETDB2/H3K9me3 on inflammatory gene promoters. Together, these results describe a potential mechanism for the increased Mφ-mediated cytokine storm in patients with T2D in response to COVID-19 and suggest that therapeutic targeting of the IFNβ/SETDB2 axis in T2D patients may decrease pathologic inflammation associated with COVID-19.
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Kazakou P, Paschou SA, Psaltopoulou T, Gavriatopoulou M, Korompoki E, Stefanaki K, Kanouta F, Kassi GN, Dimopoulos MA, Mitrakou A. Early and late endocrine complications of COVID-19. Endocr Connect 2021; 10:R229-R239. [PMID: 34424853 PMCID: PMC8494407 DOI: 10.1530/ec-21-0184] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 08/20/2021] [Indexed: 01/08/2023]
Abstract
Endocrine system plays a vital role in controlling human homeostasis. Understanding the possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19-infected patients as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express angiotensin-converting enzyme 2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with low triiodothyronine, low thyroid stimulating hormone, or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited, and therefore, long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.
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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
| | - Stavroula A Paschou
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Unit of Hematology and Oncology, 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
| | - Katerina Stefanaki
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Kanouta
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Meletios-Athanasios 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 should be addressed to A Mitrakou:
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Kazakou P, Paschou SA, Psaltopoulou T, Gavriatopoulou M, Korompoki E, Stefanaki K, Kanouta F, Kassi GN, Dimopoulos MA, Mitrakou A. Early and late endocrine complications of COVID-19. Endocr Connect 2021. [PMID: 34424853 DOI: 10.1530/ec-21-0184.pmid:34424853;pmcid:pmc8494407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Endocrine system plays a vital role in controlling human homeostasis. Understanding the possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19-infected patients as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express angiotensin-converting enzyme 2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with low triiodothyronine, low thyroid stimulating hormone, or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited, and therefore, long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.
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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
| | - Stavroula A Paschou
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Unit of Hematology and Oncology, 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
| | - Katerina Stefanaki
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Kanouta
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Meletios-Athanasios 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
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214
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Gangadharan C, Ahluwalia R, Sigamani A. Diabetes and COVID-19: Role of insulin resistance as a risk factor for COVID-19 severity. World J Diabetes 2021; 12:1550-1562. [PMID: 34630907 PMCID: PMC8472493 DOI: 10.4239/wjd.v12.i9.1550] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/11/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with diabetes are more susceptible to coronavirus disease 2019 (COVID-19), and as a consequence, develop more severe form of disease. This is partly due to a systemic inflammatory state and pro thrombotic milieu seen in metabolic syndrome. In this review, we attempt to explore the pathogenetic links between insulin resistance and COVID-19 disease severity. Insulin resistance is an underlying condition for metabolic syndromes, including type 2 diabetes, which impairs insulin signaling pathways affecting metabolic and cardiovascular homeostasis. A high concentration of circulating insulin shifts the balance to mitogen activated protein kinase (MAPK)-dependent signaling and causes endothelial cell damage. The phosphatidylinositol 3 kinase and MAPK dependent signaling pathways maintain a balance between nitric oxide-dependent vasodilator and endothelin-1 dependent vasoconstriction actions of insulin. Vascular smooth muscle cell dysfunction is responsible for inflammation and blood coagulation leading to microvascular and macrovascular complications in diabetes. Hyperactivity in renin-angiotensin system is implicated in development of islet oxidative stress and subsequent β-cell dysfunction, as it alters the islet blood flow. These deleterious effects of insulin resistance involving altered blood pressure, vascular dysfunction, and inflammation could be associated with increased severity in COVID-19 patients. We conclude that clinical and/or biochemical markers of insulin resistance should be included as prognostic markers in assessment of acute COVID-19 disease.
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Affiliation(s)
- Charitha Gangadharan
- Department of Clinical Research, Narayana Hrudayalaya Limited, Bangalore 560099, Karnataka, India
| | - Rupa Ahluwalia
- Consultant in Diabetes and Endocrinology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - Alben Sigamani
- Chief Scientific Officer, Numen Health, Bangalore 560095, Karnataka, India
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215
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Morse J, Gay W, Korwek KM, McLean LE, Poland RE, Guy J, Sands K, Perlin JB. Hyperglycaemia increases mortality risk in non-diabetic patients with COVID-19 even more than in diabetic patients. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00291. [PMID: 34505406 PMCID: PMC8420416 DOI: 10.1002/edm2.291] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 01/08/2023]
Abstract
Aim Diabetes has been identified as a risk factor for poor outcomes in patients with COVID‐19. We examined the association of hyperglycaemia, both in the presence and absence of pre‐existing diabetes, with severity and outcomes in COVID‐19 patients. Methods Data from 74,148 COVID‐19‐positive inpatients with at least one recorded glucose measurement during their inpatient episode were analysed for presence of pre‐existing diabetes diagnosis and any glucose values in the hyperglycaemic range (>180 mg/dl). Results Among patients with and without a pre‐existing diabetes diagnosis on admission, mortality was substantially higher in the presence of high glucose measurements versus all measurements in the normal range (70–180 mg/dl) in both groups (non‐diabetics: 21.7% vs. 3.3%; diabetics 14.4% vs. 4.3%). When adjusting for patient age, BMI, severity on admission and oxygen saturation on admission, this increased risk of mortality persisted and varied by diabetes diagnosis. Among patients with a pre‐existing diabetes diagnosis, any hyperglycaemic value during the episode was associated with a substantial increase in the odds of mortality (OR: 1.77, 95% CI: 1.52–2.07); among patients without a pre‐existing diabetes diagnosis, this risk nearly doubled (OR: 3.07, 95% CI: 2.79–3.37). Conclusion This retrospective analysis identified hyperglycaemia in COVID‐19 patients as an independent risk factor for mortality after adjusting for the presence of diabetes and other known risk factors. This indicates that the extent of glucose control could serve as a mechanism for modifying the risk of COVID‐19 morality in the inpatient environment.
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Affiliation(s)
- Jennifer Morse
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | - Wendy Gay
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | | | - Laura E McLean
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | | | - Jeffrey Guy
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | - Kenneth Sands
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
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216
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Campos-Murguía A, Román-Calleja BM, González-Regueiro JA, Hurtado-Díaz-de-León I, Solís-Ortega AA, Flores-García NC, García-Juárez I, Ruiz-Margáin A, Macías-Rodríguez RU. Clinical perspectives, assessment, and mechanisms of metabolic-associated fatty liver disease in patients with COVID-19. World J Gastroenterol 2021; 27:5502-5519. [PMID: 34588748 PMCID: PMC8433612 DOI: 10.3748/wjg.v27.i33.5502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/17/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Metabolic diseases are highly prevalent worldwide and have been associated with adverse clinical outcomes, including mortality, in patients developing coronavirus disease (COVID-19). Because of the close relationship between metabolic diseases such as type 2 diabetes mellitus and obesity and the presence of metabolic-associated fatty liver disease (MAFLD), a high number of cases of patients affected by both MAFLD and COVID-19 would be expected, especially in high-risk populations. Some studies have shown an increased risk of adverse clinical outcomes, viral shedding, and deep vein thrombosis, especially in patients with MAFLD- related liver fibrosis. The predisposition to poor outcomes and severe acute respiratory syndrome coronavirus 2 infection in patients with MAFLD could be secondary to mechanisms common to both, including preexisting systemic chronic inflammation, endothelial dysfunction, and involvement of the renin-angiotensin system. Because of the increased risk of adverse outcomes, MAFLD should be screened in all patients admitted for COVID-19. Available computed tomography scans could be of help, assessment of liver fibrosis is also recommended, favoring noninvasive methods to limit the exposure of healthcare workers. Liver involvement in this population ranges from abnormalities in liver chemistry to hepatic steatosis in postmortem biopsies. Finally, preventive measures should be strongly advocated in patients already known to have MAFLD, including the use of telemedicine and vaccination in addition to general measures.
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Affiliation(s)
- Alejandro Campos-Murguía
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Berenice M Román-Calleja
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - José A González-Regueiro
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Ivonne Hurtado-Díaz-de-León
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Alberto Adrián Solís-Ortega
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Nayelli C Flores-García
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Ignacio García-Juárez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Astrid Ruiz-Margáin
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Liver Fibrosis and Nutrition Lab (LFN-Lab), MICTLÁN-Network (Mechanisms of Liver Injury, Cell Death and Translational Nutrition in Liver Diseases- Research Network), Mexico City 14080, Mexico
| | - Ricardo Ulises Macías-Rodríguez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Liver Fibrosis and Nutrition Lab (LFN-Lab), MICTLÁN-Network (Mechanisms of Liver Injury, Cell Death and Translational Nutrition in Liver Diseases- Research Network), Mexico City 14080, Mexico
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217
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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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218
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Danne T, Limbert C, Puig Domingo M, Del Prato S, Renard E, Choudhary P, Seibold A. Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future. Diabetes Ther 2021; 12:2289-2310. [PMID: 34338994 PMCID: PMC8327601 DOI: 10.1007/s13300-021-01114-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023] Open
Abstract
People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70-180 mg/dL (3.9-10 mmol/L) increased across 19/27 cohorts with a median 3.3% (- 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.
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Affiliation(s)
- Thomas Danne
- Diabetes Center for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
| | - Catarina Limbert
- Unit for Paediatric Endocrinology and Diabetes, CHULC, Hospital Dona Estefania, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Manel Puig Domingo
- Endocrinology and Nutrition Service, Department of Medicine, Germans Trias i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Department of Physiology, Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pratik Choudhary
- Department of Diabetes and Nutritional Sciences, King's College London, London, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
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219
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Jayaswal SK, Singh S, Malik PS, Venigalla SK, Gupta P, Samaga SN, Hota RN, Bhatia SS, Gupta I. Detrimental effect of diabetes and hypertension on the severity and mortality of COVID-19 infection: A multi-center case-control study from India. Diabetes Metab Syndr 2021; 15:102248. [PMID: 34412000 PMCID: PMC8364674 DOI: 10.1016/j.dsx.2021.102248] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023]
Abstract
AIMS This study aims to find a quantitative association between the presence of co-existing diabetes mellitus (DM) and/or hypertension (HTN) with COVID-19 infection severity and mortality. METHODS A total of 813 patients with a positive COVID-19 were included. A case-control design was used to dissect the association between DM and HTN with COVID-19 severity and mortality. RESULTS According to MOHFW guidelines, 535 (65.7%) patients had mild, 160 (19.7%) patients had moderate, and 118 (14.5%) patients had severe disease outcomes including mortality in 52 patients. Age, Neutrophil%, and Diabetes status were significantly associated with severe COVID-19 infection. After adjusting for age, patients with diabetes were 2.46 times more likely to have severe disease (Chi-squared = 18.89, p-value<0.0001) and 2.11 times more likely to have a fatal outcome (Chi-squared = 6.04, p-value = 0.014). However, we did not find evidence for Hypertension modifying the COVID-19 outcomes in Diabetic patients. CONCLUSION COVID-19 severity and mortality both were significantly associated with the status of DM and its risk may not be modified by the presence of HTN.
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Affiliation(s)
- Sneha Kumar Jayaswal
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi, 110016, India.
| | - Shalendra Singh
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, 411040, Maharashtra, India.
| | - Prabhat Singh Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India.
| | - Sri Krishna Venigalla
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, 411040, Maharashtra, India.
| | - Pallavi Gupta
- Department of Biological Sciences, Indian Institute of Science Education and Research, Bhopal, Bhauri, Madhya Pradesh, 462066, India.
| | - Shreyas N Samaga
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi, 110016, India.
| | - Rabi Narayan Hota
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, 411040, Maharashtra, India.
| | | | - Ishaan Gupta
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi, 110016, India.
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220
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Shah VS, Pareikh D, Manjunatha BS. Salivary alpha-amylase-biomarker for monitoring type II diabetes. J Oral Maxillofac Pathol 2021; 25:441-445. [PMID: 35281155 PMCID: PMC8859584 DOI: 10.4103/jomfp.jomfp_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Diabetes is one of the most important causes of mortality worldwide. People having diabetes are vulnerable to infectious diseases and have been clinically recognized; which may be because of their deregulated immune system. Hyperglycemia in diabetes is consequence of chronic resistance to insulin and relative insulin deficiency on target cells. Alpha-amylase, a salivary enzyme is shown to increase in diabetic individuals compared to nondiabetics and can be used as a marker for the diagnosis of diabetes. Aim and Objective: The present study was undertaken to investigate the levels of salivary amylase in type II diabetic patients. Materials and Methods: A total of 80 participants in the age range of 30–60 years, were divided into three groups as Group I: Uncontrolled diabetics (30), Group II: Controlled diabetics (30) and Group III: Age- and sex-matched healthy controls (20) were taken for the study. Unstimulated whole saliva was collected for salivary amylase level estimation and blood samples were from the antecubital vein, after 12 h of overnight fasting of each individual for the estimation of blood glucose levels. Results: The mean random blood sugar and glycated hemoglobin A1c levels were found to be statistically significant among diabetics and healthy individuals. Salivary amylase levels were much higher in uncontrolled and controlled diabetics compared to healthy individuals showing a significant correlation (P = 0.001) between all groups. However, the salivary amylase levels nonsignificant (P = 0.060) between the controlled diabetics (Group II) and healthy individuals (Group III). Conclusion: Our study confirms the considerable increase in salivary amylase levels in diabetes patients as compared to healthy individuals. Studies with a larger sample size comprising prediabetics, type I diabetics and type II diabetics in all age groups are required to validate these results. Further, if our results are established, salivary amylase can be used as biomarker for the diagnosis of diabetes and also monitoring it.
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Affiliation(s)
- Vandana S Shah
- Department of Oral and Maxillofacial Pathology, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Waghodia, Gujarat, India
| | - Dishant Pareikh
- Dental Surgeon, Rajpath Society, Old Padra Road, Vadodara, Gujarat, India
| | - Bhari S Manjunatha
- Department of Basic Oral Medicine and Allied Dental Sciences, College of Dentistry, Al-Hawaiya, Taif University, At Taif, Kingdom of Saudi Arabia
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221
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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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222
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Choudhary P, Bellido V, Graner M, Altpeter B, Cicchetti A, Durand-Zaleski I, Kristensen FB. The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond. Diabetes Ther 2021; 12:2311-2327. [PMID: 34390477 PMCID: PMC8363869 DOI: 10.1007/s13300-021-01132-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.
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Affiliation(s)
- Pratik Choudhary
- Leicester Diabetes Centre (Bloom), Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Bernd Altpeter
- Digital Health Groupe and German Institute of Telemedicine, Frankfurt, Germany
| | - Americo Cicchetti
- School of Healthcare Systems, Economics and Management, Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Finn Børlum Kristensen
- Danish Centre for Health Economics (DaCHE), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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223
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Dandona P, Ghanim H. Diabetes, Obesity, COVID-19, Insulin, and Other Antidiabetes Drugs. Diabetes Care 2021; 44:1929-1933. [PMID: 34244331 DOI: 10.2337/dci21-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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Kesavadev J, Basanth A, Krishnan G, Vitale R, Parameswaran H, Shijin S, R S, Raj S, Ashik A, Shankar A, Badarudeen S, Raveendran AV, Rajalakshmy I, Sanal G, Manoj A, Jose R, Unes Y, Jothydev S. A new interventional home care model for COVID management: Virtual Covid IP. Diabetes Metab Syndr 2021; 15:102228. [PMID: 34330071 PMCID: PMC8299213 DOI: 10.1016/j.dsx.2021.102228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 02/09/2023]
Abstract
AIM Amidst COVID-19 pandemic, the health care delivery in India faces major challenges owing to the overwhelming hospitals, exhausted healthcare workers, and shortage of crucial medical supplies such as ventilators and oxygen. The study aims to propose a novel successful interventional home care model, the Virtual COVID In-Patient (VCIP) care for effective COVID management. METHODS The Covid-19 positive patients enrolled in VCIP were chosen for the study. A 24/7 active multidisciplinary WhatsApp group was created for each patient, for remote monitoring of temperature, blood pressure, blood glucose, respiratory and pulse rate along with the symptoms. Advice on sleep and exercises were given along with the medication via video-audio consultations. Lab facility was provided at the doorstep. Training on various devices, medications including steroids, delivering subcutaneous injections etc were given via video platforms. RESULTS Among the 220 patients who availed the VCIP facility, only two were hospitalized, yielding a 99.5 % success rate in preventing hospitalizations and patients enrolled have been immensely satisfied with their experience. CONCLUSIONS With similar pandemics anticipated in near future, VCIP model may be considered for successful domiciliary treatment and overcoming the challenges.
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Affiliation(s)
- Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India.
| | - Anjana Basanth
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Gopika Krishnan
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Rebecca Vitale
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Hari Parameswaran
- Department of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sajna Shijin
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Sreelakshmi R
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Sumesh Raj
- Department of Internal Medicine, Sree Gokulam Medical College, Trivandrum, India
| | - Asha Ashik
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Arun Shankar
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Sameer Badarudeen
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, USA
| | - A V Raveendran
- Department of Internal Medicine, Badr Al Samaa, Barka, Oman
| | - Indu Rajalakshmy
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Geethu Sanal
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Akhila Manoj
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Remya Jose
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Yaseen Unes
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
| | - Sunitha Jothydev
- Department of Diabetology, Jothydev's Diabetes Research Centers, Kerala, India
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Hakim A, Hasan MM, Hasan M, Lokman SM, Azim KF, Raihan T, Chowdhury PA, Azad AK. Major Insights in Dynamics of Host Response to SARS-CoV-2: Impacts and Challenges. Front Microbiol 2021; 12:637554. [PMID: 34512561 PMCID: PMC8424194 DOI: 10.3389/fmicb.2021.637554] [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] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), a pandemic declared by the World Health Organization on March 11, 2020, is caused by the infection of highly transmissible species of a novel coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As of July 25, 2021, there are 194,372,584 cases and 4,167,937 deaths with high variability in clinical manifestations, disease burden, and post-disease complications among different people around the globe. Overall, COVID-19 is manifested as mild to moderate in almost 90% of the cases and only the rest 10% of the cases need hospitalization. However, patients with older age and those having different comorbidities have made worst the pandemic scenario. The variability of pathological consequences and clinical manifestations of COVID-19 is associated with differential host-SARS-CoV-2 interactions, which are influenced by the factors that originated from the SARS-CoV-2 and the host. These factors usually include the genomic attributes and virulent factors of the SARS-CoV-2, the burden of coinfection with other viruses and bacteria, age and gender of the individuals, different comorbidities, immune suppressions/deficiency, genotypes of major histocompatibility complex, and blood group antigens and antibodies. We herein retrieved and reviewed literatures from PubMed, Scopus, and Google relevant to clinical complications and pathogenesis of COVID-19 among people of different age, sex, and geographical locations; genomic characteristics of SARS-CoV-2 including its variants, host response under different variables, and comorbidities to summarize the dynamics of the host response to SARS-CoV-2 infection; and host response toward approved vaccines and treatment strategies against COVID-19. After reviewing a large number of published articles covering different aspects of host response to SARS-CoV-2, it is clear that one aspect from one region is not working with the scenario same to others, as studies have been done separately with a very small number of cases from a particular area/region of a country. Importantly, to combat such a pandemic as COVID-19, a conclusive understanding of the disease dynamics is required. This review emphasizes on the identification of the factors influencing the dynamics of host responses to SARS-CoV-2 and offers a future perspective to explore the molecular insights of COVID-19.
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Affiliation(s)
- Al Hakim
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md. Mahbub Hasan
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, London, United Kingdom
| | - Mahmudul Hasan
- Department of Pharmaceutical and Industrial Biotechnology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Syed Mohammad Lokman
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Kazi Faizul Azim
- Department of Microbial Biotechnology, Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Topu Raihan
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Abul Kalam Azad
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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226
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Lesniak C, Ong R, Akula MS, Douedi S, Akoluk A, Soomro R, Copca-Alvarez A, Purewal T, Patel I, Upadhyaya V, Cheng J, Jain A, Asif A, Chalasani K, Hossain MA. Inpatient glycemic control and outcome of COVID-19 patients: A retrospective cohort. SAGE Open Med 2021; 9:20503121211039105. [PMID: 34422272 PMCID: PMC8375327 DOI: 10.1177/20503121211039105] [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: 04/20/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: Although there have been associations between diabetes and mortality in COVID-19 patients, it is unclear whether this is driven by the disease itself or whether it can be attributed to an inability to exhibit effective glucose control. Methods: We conducted a retrospective cohort study of 292 patients admitted to a tertiary referral center to assess the association of mortality and glycemic control among COVID-19-positive patients. We used a logistic regression model to determine whether average fasting glycemic levels were associated with in-hospital mortality. Results: Among the diabetic and non-diabetic patients, there were no differences between mortality or length of stay. Mean glucose levels in the first 10 days of admission were higher on average among those who died (150–185 mg/dL) compared with those who survived (125–165 mg/dL). When controlling for multiple variables, there was a significant association between mean fasting glucose and mortality (odds ratio = 1.014, p < 0.001). The associations between glucose and mortality remained when controlled for comorbidities and glucocorticoid use. Conclusion: The results of this retrospective study show an association between mortality and inpatient glucose levels, suggesting that there may be some benefit to tighter glucose control in patients diagnosed with COVID-19.
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Affiliation(s)
- Christopher Lesniak
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Raquel Ong
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Monika S Akula
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Arda Akoluk
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Rabail Soomro
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Albino Copca-Alvarez
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Tiffany Purewal
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Ishan Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Vandan Upadhyaya
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Jennifer Cheng
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Ashali Jain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Krishna Chalasani
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Neptune, NJ, USA
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Mistry S, Gouripeddi R, Facelli JC, Facelli JC. Data-driven identification of temporal glucose patterns in a large cohort of nondiabetic patients with COVID-19 using time-series clustering. JAMIA Open 2021; 4:ooab063. [PMID: 34409266 PMCID: PMC8364667 DOI: 10.1093/jamiaopen/ooab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Hyperglycemia has emerged as an important clinical manifestation of coronavirus disease 2019 (COVID-19) in diabetic and nondiabetic patients. Whether these glycemic changes are specific to a subgroup of patients and persist following COVID-19 resolution remains to be elucidated. This work aimed to characterize longitudinal random blood glucose in a large cohort of nondiabetic patients diagnosed with COVID-19. Materials and Methods De-identified electronic medical records of 7502 patients diagnosed with COVID-19 without prior diagnosis of diabetes between January 1, 2020, and November 18, 2020, were accessed through the TriNetX Research Network. Glucose measurements, diagnostic codes, medication codes, laboratory values, vital signs, and demographics were extracted before, during, and after COVID-19 diagnosis. Unsupervised time-series clustering algorithms were trained to identify distinct clusters of glucose trajectories. Cluster associations were tested for demographic variables, COVID-19 severity, glucose-altering medications, glucose values, and new-onset diabetes diagnoses. Results Time-series clustering identified a low-complexity model with 3 clusters and a high-complexity model with 19 clusters as the best-performing models. In both models, cluster membership differed significantly by death status, COVID-19 severity, and glucose levels. Clusters membership in the 19 cluster model also differed significantly by age, sex, and new-onset diabetes mellitus. Discussion and Conclusion This work identified distinct longitudinal blood glucose changes associated with subclinical glucose dysfunction in the low-complexity model and increased new-onset diabetes incidence in the high-complexity model. Together, these findings highlight the utility of data-driven techniques to elucidate longitudinal glycemic dysfunction in patients with COVID-19 and provide clinical evidence for further evaluation of the role of COVID-19 in diabetes pathogenesis.
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Affiliation(s)
- Sejal Mistry
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ramkiran Gouripeddi
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Julio C Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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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. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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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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229
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Alshanwani A, Kashour T, Badr A. Anti-Diabetic Drugs GLP-1 Agonists and DPP-4 Inhibitors may Represent Potential Therapeutic Approaches for COVID-19. Endocr Metab Immune Disord Drug Targets 2021; 22:571-578. [PMID: 34370655 DOI: 10.2174/1871530321666210809153558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 01/08/2023]
Abstract
The fast spread of coronavirus 2019 (COVID-19) calls for immediate action to counter the associated significant loss of human life and deep economic impact. Certain patient populations like those with obesity and diabetes are at higher risk for acquiring severe COVID-19 disease and have a higher risk of COVID-19 associated mortality. In the absence of an effective and safe vaccine, the only immediate promising approach is to repurpose an existing approved drug. Several drugs have been proposed and tested as adjunctive therapy for COVID-19. Among these drugs are the glucagon-like peptide-1 (GLP-1) 2 agonists and the dipeptidylpeptidase-4 (DPP-4) inhibitors. Beyond their glucose-lowering effects, these drugs have several pleiotropic protective properties, which include cardioprotective effects, anti-inflammatory and immunomodulatory activities, antifibrotic effects, antithrombotic effects, and vascular endothelial protective properties. This narrative review discusses these protective properties and addresses their scientific plausibility for their potential use as adjunctive therapy for COVID-19 disease.
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Affiliation(s)
- Aliah Alshanwani
- College of Medicine, Physiology Department, King Saud University, Riyadh, Saudi Arabia
| | - Tarek Kashour
- King Fahd Cardiac Centre, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Amira Badr
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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230
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Laurenzi A, Caretto A, Molinari C, Bazzigaluppi E, Brigatti C, Marzinotto I, Mercalli A, Melzi R, Nano R, Tresoldi C, Landoni G, Ciceri F, Lampasona V, Scavini M, Piemonti L. Pre-Existing Diabetes and COVID-Associated Hyperglycaemia in Patients with COVID-19 Pneumonia. BIOLOGY 2021; 10:biology10080754. [PMID: 34439986 PMCID: PMC8389579 DOI: 10.3390/biology10080754] [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: 07/07/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 01/08/2023]
Abstract
Simple Summary COVID-associated hyperglycaemia is emerging as a complication of Sars-CoV-2 infection, and this clinical entity still needs to be adequately characterized in comparison to pre-existing diabetes. Few studies have comparatively characterized these two conditions in relation to the presence of comorbidities, pre-hospitalization treatments, symptoms at admission, and laboratory variables associated with COVID-19 severity. Our study generated several interesting findings. Patients with COVID-associated hyperglycaemia had significantly less comorbidities, increased levels of inflammatory markers, and indicators of multi-organ injury than those with pre-existing diabetes, while islet autoimmunity prevalence and anti-SARS-CoV-2 antibody responses were similar. COVID-associated hyperglycaemia was associated with a poorer clinical outcome and a longer viral clearance time compared to pre-existing diabetes. This strongly supports the need to screen all COVID-19 patients for hyperglycaemia at the time of admission despite a mute personal or family history of diabetes and to treat them in order to reach and maintain good glycemic control during hospitalization for COVID-19 pneumonia. Abstract Aim. The aim of the current study was to compare clinical characteristics, laboratory findings, and major outcomes of patients hospitalized for COVID-19 pneumonia with COVID-associated hyperglycaemia or pre-existing diabetes. Methods. A cohort of 176 adult patients with a diagnosis of pre-existing diabetes (n = 112) or COVID-associated hyperglycaemia (n = 55) was studied. Results. Patients with COVID-associated hyperglycaemia had lower BMI, significantly less comorbidities, and higher levels of inflammatory markers and indicators of multi-organ injury than those with pre-existing diabetes. No differences between pre-existing diabetes and COVID-associated hyperglycaemia were evident for symptoms at admission, the humoral response against SARS-CoV-2, or autoantibodies to glutamic acid decarboxylase or interferon alpha-4. COVID-associated hyperglycaemia was independently associated with the risk of adverse clinical outcome, which was defined as ICU admission or death (HR 2.11, 95% CI 1.34–3.31; p = 0.001), even after adjustment for age, sex, and other selected variables associated with COVID-19 severity. Furthermore, at the same time, we documented a negative association (HR 0.661, 95% CI 0.43–1.02; p = 0.063) between COVID-associated hyperglycaemia to swab negativization. Conclusions. Recognizing hyperglycaemia as a specific clinical entity associated with COVID-19 pneumonia is relevant for early and appropriate patient management and close monitoring for the progression of disease severity.
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Affiliation(s)
- Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Amelia Caretto
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Chiara Molinari
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Elena Bazzigaluppi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Cristina Brigatti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Ilaria Marzinotto
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Alessia Mercalli
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Raffaella Melzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Rita Nano
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy;
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy;
- School of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy;
| | - Fabio Ciceri
- School of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy;
- Hematology and Bone Marrow Transplantation Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Vito Lampasona
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Marina Scavini
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
| | - Lorenzo Piemonti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (A.L.); (A.C.); (C.M.); (E.B.); (C.B.); (I.M.); (A.M.); (R.M.); (R.N.); (V.L.); (M.S.)
- School of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy;
- Correspondence: ; Tel.: +39-02-2643-2706; Fax: +39-02-2643-2871
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Farag AA, Hassanin HM, Soliman HH, Sallam A, Sediq AM, Abd elbaser ES, Elbanna K. Newly Diagnosed Diabetes in Patients with COVID-19: Different Types and Short-Term Outcomes. Trop Med Infect Dis 2021; 6:tropicalmed6030142. [PMID: 34449740 PMCID: PMC8396224 DOI: 10.3390/tropicalmed6030142] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 01/08/2023] Open
Abstract
A great global concern is currently focused on the coronavirus disease 2019 (COVID-19) pandemic and its associated morbidities. The goal of this study was to determine the frequency of newly diagnosed diabetes mellitus (DM) and its different types among COVID-19 patients, and to check the glycemic control in diabetic cases for three months. After excluding known cases of DM, 570 patients with confirmed COVID-19 were studied. All participants were classified as non-diabetic or newly discovered diabetic. According to hemoglobin A1c (HbA1c) and fasting insulin, newly discovered diabetic patients were further classified into pre-existing DM, new-onset type 1 DM, and new-onset type 2 DM. Glycemic control was monitored for three months in newly diagnosed diabetic patients. DM was diagnosed in 77 patients (13.5%); 12 (2.1%) with pre-existing DM, 7 (1.2%) with new-onset type 1 DM, and 58 (10.2%) with new-onset type 2 DM. Significantly higher rates of severe infection and mortality (p < 0.001 and p = 0.046) were evident among diabetic patients. Among survived diabetic patients (n = 63), hyperglycemia and the need for anti-diabetic treatment persisted in 73% of them for three months. COVID-19 was associated with a new-onset of DM in 11.4% of all participants and expression of pre-existing DM in 2.1% of all participants, both being associated with severe infection. COVID-19 patients with newly diagnosed diabetes had high risk of mortality. New-onset DM persisted for at least three months in more than two-thirds of cases.
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Affiliation(s)
- Alaa A. Farag
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt; (H.M.H.); (K.E.)
- Correspondence: or
| | - Hassan M. Hassanin
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt; (H.M.H.); (K.E.)
| | - Hanan H. Soliman
- Community Medicine Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt;
| | - Ahmad Sallam
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt; (A.S.); (A.M.S.)
| | - Amany M. Sediq
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt; (A.S.); (A.M.S.)
| | - Elsayed S. Abd elbaser
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt;
| | - Khaled Elbanna
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt; (H.M.H.); (K.E.)
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Haymana C, Demirci I, Tasci I, Cakal E, Salman S, Ertugrul D, Ata N, Unluturk U, Dagdelen S, Atmaca A, Sahin M, Celik O, Demir T, Emral R, Sahin I, Caglayan M, Satman I, Sonmez A. Clinical outcomes of non-diabetic COVID-19 patients with different blood glucose levels: a nationwide Turkish study (TurCoGlycemia). Endocrine 2021; 73:261-269. [PMID: 34156609 PMCID: PMC8218282 DOI: 10.1007/s12020-021-02789-9] [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: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE New coronavirus disease 2019 (COVID-19) has a worse prognosis in patients with diabetes. However, there are insufficient data about the effect of hyperglycemia on COVID-19 prognosis in non-diabetic patients. This study aimed to investigate the relationship between random blood glucose levels measured at the time of diagnosis and prognosis of COVID-19 disease in non-diabetic patients. METHODS A nationwide retrospective cohort of non-diabetic patients with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. The patients were stratified into three groups according to blood glucose levels which were <100 mg/dL in group-1, in the range of 100-139 mg/dl in group-2, and the range of 140-199 mg/dl in group-3. Clinical characteristics and outcomes were compared among the groups. The primary outcome was mortality. RESULTS A total of 12,817 non-diabetic patients (median age [IQR]: 44 [25] years, females: 50.9%) were included. Patients in group-2 (5%) and group-3 (14%) had higher mortality rates than patients in group-1 (2.1%). The rates of hospitalization, hospital stays longer than 8 days, intensive care unit (ICU) admission, ICU stay more than 6 days, and mechanical ventilation were also significantly higher in group-3 patients. Likewise, glucose levels in the range of 140-199 mg/dL were an independent associate of mortality and composite of ICU admission and/or mechanical ventilation. CONCLUSION Hyperglycemia at the time of COVID-19 diagnosis is associated with poor prognosis in non-diabetic patients. Clinicians should be more careful in the treatment of non-diabetic COVID-19 patients with hyperglycemia.
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Affiliation(s)
- Cem Haymana
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Gulhane Training and Research Hospital, Ankara, Turkey.
| | - Ibrahim Demirci
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ilker Tasci
- Department of Internal Medicine, University of Health Sciences Turkey, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Faculty of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Serpil Salman
- Department of Endocrinology and Metabolism, Medica Clinic, Istanbul, Turkey
| | - Derun Ertugrul
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Faculty of Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Naim Ata
- Department of Strategy Development, Republic of Turkey, Ministry of Health, Ankara, Turkey
| | - Ugur Unluturk
- Department of Endocrinology and Metabolism, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Selcuk Dagdelen
- Department of Endocrinology and Metabolism, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Aysegul Atmaca
- Department of Endocrinology and Metabolism, Samsun 19 Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolism, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Osman Celik
- Public Hospitals General Directorate, Republic of Turkey, Ministry of Health, Ankara, Turkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University, Faculty of Medicine, Ankara, Turkey
| | - Rifat Emral
- Department of Endocrinology and Metabolism, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Malatya Inonu University, Faculty of Medicine, Malatya, Turkey
| | | | - Ilhan Satman
- Department of Endocrinology and Metabolism, Istanbul University, Faculty of Medicine, Istanbul, Turkey
- Turkish Institute of Public Health and Chronic Diseases, Istanbul, Turkey
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Ankara, Turkey
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Barrett CE, Park J, Kompaniyets L, Baggs J, Cheng YJ, Zhang P, Imperatore G, Pavkov ME. Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S. Diabetes Care 2021; 44:1788-1796. [PMID: 34158365 PMCID: PMC9109617 DOI: 10.2337/dc21-0604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether risk of severe outcomes among patients with type 1 diabetes mellitus (T1DM) hospitalized for coronavirus disease 2019 (COVID-19) differs from that of patients without diabetes or with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Using the Premier Healthcare Database Special COVID-19 Release records of patients discharged after COVID-19 hospitalization from U.S. hospitals from March to November 2020 (N = 269,674 after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without diabetes or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes. RESULTS Compared with patients without diabetes, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD 0.21, 95% CI 0.19-0.24; RR 1.49, 95% CI 1.43-1.56) and a 5% higher absolute risk of mortality (RD 0.05, 95% CI 0.03-0.07; RR 1.40, 95% CI 1.24-1.57), with adjustment for age, sex, and race or ethnicity. Compared with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD 0.09, 95% CI 0.07-0.12; RR 1.17, 95% CI 1.12-1.22), but no difference in mortality (RD 0.00, 95% CI -0.02 to 0.02; RR 1.00, 95% CI 0.89-1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD 0.01, 95% CI -0.01 to 0.03) and had lower mortality (RD -0.03, 95% CI -0.05 to -0.01) in comparisons with patients with T2DM. CONCLUSIONS Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without diabetes. Higher risk of ICU/MV in patients with T1DM than in patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to diabetes management and the prevention of COVID-19.
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Affiliation(s)
- Catherine E Barrett
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA .,COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joohyun Park
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - James Baggs
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yiling J Cheng
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Meda E Pavkov
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Khanh VC, Fukushige M, Chang YH, Hoang NN, Yamashita T, Obata-Yasuoka M, Hamada H, Osaka M, Hiramatsu Y, Ohneda O. Wharton's Jelly Mesenchymal Stem Cell-Derived Extracellular Vesicles Reduce SARS-CoV2-Induced Inflammatory Cytokines Under High Glucose and Uremic Toxin Conditions. Stem Cells Dev 2021; 30:758-772. [PMID: 34074129 PMCID: PMC8356045 DOI: 10.1089/scd.2021.0065] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Cytokine storm is recognized as one of the factors contributing to organ failures and mortality in patients with COVID-19. Due to chronic inflammation, COVID-19 patients with diabetes mellitus (DM) or renal disease (RD) have more severe symptoms and higher mortality. However, the factors that contribute to severe outcomes of COVID-19 patients with DM and RD have received little attention. In an effort to investigate potential treatments for COVID-19, recent research has focused on the immunomodulation functions of mesenchymal stem cells (MSCs). In this study, the correlation between DM and RD and the severity of COVID-19 was examined by a combined approach with a meta-analysis and experimental research. The results of a systematic review and meta-analysis suggested that the odd of mortality in patients with both DM and RD was increased in comparison to those with a single comorbidity. In addition, in the experimental research, the data showed that high glucose and uremic toxins contributed to the induction of cytokine storm in human lung adenocarcinoma epithelial cells (Calu-3 cells) in response to SARS-CoV Peptide Pools. Of note, the incorporation of Wharton's jelly MSC-derived extracellular vesicles (WJ-EVs) into SARS-CoV peptide-induced Calu-3 resulted in a significant decrease in nuclear NF-κB p65 and the downregulation of the cytokine storm under high concentrations of glucose and uremic toxins. This clearly suggests the potential for WJ-EVs to reduce cytokine storm reactions in patients with both chronic inflammation diseases and viral infection.
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Affiliation(s)
- Vuong Cat Khanh
- Laboratory of Regenerative Medicine and Stem Cell Biology, Departments of University of Tsukuba, Tsukuba, Japan
| | - Mizuho Fukushige
- Laboratory of Regenerative Medicine and Stem Cell Biology, Departments of University of Tsukuba, Tsukuba, Japan
| | - Yun Hsuan Chang
- Laboratory of Regenerative Medicine and Stem Cell Biology, Departments of University of Tsukuba, Tsukuba, Japan
| | - Ngo Nhat Hoang
- Laboratory of Regenerative Medicine and Stem Cell Biology, Departments of University of Tsukuba, Tsukuba, Japan
| | - Toshiharu Yamashita
- Laboratory of Regenerative Medicine and Stem Cell Biology, Departments of University of Tsukuba, Tsukuba, Japan
| | | | - Hiromi Hamada
- Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
| | - Motoo Osaka
- Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yuji Hiramatsu
- Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Osamu Ohneda
- Laboratory of Regenerative Medicine and Stem Cell Biology, Departments of University of Tsukuba, Tsukuba, Japan
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235
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Govender N, Khaliq OP, Moodley J, Naicker T. Insulin resistance in COVID-19 and diabetes. Prim Care Diabetes 2021; 15:629-634. [PMID: 33849817 PMCID: PMC8031259 DOI: 10.1016/j.pcd.2021.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The epidemiology of COVID-19 and its association with cardiometabolic disorders is poorly understood. This is a narrative review that investigates the effects of COVID-19 infection on insulin resistance in patients with diabetes. METHODS An online search of all published literature was done via PubMed and Google Scholar using the MeSH terms "COVID-19," "SARS-CoV-2," "coronavirus," "insulin resistance," and "diabetes." Only articles that were directly applicable to insulin resistance in COVID-19 and diabetes was reviewed. RESULTS Current data shows an increased risk of mortality in patients with diabetes and COVID-19 compared to those without diabetes. COVID-19 triggers insulin resistance in patients, causing chronic metabolic disorders that were non-existent prior to infection. CONCLUSION Patients with diabetes are more susceptible to COVID-19 infection than those without diabetes. ACE2 expression decreases with infection, exaggerating Ang II activity with subsequent insulin resistance development, an exaggerated immune response and severe SARS-COV-2 infection.
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Affiliation(s)
- Nalini Govender
- Dept of Basic Medical Sciences, Durban University of Technology, Durban, South Africa.
| | - Olive P Khaliq
- Women's Health and HIV Research Group, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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236
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Kristan MM, Kim YK, Nelson T, Moxley MC, Yip TCF, Munir K, Malek R. Predictors of Severe COVID-19 in Patients With Diabetes: A Multicenter Review. Endocr Pract 2021; 27:842-849. [PMID: 34102308 PMCID: PMC8179716 DOI: 10.1016/j.eprac.2021.05.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Diabetes is an independent risk factor for severe SARS-CoV-2 infections. This study aims to elucidate the risk factors predictive of more severe outcomes in patients with diabetes by comparing the clinical characteristics of those requiring inpatient admissions with those who remain outpatient. METHODS A retrospective review identified 832 patients-631 inpatients and 201 outpatients-with diabetes and a positive SARS-CoV-2 test result between March 1 and June 15, 2020. Comparisons between the outpatient and inpatient cohorts were conducted to identify risk factors associated with severity of disease determined by admission rate and mortality. Previous dipeptidyl peptidase 4 inhibitor use and disease outcomes were analyzed. RESULTS Risk factors for increased admission included older age (odds ratio [OR], 1.04 [95% CI, 1.01-1.06]; P = .003), the presence of chronic kidney disease (OR, 2.32 [1.26-4.28]; P = .007), and a higher hemoglobin A1c at the time of admission (OR, 1.25 [1.12-1.39]; P < .001). Lower admission rates were seen in those with commercial insurance. Increased mortality was seen in individuals with older age (OR, 1.09 [1.07-1.11]; P < .001), higher body mass index number (OR, 1.04 [1.01-1.07]; P = .003), and higher hemoglobin A1c value at the time of diagnosis of COVID-19 (OR, 1.12 [1.01-1.24]; P = .028) and patients requiring hospitalization. Lower mortality was seen in those with hyperlipidemia. Dipeptidyl peptidase 4 inhibitor use prior to COVID-19 infection was not associated with a decreased hospitalization rate. CONCLUSION This retrospective review offers the first analysis of outpatient predictors for admission rate and mortality of COVID-19 in patients with diabetes.
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Affiliation(s)
- Megan M Kristan
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition, Baltimore, Maryland.
| | - Yoon K Kim
- University of Maryland Medical Center, Department of Internal Medicine, Baltimore, Maryland
| | - Toby Nelson
- University of Maryland Medical Center, Department of Internal Medicine, Baltimore, Maryland
| | - Meaghan C Moxley
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition, Baltimore, Maryland
| | - Terry Cheuk-Fung Yip
- The Chinese University of Hong Kong. Department of Medicine and Therapeutics, Medical Data Analytics Centre (MDAC), Shatin, Hong Kong
| | - Kashif Munir
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition, Baltimore, Maryland
| | - Rana Malek
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition, Baltimore, Maryland.
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237
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Sarkar S, Das D, Borsingh Wann S, Kalita J, Manna P. Is diabetes mellitus a wrongdoer to COVID-19 severity? Diabetes Res Clin Pract 2021; 178:108936. [PMID: 34217771 PMCID: PMC8247195 DOI: 10.1016/j.diabres.2021.108936] [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: 12/29/2020] [Revised: 05/25/2021] [Accepted: 06/29/2021] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 19 (COVID-19) has turned out to be a pandemic in short period of time due to the high transmissibility of its causative agent, severe acute respiratory syndrome coronavirus 2. Various reports have suggested the promising link between overexpression of angiotensin converting enzyme 2 (ACE2) and COVID-19 pathogenesis. The severity of COVID-19 pathophysiology is greatly depended on several comorbidities, like hypertension, diabetes mellitus (DM), respiratory and cardiovascular disease, out of which DM has emerged as a major risk factor. The current review focuses on the link among the expression of ACE2, use of ACE inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs), and risk of COVID-19 pathogenesis in DM. The review also emphasizes on synergistic detrimental effect of DM and COVID-19 on the immune system in provoking uncontrolled cytokine storm which eventually leads to lethal consequences. Finally, several possible therapeutic strategies have been highlighted to reduce the excess of risk associated with COVID-19 in people with DM.
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Affiliation(s)
- Sanjib Sarkar
- Biotechnology Group, Biological Sciences and Technology Division, CSIR-North East Institute of Science and Technology, Jorhat 785006, Assam, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Dibyendu Das
- Biotechnology Group, Biological Sciences and Technology Division, CSIR-North East Institute of Science and Technology, Jorhat 785006, Assam, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Sawlang Borsingh Wann
- Biotechnology Group, Biological Sciences and Technology Division, CSIR-North East Institute of Science and Technology, Jorhat 785006, Assam, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Jatin Kalita
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India; Research Planning and Business Development Division, CSIR-North East Institute of Science and Technology, Jorhat 785006, Assam, India.
| | - Prasenjit Manna
- Biotechnology Group, Biological Sciences and Technology Division, CSIR-North East Institute of Science and Technology, Jorhat 785006, Assam, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
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Boye KS, Tokar Erdemir E, Zimmerman N, Reddy A, Benneyworth BD, Dabora MC, Hankosky ER, Bethel MA, Clark C, Lensing CJ, Sailer S, San Juan R, Heine RJ, Etemad L. Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with Type 2 Diabetes Mellitus in the United States. Diabetes Ther 2021; 12:2223-2239. [PMID: 34275115 PMCID: PMC8286432 DOI: 10.1007/s13300-021-01110-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Diabetes has been identified as a high-risk comorbidity for COVID-19 hospitalization. We evaluated additional risk factors for COVID-19 hospitalization and in-hospital mortality in a nationwide US database. METHODS This retrospective study utilized the UnitedHealth Group Clinical Discovery Database (January 1, 2019-July 15, 2020) containing de-identified nationwide administrative claims, SARS-CoV-2 laboratory test results, and COVID-19 inpatient admissions data. Logistic regression was used to understand risk factors for hospitalization and in-hospital mortality among people with type 2 diabetes (T2D) and in the overall population. Robustness of associations was further confirmed by subgroup and sensitivity analyses in the T2D population. RESULTS A total of 36,364 people were identified who were either SARS-CoV-2+ or hospitalized for COVID-19. T2D was associated with increased COVID-19-related hospitalization and mortality. Factors associated with increased hospitalization risk were largely consistent in the overall population and the T2D subgroup, including age, male sex, and these top five comorbidities: dementia, metastatic tumor, congestive heart failure, paraplegia, and metabolic disease. Biguanides (mainly metformin) were consistently associated with lower odds of hospitalization, whereas sulfonylureas and insulins were associated with greater odds of hospitalization among people with T2D. CONCLUSION In this nationwide US analysis, T2D was identified as an independent risk factor for COVID-19 complications. Many factors conferred similar risk of hospitalization across both populations; however, particular diabetes medications may be markers for differential risk. The insights on comorbidities and medications may inform population health initiatives, including prevention efforts for high-risk patient populations such as those with T2D.
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Affiliation(s)
| | | | | | - Abraham Reddy
- OptumLabs at UnitedHealth Group, Minneapolis, MN, USA
| | | | | | | | | | | | | | - Scott Sailer
- OptumLabs at UnitedHealth Group, Minneapolis, MN, USA
| | | | | | - Lida Etemad
- OptumLabs at UnitedHealth Group, Minneapolis, MN, USA
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Pranata R, Henrina J, Raffaello WM, Lawrensia S, Huang I. Diabetes and COVID-19: The past, the present, and the future. Metabolism 2021; 121:154814. [PMID: 34119537 PMCID: PMC8192264 DOI: 10.1016/j.metabol.2021.154814] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
Diabetes, one of the most prevalent chronic diseases in the world, is strongly associated with a poor prognosis in COVID-19. Scrupulous blood sugar management is crucial, since the worse outcomes are closely associated with higher blood sugar levels in COVID-19 infection. Although recent observational studies showed that insulin was associated with mortality, it should not deter insulin use in hospitalized patients requiring tight glucose control. Back and forth dilemma in the past with regards to continue/discontinue certain medications used in diabetes have been mostly resolved. The initial fears of consequences related to continuing certain medications have been largely dispelled. COVID-19 also necessitates the transformation in diabetes care through the integration of technologies. Recent advances in health-related technologies, notably telemedicine and remote continuous glucose monitoring, have become essential in the management of diabetes during the pandemic. Today, these technologies have changed the landscape of medicine and become more important than ever. Being a high-risk population, patients with type 1 or type 2 diabetes, should be prioritized for vaccination. In the future, as the pandemic fades, the prevalence of non-communicable diseases is expected to rise due to lifestyle changes and medical issues/dilemma encountered during the pandemic.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | | | | | | | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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240
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Borgnakke WS, Poudel P. Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.709831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.
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241
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Stevens JS, Bogun MM, McMahon DJ, Zucker J, Kurlansky P, Mohan S, Yin MT, Nickolas TL, Pajvani UB. Diabetic ketoacidosis and mortality in COVID-19 infection. DIABETES & METABOLISM 2021; 47:101267. [PMID: 34332112 PMCID: PMC8317499 DOI: 10.1016/j.diabet.2021.101267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/13/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023]
Abstract
Aim - Patients with diabetes have increased morbidity and mortality from COVID-19. Case reports describe patients with simultaneous COVID-19 and diabetic acidosis (DKA), however there is limited data on the prevalence, predictors and outcomes of DKA in these patients. Methods - Patients with COVID-19 were identified from the electronic medical record. DKA was defined by standardized criteria. Proportional hazard regression models were used to determine risk factors for, and mortality from DKA in COVID-19. Results - Of 2366 patients admitted for COVID-19, 157 (6.6%) patients developed DKA, 94% of whom had antecedent type 2 diabetes, 0.6% had antecedent type 1 diabetes, and 5.7% patients had no prior diagnosis of diabetes. Patients with DKA had increased hospital length of stay and in-patient mortality. Higher HbA1c predicted increased risk of incident DKA (HR 1.47 per 1% increase, 95% CI 1.40–1.54). Risk factors for mortality included older age (HR 1.07 per 5 years, 95% CI 1.06–1.08) and need for pressors (HR 2.33, 95% CI 1.82–2.98). Glucocorticoid use was protective in patients with and without DKA. Conclusion - The combination of DKA and COVID-19 is associated with greater mortality, driven by older age and COVID-19 severity.
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Affiliation(s)
- J S Stevens
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - M M Bogun
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - D J McMahon
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - J Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - P Kurlansky
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - S Mohan
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - M T Yin
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.
| | - T L Nickolas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.
| | - U B Pajvani
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.
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Logette E, Lorin C, Favreau C, Oshurko E, Coggan JS, Casalegno F, Sy MF, Monney C, Bertschy M, Delattre E, Fonta PA, Krepl J, Schmidt S, Keller D, Kerrien S, Scantamburlo E, Kaufmann AK, Markram H. A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19. Front Public Health 2021; 9:695139. [PMID: 34395368 PMCID: PMC8356061 DOI: 10.3389/fpubh.2021.695139] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 started spreading toward the end of 2019 causing COVID-19, a disease that reached pandemic proportions among the human population within months. The reasons for the spectrum of differences in the severity of the disease across the population, and in particular why the disease affects more severely the aging population and those with specific preconditions are unclear. We developed machine learning models to mine 240,000 scientific articles openly accessible in the CORD-19 database, and constructed knowledge graphs to synthesize the extracted information and navigate the collective knowledge in an attempt to search for a potential common underlying reason for disease severity. The machine-driven framework we developed repeatedly pointed to elevated blood glucose as a key facilitator in the progression of COVID-19. Indeed, when we systematically retraced the steps of the SARS-CoV-2 infection, we found evidence linking elevated glucose to each major step of the life-cycle of the virus, progression of the disease, and presentation of symptoms. Specifically, elevations of glucose provide ideal conditions for the virus to evade and weaken the first level of the immune defense system in the lungs, gain access to deep alveolar cells, bind to the ACE2 receptor and enter the pulmonary cells, accelerate replication of the virus within cells increasing cell death and inducing an pulmonary inflammatory response, which overwhelms an already weakened innate immune system to trigger an avalanche of systemic infections, inflammation and cell damage, a cytokine storm and thrombotic events. We tested the feasibility of the hypothesis by manually reviewing the literature referenced by the machine-generated synthesis, reconstructing atomistically the virus at the surface of the pulmonary airways, and performing quantitative computational modeling of the effects of glucose levels on the infection process. We conclude that elevation in glucose levels can facilitate the progression of the disease through multiple mechanisms and can explain much of the differences in disease severity seen across the population. The study provides diagnostic considerations, new areas of research and potential treatments, and cautions on treatment strategies and critical care conditions that induce elevations in blood glucose levels.
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Affiliation(s)
- Emmanuelle Logette
- Blue Brain Project, École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Henry Markram
- Blue Brain Project, École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland
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Hentschel V, Groß R, Krüger J, Münch J, Müller M, Kleger A. [SARS-CoV-2 and the digestive tract - Organoids to model gastrointestinal infection]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1205-1213. [PMID: 34311478 DOI: 10.1055/a-1500-8420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SARS-CoV-2 is a novel human pathogenic coronavirus whose predilection for the respiratory tract has given rise to a rapid pandemic spread via airborne particles. Organ-specific susceptibility is substantially determined by the density of cell surface expression of ACE2, which is exploited by viral spike protein as a receptor molecule to mediate adhesion and, thus, to permit internalization of the viral genome into the host cell. Based on an ample data set derived from clinical studies and case reports, evidence suggests that distinct cell populations of the digestive and olfactory-gustatory system are equally equipped with membrane-bound ACE2, rendering them "vulnerable" to SARS-CoV-2. Numerous reports on concomitant gastrointestinal complaints and laboratory abnormalities are thought to reflect a relevant degree of organ dysfunction and underscore the tropism of SARS-CoV-2 for the digestive tract. Organoids are three-dimensional in vitro replicas of organ tissue which, owing to their organotypic complex cellular composition and functional resemblance to primary cells, are particularly appreciated for basic research in the field of infectious diseases. This review specifically addresses the involvement of digestive organs by SARS-CoV-2 and outlines the significant contribution of organoid- and primary-cell culture-based models to gaining a deeper understanding of the underlying pathophysiological processes.
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Affiliation(s)
| | - Rüdiger Groß
- Institut für molekulare Virologie, Universitätsklinik Ulm, Ulm, Germany
| | - Jana Krüger
- Klinik für Innere Medizin I, Universitätsklinik Ulm, Ulm, Germany
| | - Jan Münch
- Institut für molekulare Virologie, Universitätsklinik Ulm, Ulm, Germany
| | - Martin Müller
- Klinik für Innere Medizin I, Universitätsklinik Ulm, Ulm, Germany
| | - Alexander Kleger
- Klinik für Innere Medizin I, Universitätsklinik Ulm, Ulm, Germany
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244
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Both high and low pre-infection glucose levels associated with increased risk for severe COVID-19: New insights from a population-based study. PLoS One 2021; 16:e0254847. [PMID: 34293038 PMCID: PMC8297851 DOI: 10.1371/journal.pone.0254847] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/03/2021] [Indexed: 01/19/2023] Open
Abstract
Importance Patients with diabetes are known to be at increased risk for infections including severe coronavirus disease 2019 (COVID-19) but the relationship between COVID-19 severity and specific pre-infection glucose levels is not known. Objective To assess the differential effects of pre-infection glucose levels on the risk for severe COVID-19 amongst patients with and without diabetes. Design Population based historical cohort study. Setting National state-mandated HMO. Patients All adult patients with a positive SARS-COV2 test between March-October 2020. Exposure Recent fasting blood glucose (FBG) and glycated hemoglobin (HBA1C), age, gender, body mass index (BMI) and diagnoses of diabetes, hypertension, ischemic heart disease. Outcome Risk for severe COVID-19, defined as resulting in ≥10 hospitalization days, ICU admission or death. Results 37,121 patients with a positive SARS-COV2 test were identified; 707 defined as severe (1.9%). Unadjusted risk factors for severe disease were age (OR = 1.1 for every year increase; 95% CI 1.09–1.11, p < 0.001), male gender (OR = 1.34, 95% CI 1.06–1.68, p = 0.012); BMI (OR = 1.02 for 1 kg/m2 increase, 95% CI 1.00–1.04, p = 0.025). Controlling for these factors, we found an association between pre-infection FBG and the risk of severe COVID-19, with a differential effect in patients with and without a diagnosis of diabetes. For patients without diabetes, elevated FBG in the pre-diabetes range (106–125 mg/dl) was associated with severe COVID-19 (OR 1.55 95% CI 1.04–2.26 p = 0.027). For patients with a diagnosis of diabetes, we found a J-shaped association between pre-infection glucose control and the risk for severe COVID-19 where the lowest risk for was for patients with FBG 106–125 mg/dl; the risk increased with higher pre-infection glucose levels but strikingly also for patients with a low pre-infection FBG (<100mg/dl) or HbA1C (<5.7%). Conclusions and relevance Elevated pre-infection blood glucose is a risk factor for severe COVID-19 even in non-diabetics. For patients with a diagnosis of diabetes both high as well as low pre-infection glucose levels are risk factors for severe COVID-19. Further research is required to assess whether these associations are causal, but we believe these findings can already have clinical implications for COVID-19 risk assessment and stratification.
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245
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Li Z, Jiang N, Li X, Yang B, Jin M, Sun Y, He Y, Liu Y, Wang Y, Si D, Ma P, Zhang J, Liu T, Yu Q. Two novel nomograms based on inflammatory cytokines or lymphocyte subsets to differentially diagnose severe or critical and Non-Severe COVID-19. Aging (Albany NY) 2021; 13:17961-17977. [PMID: 34282057 PMCID: PMC8351679 DOI: 10.18632/aging.203307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/02/2021] [Indexed: 01/08/2023]
Abstract
We intend to evaluate the differences of the clinical characteristics, cytokine profiles and immunological features in patients with different severity of COVID-19, and to develop novel nomograms based on inflammatory cytokines or lymphocyte subsets for the differential diagnostics for severe or critical and non-severe COVID-19 patients. We retrospectively studied 254 COVID-19 patients, 90 of whom were severe or critical patients and 164 were non-severe patients. Severe or critical patients had significantly higher levels of inflammatory cytokines than non-severe patients as well as lower levels of lymphocyte subsets. Significantly positive correlations between cytokine profiles were observed, while they were all significantly negatively correlated with lymphocyte subsets. Two effective nomograms were developed according to two multivariable logistic regression cox models based on inflammatory cytokine profiles and lymphocyte subsets separately. The areas under the receiver operating characteristics of two nomograms were 0.834 (95% CI: 0.779-0.888) and 0.841 (95% CI: 0.756-0.925). The bootstrapped-concordance indexes of two nomograms were 0.834 and 0.841 in training set, and 0.860 and 0.852 in validation set. Calibration curves and decision curve analyses demonstrated that the nomograms were well calibrated and had significantly more clinical net benefits. Our novel nomograms can accurately predict disease severity of COVID-19, which may facilitate the identification of severe or critical patients and assist physicians in making optimized treatment suggestions.
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Affiliation(s)
- Zhijun Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
| | - Nan Jiang
- Department of Emergency, China-Japan Union Hospital of Jilin University, Changchun 130021, China
| | - Xinwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
| | - Bo Yang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Mengdi Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
| | - Yaoyao Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
| | - Yang He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
| | - Yang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
| | - Yueying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
| | - Daoyuan Si
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130021, China
| | - Piyong Ma
- Department of Critical Care Unit, China-Japan Union Hospital of Jilin University, Changchun 130021, China
| | - Jinnan Zhang
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun 130021, China
| | - Tianji Liu
- Department of Emergency, China-Japan Union Hospital of Jilin University, Changchun 130021, China
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China
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246
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Patel AJ, Klek SP, Peragallo-Dittko V, Goldstein M, Burdge E, Nadile V, Ramadhar J, Islam S, Rothberger GD. Correlation of Hemoglobin A1C and Outcomes in Patients Hospitalized With COVID-19. Endocr Pract 2021; 27:1046-1051. [PMID: 34284145 PMCID: PMC8286241 DOI: 10.1016/j.eprac.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/08/2023]
Abstract
Objective Diabetes is a known risk factor for severe coronavirus disease 2019 (COVID-19). We conducted this study to determine if there is a correlation between hemoglobin A1C (HbA1C) level and poor outcomes in hospitalized patients with diabetes and COVID-19. Methods This is a retrospective, single-center, observational study of patients with diabetes (defined by an HbA1C level of ≥6.5% or known medical history of diabetes) who had a confirmed case of COVID-19 and required hospitalization. All patients were admitted to our institution between March 3, 2020, and May 5, 2020. HbA1C results for each patient were divided into quartiles: 5.1% to 6.7% (32-50 mmol/mol), 6.8% to 7.5% (51-58 mmol/mol), 7.6% to 8.9% (60-74 mmol/mol), and >9% (>75 mmol/mol). The primary outcome was in-hospital mortality. Secondary outcomes included admission to an intensive care unit, invasive mechanical ventilation, acute kidney injury, acute thrombosis, and length of hospital stay. Results A total of 506 patients were included. The number of deaths within quartiles 1 through 4 were 30 (25%), 37 (27%), 34 (27%), and 24 (19%), respectively. There was no statistical difference in the primary or secondary outcomes among the quartiles, except that acute kidney injury was less frequent in quartile 4. Conclusion There was no significant association between HbA1C level and adverse clinical outcomes in patients with diabetes who are hospitalized with COVID-19. HbA1C levels should not be used for risk stratification in these patients.
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Affiliation(s)
- Amy J Patel
- Division of Endocrinology, Diabetes, and Metabolism, New York University Long Island School of Medicine, Mineola, New York
| | - Stanislaw P Klek
- Division of Endocrinology, Diabetes, and Metabolism, New York University Long Island School of Medicine, Mineola, New York
| | - Virginia Peragallo-Dittko
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York
| | - Michael Goldstein
- Department of Medicine, New York University Long Island School of Medicine, Mineola, New York
| | - Eric Burdge
- Department of Medicine, New York University Long Island School of Medicine, Mineola, New York
| | - Victoria Nadile
- Department of Medicine, New York University Long Island School of Medicine, Mineola, New York
| | - Julia Ramadhar
- Department of Medicine, New York University Long Island School of Medicine, Mineola, New York
| | - Shahidul Islam
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York
| | - Gary D Rothberger
- Division of Endocrinology, Diabetes, and Metabolism, New York University Long Island School of Medicine, Mineola, New York.
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247
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Viurcos-Sanabria R, Escobedo G. Immunometabolic bases of type 2 diabetes in the severity of COVID-19. World J Diabetes 2021; 12:1026-1041. [PMID: 34326952 PMCID: PMC8311488 DOI: 10.4239/wjd.v12.i7.1026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/16/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 and type 2 diabetes (T2D) have now merged into an ongoing global syndemic that is threatening the lives of millions of people around the globe. For this reason, there is a deep need to understand the immunometabolic bases of the main etiological factors of T2D that affect the severity of COVID-19. Here, we discuss how hyperglycemia contributes to the cytokine storm commonly associated with COVID-19 by stimulating monocytes and macrophages to produce interleukin IL-1β, IL-6, and TNF-α in the airway epithelium. The main mechanisms through which hyperglycemia promotes reactive oxygen species release, inhibition of T cell activation, and neutrophil extracellular traps in the lungs of patients with severe SARS-CoV-2 infection are also studied. We further examine the molecular mechanisms by which proinflammatory cytokines induce insulin resistance, and their deleterious effects on pancreatic β-cell exhaustion in T2D patients critically ill with COVID-19. We address the effect of excess glucose on advanced glycation end product (AGE) formation and the role of AGEs in perpetuating pneumonia and acute respiratory distress syndrome. Finally, we discuss the contribution of preexisting endothelial dysfunction secondary to diabetes in the development of neutrophil trafficking, vascular leaking, and thrombotic events in patients with severe SARS-CoV-2 infection. As we outline here, T2D acts in synergy with SARS-CoV-2 infection to increase the progression, severity, and mortality of COVID-19. We think a better understanding of the T2D-related immunometabolic factors that contribute to exacerbate the severity of COVID-19 will improve our ability to identify patients with high mortality risk and prevent adverse outcomes.
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Affiliation(s)
| | - Galileo Escobedo
- Laboratorio de Proteómica, Dirección de Investigación, Hospital General de Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
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248
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Sarwani A, Al Saeed M, Taha H, Al Fardan RM. New-Onset Diabetes Mellitus Presenting As Diabetic Ketoacidosis in Patients With COVID-19: A Case Series. Cureus 2021; 13:e16290. [PMID: 34381649 PMCID: PMC8350906 DOI: 10.7759/cureus.16290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID‐19), a 2020 pandemic, has been linked to another global health problem, the diabetes pandemic. Both are existing in a bi-directional association. COVID-19 has been shown to be associated with worse outcomes in those with pre-existing diabetes mellitus. Nevertheless, recent data have emerged highlighting the inter-relationship between new-onset diabetes mellitus and COVID-19. Here, we present four cases admitted to the hospital with newly diagnosed diabetes mellitus associated with COVID-19. We aim to review the available literature regarding the complex association between COVID-19 and new-onset diabetes, causative factors and triggers, treatment strategies, outcomes, and its burden on the health system in general.
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Affiliation(s)
- Aysha Sarwani
- Endocrinology, Salmaniya Medical Complex, Manama, BHR
| | | | - Husain Taha
- Endocrinology, Salmaniya Medical Complex, Manama, BHR
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249
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Nouri-Keshtkar M, Taghizadeh S, Farhadi A, Ezaddoustdar A, Vesali S, Hosseini R, Totonchi M, Kouhkan A, Chen C, Zhang JS, Bellusci S, Tahamtani Y. Potential Impact of Diabetes and Obesity on Alveolar Type 2 (AT2)-Lipofibroblast (LIF) Interactions After COVID-19 Infection. Front Cell Dev Biol 2021; 9:676150. [PMID: 34307358 PMCID: PMC8295688 DOI: 10.3389/fcell.2021.676150] [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] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 01/14/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new emerging respiratory virus, caused evolving pneumonia outbreak around the world. In SARS-Cov-2 infected patients, diabetes mellitus (DM) and obesity are two metabolic diseases associated with higher severity of SARS-CoV-2 related complications, characterized by acute lung injury requiring assisted ventilation as well as fibrosis development in surviving patients. Different factors are potentially responsible for this exacerbated response to SARS-CoV-2 infection. In patients with DM, base-line increase in inflammation and oxidative stress represent preexisting risk factors for virus-induced damages. Such factors are also likely to be found in obese patients. In addition, it has been proposed that massive injury to the alveolar epithelial type 2 (AT2) cells, which express the SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2), leads to the activation of their stromal niches represented by the Lipofibroblasts (LIF). LIF are instrumental in maintaining the self-renewal of AT2 stem cells. LIF have been proposed to transdifferentiate into Myofibroblast (MYF) following injury to AT2 cells, thereby contributing to fibrosis. We hypothesized that LIF's activity could be impacted by DM or obesity in an age- and gender-dependent manner, rendering them more prone to transition toward the profibrotic MYF status in the context of severe COVID-19 pneumonia. Understanding the cumulative effects of DM and/or obesity in the context of SARS-CoV-2 infection at the cellular level will be crucial for efficient therapeutic solutions.
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Affiliation(s)
- Marjan Nouri-Keshtkar
- Faculty of Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Sara Taghizadeh
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Excellence Cluster Cardio-Pulmonary System, Justus Liebig University Giessen, Giessen, Germany
| | - Aisan Farhadi
- Faculty of Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | | | - Samira Vesali
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Roya Hosseini
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehdi Totonchi
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Azam Kouhkan
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Chengshui Chen
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jin-San Zhang
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Saverio Bellusci
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Excellence Cluster Cardio-Pulmonary System, Justus Liebig University Giessen, Giessen, Germany
| | - Yaser Tahamtani
- Faculty of Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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250
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Magdy Beshbishy A, Oti VB, Hussein DE, Rehan IF, Adeyemi OS, Rivero-Perez N, Zaragoza-Bastida A, Shah MA, Abouelezz K, Hetta HF, Cruz-Martins N, Batiha GES. Factors Behind the Higher COVID-19 Risk in Diabetes: A Critical Review. Front Public Health 2021; 9:591982. [PMID: 34307267 PMCID: PMC8292635 DOI: 10.3389/fpubh.2021.591982] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19) are public health issues worldwide, and their comorbidities trigger the progress to severe disease and even death in such patients. Globally, DM has affected an estimated 9.3% adults, and as of April 18, 2021, the World Health Organization (WHO) has confirmed 141,727,940 COVID-19 confirmed cases. The virus is spread via droplets, aerosols, and direct touch with others. Numerous predictive factors have been linked to COVID-19 severity, including impaired immune response and increased inflammatory response, among others. Angiotensin receptor blockers and angiotensin converting enzyme 2 have also been identified as playing a boosting role in both susceptibility and severity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Specifically, in DM patients, both their control and management during this pandemic is herculean as the restriction periods have markedly hampered the maintenance of means to control glycemia, hypertension, and neuroendocrine and kidney diseases. In addition, as a result of the underlyin cardio-metabolic and immunological disorders, DM patients are at a higher risk of developing the severe form of COVID-19 despite other comorbidities, such as hypertension, also potentially boosting the development of higher COVID-19 severity. However, even in non-DM patients, SARS-CoV-2 may also cause transient hyperglycemia through induction of insulin resistance and/or pancreatic β-cell injury. Therefore, a strict glucose monitoring of DM patients with COVID-19 is mandatory to prevent life-threatening complications.
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Affiliation(s)
- Amany Magdy Beshbishy
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Victor B. Oti
- Department of Microbiology, Nasarawa State University, Keffi, Nigeria
| | - Diaa E. Hussein
- Researcher, Department of Food Hygiene, Agricultural Research Center, Animal Health Research Institute, Port of Alexandria, Egypt
| | - Ibrahim F. Rehan
- Department of Husbandry and Development of Animal Wealth, Faculty of Veterinary Medicine, Menofa University, Shebin Alkom, Egypt
| | - Oluyomi S. Adeyemi
- Medicinal Biochemistry, Infectious Diseases, Nanomedicine & Toxicology Laboratory, Department of Biochemistry, Landmark University, Omu-Aran, Nigeria
| | - Nallely Rivero-Perez
- Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuaria, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Mexico
| | - Adrian Zaragoza-Bastida
- Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuaria, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Mexico
| | - Muhammad Ajmal Shah
- Department of Pharmacognosy, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Khaled Abouelezz
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Helal F. Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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