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Silverii GA, Fumagalli C, Rozzini R, Milani M, Mannucci E, Marchionni N. Is Metformin Use Associated with a More Favorable COVID-19 Course in People with Diabetes? J Clin Med 2024; 13:1874. [PMID: 38610639 PMCID: PMC11012895 DOI: 10.3390/jcm13071874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Diabetes Mellitus (DM) has been associated with a higher Coronavirus disease-19 (COVID-19) mortality, both in hospitalized patients and in the general population. A possible beneficial effect of metformin on the prognosis of COVID-19 has been reported in some observational studies, whereas other studies disagree. Methods: To investigate the possible effect of metformin on COVID-19 in-hospital mortality, we performed a retrospective study that included all SARS-CoV-2-positive patients with DM who were admitted to two Italian hospitals. In order to adjust for possible confounders accounting for the observed reduction of mortality in metformin users, we adopted the COVID-19 Mortality Risk Score (COVID-19 MRS) as a covariate. Results: Out of the 524 included patients, 33.4% died. A binomial logistic regression showed that metformin use was associated with a significant reduction in case fatality (OR 0.67 [0.45-0.98], p = 0.039), with no significant effect on the need for ventilation (OR 0.75 [0.5-1.11], p = 0.146). After adjusting for COVID-19 MRS, metformin did not retain a significant association with in-hospital mortality [OR 0.795 (0.495-1.277), p = 0.342]. Conclusions: A beneficial effect of metformin on COVID-19 was not proven after adjusting for confounding factors. The use of validated tools to stratify the risk for COVID-19 severe disease and death, such as COVID-19 MRS, may be useful to better explore the potential association of medications and comorbidities with COVID-19 prognosis.
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Affiliation(s)
- Giovanni Antonio Silverii
- Experimental and Clinical Biomedical Sciences “Mario Serio” Department, University of Florence, 50134 Florence, Italy (G.A.S.)
| | - Carlo Fumagalli
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Renzo Rozzini
- Department of Internal Medicine and Geriatrics, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy;
| | - Marta Milani
- Experimental and Clinical Biomedical Sciences “Mario Serio” Department, University of Florence, 50134 Florence, Italy (G.A.S.)
| | - Edoardo Mannucci
- Experimental and Clinical Biomedical Sciences “Mario Serio” Department, University of Florence, 50134 Florence, Italy (G.A.S.)
| | - Niccolò Marchionni
- Experimental and Clinical Medicine Department, University of Florence, 50134 Florence, Italy;
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2
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Guo Z, Gao Y, Xie E, Ye Z, Li Y, Zhao X, Shen N, Zheng J. Effects of Metformin on COVID-19 Patients with Type 2 Diabetes: A Retrospective Study. Diabetes Metab Syndr Obes 2023; 16:2573-2582. [PMID: 37645237 PMCID: PMC10461736 DOI: 10.2147/dmso.s417925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose The pandemic of coronavirus disease 2019 (COVID-19) has highlighted the intricate relationship between underlying conditions and death. We designed this study to determine whether metformin therapy for type 2 diabetes mellitus (T2D) is associated with low in-hospital mortality in patients hospitalized for COVID-19. Materials and Methods This was a retrospective study including patients with COVID-19 and T2D in Wuhan, from February 4th to April 11th, 2020. Patients were divided into two groups according to metformin exposure. The hazard ratio (HR) of COVID-19-related mortality and invasive mechanical ventilation was estimated using Cox regression. Results There were 571 T2D patients among the 4330 confirmed COVID-19 patients. Of those patients, 241 received metformin therapy. The in-hospital mortality and invasive mechanical ventilation of metformin group was lower than non-metformin group. In the multivariate model, metformin use was linked to a decreased in-hospital mortality and invasive mechanical ventilation when compared with that of the control group (HR: 0.376 [95% CI 0.154-0.922]; P = 0.033). Conclusion Our study indicated that metformin therapy was associated with decreased death risk in COVID-19 patients with T2D.
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Affiliation(s)
- Ziyu Guo
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Yanxiang Gao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Enmin Xie
- Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zixiang Ye
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Yike Li
- Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xuecheng Zhao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Nan Shen
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Jingang Zheng
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
- Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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3
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Roham PH, Kamath JJ, Sharma S. Dissecting the Interrelationship between COVID-19 and Diabetes Mellitus. Adv Biol (Weinh) 2023; 7:e2300107. [PMID: 37246237 DOI: 10.1002/adbi.202300107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/20/2023] [Indexed: 05/30/2023]
Abstract
COVID-19 disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to enormous morbidity and mortality worldwide. After gaining entry into the human host, the virus initially infects the upper and lower respiratory tract, subsequently invading multiple organs, including the pancreas. While on one hand, diabetes mellitus (DM) is a significant risk factor for severe COVID-19 infection and associated death, recent reports have shown the onset of DM in COVID-19-recovered patients. SARS-CoV-2 infiltrates the pancreatic islets and activates stress response and inflammatory signaling pathways, impairs glucose metabolism, and consequently leads to their death. Indeed, the pancreatic autopsy samples of COVID-19 patients reveal the presence of SARS-CoV-2 particles in β-cells. The current review describes how the virus enters the host cells and activates an immunological response. Further, it takes a closer look into the interrelationship between COVID-19 and DM with the aim to provide mechanistic insights into the process by which SARS-CoV-2 infects the pancreas and mediates dysfunction and death of endocrine islets. The effects of known anti-diabetic interventions for COVID-19 management are also discussed. The application of mesenchymal stem cells (MSCs) as a future therapy for pancreatic β-cells damage to reverse COVID-19-induced DM is also emphasized.
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Affiliation(s)
- Pratiksha H Roham
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, 411007, India
| | - Jayesh J Kamath
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, 411007, India
| | - Shilpy Sharma
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, 411007, India
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4
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Mirahmadizadeh A, Ghelichi-Ghojogh M, Jokari K, Amiri S, Moftakhar L, Moradian MJ, Habibi M, Dehghani SS, Hassani AH, Jafari A, Rezaei F. Correlation Between Diabetes and COVID-19 Indices: A Global Level Ecological
Study. SAGE Open Nurs 2023; 9:23779608231165485. [PMID: 37032958 PMCID: PMC10074615 DOI: 10.1177/23779608231165485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Coronavirus is threatening the global public health as a new and widespread crisis. The
researchers must keep in mind that one of the most vulnerable groups to COVID-19 are the
people with underlying diseases, especially diabetes. Objective This ecological study aimed to investigate the correlation between diabetes and the
epidemiological indices of COVID-19. Methods This ecological study included 144 countries. Their available data consists of the
cumulative incidence rate of cases, cumulative incidence rate of death, recovery rate,
case fatality rate, and performed tests of COVID-19, and diabetes. To collect the
variables, a data set was provided which included the information of 144 countries based
on diabetes and COVID-19 indices. Spearman coefficients were used for assess correlation
between diabetes and COVID-19 indices. Also, Scatter plots of diabetes for the studied
countries were drawn based on cumulative incidence rate of cases, cumulative incidence
rate of death, tests, recovery rate, and case fatality rate of COVID-19. Results The results of this ecological study showed in total countries, there was a weak
positive correlation between diabetes and cumulative incidence rate of cases and also
cumulative incidence rate of death. Correlation between diabetes with test of COVID-19
was very weak. Scatter plots showed a weak liner correlation between diabetes and
cumulative incidence rate of cases, cumulative incidence rate of death and test of
COVID-19. Conclusions In this study, there was a weak positive correlation between diabetes and cumulative
incidence rate of cases, cumulative incidence rate of death, and performed test of
COVID-19. This disease is an enormous challenge for health policymakers; therefore, it
is necessary to develop strategies and practical guidelines specific to each region to
take the necessary care, especially for diabetic patients.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center,
School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mousa Ghelichi-Ghojogh
- Neonatal and Children's Health Research
Center, Golestan University of Medical
Sciences, Gorgan, Iran
| | - Kimia Jokari
- Student Research Committee, Shiraz University
of Medical Sciences, Shiraz, Iran
| | - Sanaz Amiri
- Student Research Committee, Shiraz University
of Medical Sciences, Shiraz, Iran
| | - Leila Moftakhar
- Student Research Committee, Shiraz University
of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Moradian
- Trauma Research Center, Shahid Rajaee
(Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | - Alireza Jafari
- Department of Health Education and Health
Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical
Sciences, Gonabad, Iran
| | - Fatemeh Rezaei
- Research Center for Social Determinants of
Health, Jahrom University of Medical Sciences, Jahrom, Iran
- Fatemeh Rezaei, Department of Social Medicine,
Jahrom University of Medical Sciences, Jahrom, Iran.
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Dallavalasa S, Tulimilli SV, Prakash J, Ramachandra R, Madhunapantula SV, Veeranna RP. COVID-19: Diabetes Perspective-Pathophysiology and Management. Pathogens 2023; 12:pathogens12020184. [PMID: 36839456 PMCID: PMC9967788 DOI: 10.3390/pathogens12020184] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Recent evidence relating to the impact of COVID-19 on people with diabetes is limited but continues to emerge. COVID-19 pneumonia is a newly identified illness spreading rapidly throughout the world and causes many disabilities and fatal deaths. Over the ensuing 2 years, the indirect effects of the pandemic on healthcare delivery have become prominent, along with the lingering effects of the virus on those directly infected. Diabetes is a commonly identified risk factor that contributes not only to the severity and mortality of COVID-19 patients, but also to the associated complications, including acute respiratory distress syndrome (ARDS) and multi-organ failure. Diabetic patients are highly affected due to increased viral entry into the cells and decreased immunity. Several hypotheses to explain the increased incidence and severity of COVID-19 infection in people with diabetes have been proposed and explained in detail recently. On the other hand, 20-50% of COVID-19 patients reported new-onset hyperglycemia without diabetes and new-onset diabetes, suggesting the two-way interactions between COVID-19 and diabetes. A systematic review is required to confirm diabetes as a complication in those patients diagnosed with COVID-19. Diabetes and diabetes-related complications in COVID-19 patients are primarily due to the acute illness caused during the SARS-CoV-2 infection followed by the release of glucocorticoids, catecholamines, and pro-inflammatory cytokines, which have been shown to drive hyperglycemia positively. This review provides brief insights into the potential mechanisms linking COVID-19 and diabetes, and presents clinical management recommendations for better handling of the disease.
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Affiliation(s)
- Siva Dallavalasa
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR) Laboratory (DST-FIST Supported Centre), Department of Biochemistry (DST-FIST Supported Department), JSS Medical College, JSS Academy of Higher Education and Research (JSS AHER), Mysuru 570015, India
| | - SubbaRao V. Tulimilli
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR) Laboratory (DST-FIST Supported Centre), Department of Biochemistry (DST-FIST Supported Department), JSS Medical College, JSS Academy of Higher Education and Research (JSS AHER), Mysuru 570015, India
| | - Janhavi Prakash
- Department of Biochemistry, Council of Scientific and Industrial Research (CSIR)-Central Food Technological Research Institute (CFTRI), Mysuru 570020, India
| | - Ramya Ramachandra
- Department of Biochemistry, Council of Scientific and Industrial Research (CSIR)-Central Food Technological Research Institute (CFTRI), Mysuru 570020, India
| | - SubbaRao V. Madhunapantula
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR) Laboratory (DST-FIST Supported Centre), Department of Biochemistry (DST-FIST Supported Department), JSS Medical College, JSS Academy of Higher Education and Research (JSS AHER), Mysuru 570015, India
- Leader, Special Interest Group in Cancer Biology and Cancer Stem Cells (SIG-CBCSC), JSS Medical College, JSS Academy of Higher Education and Research (JSS AHER), Mysuru 570015, India
| | - Ravindra P. Veeranna
- Department of Biochemistry, Council of Scientific and Industrial Research (CSIR)-Central Food Technological Research Institute (CFTRI), Mysuru 570020, India
- Correspondence:
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Novida H, Soelistyo SA, Cahyani C, Siagian N, Hadi U, Pranoto A. Factors associated with disease severity of COVID‑19 in patients with type 2 diabetes mellitus. Biomed Rep 2023; 18:8. [PMID: 36570802 PMCID: PMC9764056 DOI: 10.3892/br.2022.1590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022] Open
Abstract
Diabetes mellitus causes a decline in immunological function, an increase in proinflammatory cytokines, and a prothrombotic state, thus providing risk factors for the severity of coronavirus disease 2019 (COVID-19) in patients with type 2 diabetes mellitus (T2DM). The aim of the present study was to analyze the risk factors associated with the severity of COVID-19 in patients with T2DM. A cross-sectional observational study was performed on 201 patients with T2DM from May 1 to August 31, 2020 and admitted to the isolation ward of Dr Soetomo General Hospital (Surabaya, Indonesia). The patients were divided into severe (108 cases; 53.7%) and non-severe (93 cases; 46.3%) groups, which were considered the dependent variables. Univariate and multivariate analysis was performed. The independent variables were age, sex, diabetes onset, chronic complications, presence of hypertension, randomized blood glucose, HbA1c, albumin, and neutrophil-lymphocyte ratio (NLR). A P-value <0.05 was considered to be statistically significant. The median age of the 201 subjects was 56 years, with 70.1% <60 years old, 52.7% male, 76.1% with diabetes onset <10 years, and 108 patients (53.7%) in severe condition. The results of the bivariate analysis revealed that diabetes onset >10 years (OR 2.5; P=0.011) was associated with severity of COVID-19 in patients with T2DM, however hypoalbumin (OR 1.93; P=0.054) was not associated with disease severity. Furthermore, multivariate analysis revealed that male sex (OR 2.07; P=0.042), age (≥60 years) (OR 2.92; P=0.008), HbA1c (≥8%) (OR 3.55; P=0.001), hypertension (OR 4.07; P=0.001), and an NLR ≥7.36 (OR 6.39; P=0.001) were associated with severe COVID-19. Collectively, it was revealed that increased NLR, hypertension, poor glycemic control, older age, and male sex were risk factors associated with the severity of COVID-19 among diabetic patients.
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Affiliation(s)
- Hermina Novida
- Division of Endocrinology, Diabetes and Metabolism, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, East Java 60132, Indonesia
| | - Soebagijo Adi Soelistyo
- Division of Endocrinology, Diabetes and Metabolism, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, East Java 60132, Indonesia
| | - Cupuwatie Cahyani
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, East Java 60132, Indonesia
| | - Nency Siagian
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, East Java 60132, Indonesia
| | - Usman Hadi
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, East Java 60132, Indonesia
| | - Agung Pranoto
- Division of Endocrinology, Diabetes and Metabolism, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, East Java 60132, Indonesia
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7
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Zhu Z, Zeng Q, Liu Q, Wen J, Chen G. Association of Glucose-Lowering Drugs With Outcomes in Patients With Diabetes Before Hospitalization for COVID-19: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2022; 5:e2244652. [PMID: 36472874 PMCID: PMC9856231 DOI: 10.1001/jamanetworkopen.2022.44652] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Patients with COVID-19 have a high prevalence of diabetes, and diabetes and blood glucose control are determinants of intensive care unit admission and mortality. OBJECTIVE To evaluate the association between COVID-19-related adverse outcomes and 8 antihyperglycemic drugs in patients with diabetes who were subsequently diagnosed and hospitalized with COVID-19. DATA SOURCES Data were retrieved and collected in PubMed, Embase, Cochrane Central Register, Web of Science, and ClinicalTrials.gov from database inception to September 5, 2022. STUDY SELECTION For this systematic review and network meta-analysis, randomized clinical trials and observational studies conducted among patients with diabetes while receiving glucose-lowering therapies for at least 14 days before the confirmation of COVID-19 infection were included after blinded review by 2 independent reviewers and consultations of disagreement by a third independent reviewer. Of 1802 studies initially identified, 31 observational studies met the criteria for further analysis. DATA EXTRACTION AND SYNTHESIS This study follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Bayesian network meta-analyses were performed with random effects. MAIN OUTCOMES AND MEASURES A composite adverse outcome, including the need for intensive care unit admission, invasive and noninvasive mechanical ventilation, or in-hospital death. RESULTS Thirty-one distinct observational studies (3 689 010 patients with diabetes hospitalized for COVID-19) were included. The sodium-glucose cotransporter-2 inhibitors (SGLT-2is) were associated with relatively lower risks of adverse outcomes compared with insulin (log of odds ratio [logOR], 0.91; 95% credible interval [CrI], 0.57-1.26), dipeptidyl peptidase-4 inhibitors (logOR, 0.61; 95% CrI, 0.28-0.93), secretagogues (logOR, 0.37; 95% CrI, 0.02-0.72), and glucosidase inhibitors (logOR, 0.50; 95% CrI, 0.00-1.01). Based on the surface under the cumulative ranking curves value, SGLT-2is were associated with the lowest probability for adverse outcomes (6%), followed by glucagon-like peptide-1 receptor agonists (25%) and metformin (28%). A sensitivity analysis revealed that the study was reliable. CONCLUSIONS AND RELEVANCE These findings suggest that the use of an SGLT-2i before COVID-19 infection is associated with lower COVID-19-related adverse outcomes. In addition to SGLT-2is, glucagon-like peptide-1 receptor agonists and metformin were also associated with relatively low risk of adverse outcomes.
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Affiliation(s)
- Zheng Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujia, China
| | - Qingya Zeng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujia, China
| | - Qinyu Liu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujia, China
| | - Junping Wen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujia, China
- Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujia, China
- Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical Sciences, Fuzhou, Fujian, China
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8
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Alkhemeiri A, Al Zaabi S, Lakshmanan J, El-Khatib Z, Awofeso N. COVID-19 Case Management Outcomes Amongst Diabetes and Hypertensive Patients in the United Arab Emirates: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15967. [PMID: 36498037 PMCID: PMC9738357 DOI: 10.3390/ijerph192315967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The global pandemic of the novel Coronavirus infection 2019 (COVID-19) challenged the care of comorbid patients. The risk imposed by COVID-19 on diabetes patients is multisystemic, exponential, and involves glucose dysregulation. The increased burden for diabetes patients infected with COVID-19 is substantial in countries with a high prevalence of diabetics, such as the United Arab Emirates (UAE). This study aims to explore the prevalence of diabetes, clinical characteristic, and outcomes of patients admitted for COVID-19 treatment with or without a concurrent preadmission diagnosis of diabetes. A prospective study was performed on 1199 adults admitted with confirmed COVID-19 from December 2020 to April 2021 to a single hospital in the UAE. The study compared the demographics, clinical characteristics, and outcomes in COVID-19-infected patients with diabetes to patients without diabetes. The study endpoints include the development of new-onset diabetes, admission to ICU, trends in the blood glucose levels, and death. A total of 1199 patients (390 with diabetes) were included in the study. A diabetes prevalence was detected among 9.8% of the study population. Among the diabetes group, 10.8% were morbidly obese, 65.4% had associated hypertension, and 18.9% had coronary artery disease. Diabetes patients showed higher rates of ICU admission (11.1% vs. 7.1%), NIV requirement (9.6% vs. 6.4%), and intubation (5.45% vs. 2%) compared to the non-diabetes group. Advanced age was a predictor of a worsening COVID-19 course, while diabetes (p < 0.050) and hypertension (p < 0.025) were significant predictors of death from COVID-19. Nearly three-fourths (284 (73.4%)) of the diabetic patients developed worsened hyperglycemia as compared to one-fifth (171 (20.9%)) of the nondiabetic patients. New-onset diabetes was detected in 9.8% of COVID-19 patients. COVID-19 severity is higher in the presence of diabetes and is associated with worsening hyperglycemia and poor clinical outcomes. Preexisting hypertension is a predictor of COVID-19 severity and death.
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Affiliation(s)
- Aysha Alkhemeiri
- Department of Medicine, Tawam Hospital, Abu Dhabi P.O. Box 15258, United Arab Emirates
| | - Shaikha Al Zaabi
- Internal Medicine Department, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Jeyaseelan Lakshmanan
- Biostatistics Department, Mohammed Bin Rashed University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Ziad El-Khatib
- Department of Global Public Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Niyi Awofeso
- School of Health and Environmental Studies, Hamdan Bin Muhammed Smart University, Dubai P.O. Box 71400, United Arab Emirates
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9
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Alkouri O, Khader Y, Hweidi IM, Gharaibeh MK, Jarrah M, Hamdan KM, Al Marzouqi A, Khamaiseh K. COVID-19 Fear and Anxiety among Patients with Chronic Heart Failure: A Cross Sectional Study. J Clin Med 2022; 11:jcm11216586. [PMID: 36362814 PMCID: PMC9653698 DOI: 10.3390/jcm11216586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022] Open
Abstract
Although the current management of COVID-19 is mainly focused on efficacious vaccine and infection control, the most common psychological reactions (such as fear and anxiety) associated with the COVID-19 pandemic have not been investigated and even neglected in patients with heart failure who are at greater risk for morbidity and mortality. We assessed COVID-19 related fear and anxiety among patients with heart failure and determined their associated factors. A cross sectional survey was conducted among 300 consecutive patients with heart failure during the period of March 2021−June 2021. Almost 50.7% of patients had fear of COVID-19 and 36.3% had coronavirus anxiety. Age > 55 was significantly associated with increased odds of fear (OR = 2.6) and anxiety (OR = 4.3). Patients with angina were more likely to have fear (OR = 3.0) and anxiety (OR = 2.2) and patients with chronic lung disease were more likely to have fear (OR = 3.0) and anxiety (OR = 3.3). Increased age, having angina, and having chronic lung disease were associated with increased odds of fear of COVID-19 and coronavirus anxiety. Psychological support needs to be integrated in patient care with special attention to physiological risk factors that are associated with COVID-19 comorbidities.
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Affiliation(s)
- Osama Alkouri
- Faculty of Nursing, Yarmouk University, Irbid 2116, Jordan
- Correspondence: ; Tel.: +962-78123-5385
| | - Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid 2116, Jordan
| | - Issa M. Hweidi
- Faculty of Nursing, Jordan University of Science and Technology, Irbid 2116, Jordan
| | | | - Mohamad Jarrah
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid 2116, Jordan
| | | | - Amina Al Marzouqi
- College of Health Sciences, Health Services Administration University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Khaldoun Khamaiseh
- Faculty of Medicine, Al-Balqa University, Al-Salt P.O. Box 19117, Jordan
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10
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Novel hit of DPP-4Is as promising antihyperglycemic agents with dual antioxidant/anti-inflammatory effects for type 2 diabetes with/without COVID-19. Bioorg Chem 2022; 128:106092. [PMID: 35985159 PMCID: PMC9364673 DOI: 10.1016/j.bioorg.2022.106092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/07/2022] [Indexed: 12/15/2022]
Abstract
DPP-4Is are well recognized therapy for type 2 diabetes. In spite of sharing a common mode of action, the chemical diversity among members of DPP-4Is raised the question whether structural differences may result in distinguished activities. DPP-4Is were recently explored as drug repurposing means for treatment of SARS-CoV-2 due to the urgent need for small molecule drugs for controlling infections. The use of DPP-4Is was not correlated with adverse COVID-19-related consequences among patients with type 2 diabetes. Inspired by these reasons and the importance of pyrimidinone ring as DPP-4I with both antioxidant and anti-inflammatory activities, we succeeded to prepare some novel pyrimidinone and thio-pyrimidinone derivatives, which were then screened for their antidiabetic activity and DPP-4 inhibition. In addition, their anti-inflammatory effect on LPS-stimulated RAW 264.7 cells were evaluated. Furthermore, their antioxidant activities were also tested.
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11
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Zupa MF, Perez S, Palmisano G, Kieffer EC, Piatt GA, Valbuena FM, Deverts DJ, Yabes JG, Heisler M, Rosland AM. Changes in Self-management During the COVID-19 Pandemic Among Adults with Type 2 Diabetes at a Federally Qualified Health Center. J Immigr Minor Health 2022; 24:1375-1378. [PMID: 35301642 PMCID: PMC8929472 DOI: 10.1007/s10903-022-01351-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic affected how adults with diabetes perform self-management, and impacts may be greater among vulnerable populations. We assessed the impact of the pandemic on diabetes self-management among adults with type 2 diabetes at a Federally Qualified Health Center. Participants were surveyed by phone in Spanish and English from July to October of 2020. Most respondents (74%) were Latino and preferred to speak Spanish, with mean age of 54 years and mean HbA1c of 9.2%. Fifty-three percent reported less physical activity during the pandemic. While 43% had more difficulty obtaining healthy food, 38% reported eating more healthfully. Sixty-one percent had increased difficulty accessing medical care. Many felt more socially isolated (49%) and stressed (51%). Changes in diabetes self-management were both positive and negative for majority Latino patients in this low-resource community, which may require tailored approaches to mitigate negative impacts of the pandemic on physical and mental health.
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Affiliation(s)
- Margaret F Zupa
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, 3601 Fifth Ave, Suite 3A, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Stephanie Perez
- Community Health and Social Services Center, Inc, 5635 West Fort Street, Detroit, MI, 48209, USA
| | - Gloria Palmisano
- Community Health and Social Services Center, Inc, 5635 West Fort Street, Detroit, MI, 48209, USA
| | - Edith C Kieffer
- University of Michigan School of Social Work, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
| | - Gretchen A Piatt
- University of Michigan School of Medicine, 1301 Catherine St., Ann Arbor, MI, 48109, USA
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Felix M Valbuena
- Community Health and Social Services Center, Inc, 5635 West Fort Street, Detroit, MI, 48209, USA
| | - Denise J Deverts
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA
| | - Jonathan G Yabes
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA
| | - Michele Heisler
- University of Michigan School of Medicine, 1301 Catherine St., Ann Arbor, MI, 48109, USA
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- VA Ann Arbor Center for Clinical Management Research, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA
| | - Ann-Marie Rosland
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA
- VA Pittsburgh Center for Health Equity Research and Promotion, 4100 Allequippa St, Pittsburgh, PA, 15240, USA
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12
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Lombardi R, Mura VL, Cespiati A, Iuculano F, Sigon G, Pallini G, Proietti M, Motta I, Montinaro B, Fiorelli E, Cesari M, Bandera A, Valenti L, Peyvandi F, Montano N, Baldini M, Fracanzani AL. Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity. Intern Emerg Med 2022; 17:1739-1749. [PMID: 35754075 PMCID: PMC9244481 DOI: 10.1007/s11739-022-03000-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/06/2022] [Indexed: 01/08/2023]
Abstract
Despite vaccination programs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains a public health problem. Identifying key prognostic determinants of severity of the disease may help better focus health resources. The negative prognostic role for metabolic and hepatic alterations is established; however, the interplay among different metabolic comorbidities and their interconnections with the liver have never been explored.The objective of this study is to evaluate the impact of liver alterations in addition to metabolic comorbidities as a predictor of SARS-CoV-2 severity. 382 SARS-CoV-2 patients were enrolled. Severe SARS-CoV-2 was diagnosed according to international consensus. Transaminases > 2 times the upper limit of normality (2ULN), hepatic steatosis (by ultrasound and/or computed tomography in 133 patients), and FIB-4 defined liver alterations. All data were collected on admission. The results are severe SARS-CoV-2 infection in 156 (41%) patients (mean age 65 ± 17; 60%males). Prevalence of obesity was 25%; diabetes, 17%; hypertension, 44%; dyslipidaemia, 29%; with 13% of the cohort with ≥ 3 metabolic alterations. Seventy patients (18%) had transaminases > 2ULN, 82 (62%) steatosis; 199 (54%) had FIB-4 < 1.45 and 45 (12%) > 3.25. At multivariable analysis, ≥ 3 metabolic comorbidities (OR 4.1, CI 95% 1.8-9.1) and transaminases > 2ULN (OR 2.6, CI 95% 1.3-6.7) were independently associated with severe SARS-CoV-2. FIB-4 < 1.45 was a protective factor (OR 0.42, CI 95% 0.23-0.76). Hepatic steatosis had no impact on disease course. The presence of metabolic alterations is associated with severe SARS-CoV-2 infection, and the higher the number of coexisting comorbidities, the higher the risk of severe disease. Normal FIB-4 values are inversely associated with advanced SARS-CoV-2 regardless of metabolic comorbidities, speculating on use of these values to stratify the risk of severe infection.
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Affiliation(s)
- Rosa Lombardi
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy.
| | - Vincenzo La Mura
- Unit of Internal Medicine Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Annalisa Cespiati
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Federica Iuculano
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Giordano Sigon
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Giada Pallini
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Marco Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Montinaro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Fiorelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Unit of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Department of Transfusion Medicine and Hematology, Università degli Studi di Milano, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Unit of Internal Medicine Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Baldini
- Unit of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Ludovica Fracanzani
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
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13
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Kubatka P, Mazurakova A, Koklesova L, Samec M, Sokol J, Samuel SM, Kudela E, Biringer K, Bugos O, Pec M, Link B, Adamkov M, Smejkal K, Büsselberg D, Golubnitschaja O. Antithrombotic and antiplatelet effects of plant-derived compounds: a great utility potential for primary, secondary, and tertiary care in the framework of 3P medicine. EPMA J 2022; 13:407-431. [PMID: 35990779 PMCID: PMC9376584 DOI: 10.1007/s13167-022-00293-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/29/2022]
Abstract
Thromboembolism is the third leading vascular disease, with a high annual incidence of 1 to 2 cases per 1000 individuals within the general population. The broader term venous thromboembolism generally refers to deep vein thrombosis, pulmonary embolism, and/or a combination of both. Therefore, thromboembolism can affect both – the central and peripheral veins. Arterial thromboembolism causes systemic ischemia by disturbing blood flow and oxygen supply to organs, tissues, and cells causing, therefore, apoptosis and/or necrosis in the affected tissues. Currently applied antithrombotic drugs used, e.g. to protect affected individuals against ischemic stroke, demonstrate significant limitations. For example, platelet inhibitors possess only moderate efficacy. On the other hand, thrombolytics and anticoagulants significantly increase hemorrhage. Contextually, new approaches are extensively under consideration to develop next-generation antithrombotics with improved efficacy and more personalized and targeted application. To this end, phytochemicals show potent antithrombotic efficacy demonstrated in numerous in vitro, ex vivo, and in vivo models as well as in clinical evaluations conducted on healthy individuals and persons at high risk of thrombotic events, such as pregnant women (primary care), cancer, and COVID-19-affected patients (secondary and tertiary care). Here, we hypothesized that specific antithrombotic and antiplatelet effects of plant-derived compounds might be of great clinical utility in primary, secondary, and tertiary care. To increase the efficacy, precise patient stratification based on predictive diagnostics is essential for targeted protection and treatments tailored to the person in the framework of 3P medicine. Contextually, this paper aims at critical review toward the involvement of specific classes of phytochemicals in antiplatelet and anticoagulation adapted to clinical needs. The paper exemplifies selected plant-derived drugs, plant extracts, and whole plant foods/herbs demonstrating their specific antithrombotic, antiplatelet, and fibrinolytic activities relevant for primary, secondary, and tertiary care. One of the examples considered is antithrombotic and antiplatelet protection specifically relevant for COVID-19-affected patient groups.
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Affiliation(s)
- Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Alena Mazurakova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Lenka Koklesova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Marek Samec
- Department of Pathological Physiology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Juraj Sokol
- Department of Hematology and Transfusion Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Samson Mathews Samuel
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, 24144 Doha, Qatar
| | - Erik Kudela
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Kamil Biringer
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | | | - Martin Pec
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Barbara Link
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Marian Adamkov
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Karel Smejkal
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, 61200 Brno, Czech Republic
| | - Dietrich Büsselberg
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, 24144 Doha, Qatar
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
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14
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Alzubaidi H, Hafidh K, Saidawi W, Othman AM, Khakpour MM, Zoghbor MM, Abu-Gharbieh E, Alzoubi KH, Shaw JE. Behavioral, psychological, and clinical outcomes of Arabic-speaking people with type 2 diabetes during COVID-19 pandemic. Prim Care Diabetes 2022; 16:355-360. [PMID: 35410850 PMCID: PMC8993045 DOI: 10.1016/j.pcd.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/29/2022] [Indexed: 01/21/2023]
Abstract
AIMS Assess self-care activities, health behaviors, self-efficacy, diabetes distress, challenges, and changes in diabetes treatment and clinical parameters among Arabic-speaking people with T2DM during the COVID-19 pandemic. METHODS A cross-sectional study was conducted at a tertiary hospital in the United Arab Emirates. The study instrument collected self-reported data using validated tools about health behaviors, self-efficacy, and diabetes distress, and challenges in accessing and using healthcare services during the pandemic and documented clinical data and treatment before and during the pandemic from medical records. RESULTS 206 patients participated with a mean age of 58.7 years and 15.7 years since diabetes diagnosis. Non-adherence to healthful eating and exercise was reported by 38.3% and 73.7%, respectively. Exercise was the self-care activity that decreased the most (36.8%). Most participants had low diabetes distress (85.9%). There were no significant differences in clinical parameters before and during the pandemic, and diabetes treatment was unchanged for 72.8% of participants. Having two or more challenges with accessing and using diabetes healthcare services was significantly associated with decreased adherence to healthy eating (p = 0.025) and exercise (p = 0.003). CONCLUSIONS Arabic-speaking people with T2DM appeared to maintain relatively similar self-care levels, except exercise, with no deterioration in clinical parameters compared to pre-pandemic.
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Affiliation(s)
- Hamzah Alzubaidi
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates; Sharjah Institute for Medical Research, University of Sharjah, University City Road - University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Khadija Hafidh
- Rashid Hospital, Dubai Health Authority UAE, Dubai Medical College, United Arab Emirates.
| | - Ward Saidawi
- Sharjah Institute for Medical Research, University of Sharjah, University City Road - University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Amna M Othman
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Mahta M Khakpour
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Malaka M Zoghbor
- Pharmacist, Fakeeh University Hospital, Dubai Silicon Oasis, Dubai, United Arab Emirates.
| | - Eman Abu-Gharbieh
- Sharjah Institute for Medical Research, University of Sharjah, University City Road - University City, PO Box 27272, Sharjah, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | - Karem H Alzoubi
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Institute, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, PO Box 6492, Melbourne, VIC 3004, Australia.
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15
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Sustained Hyperglycemia and Its Relationship with the Outcome of Hospitalized Patients with Severe COVID-19: Potential Role of ACE2 Upregulation. J Pers Med 2022; 12:jpm12050805. [PMID: 35629227 PMCID: PMC9147379 DOI: 10.3390/jpm12050805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 01/09/2023] Open
Abstract
Chronic hyperglycemia increases the risk of developing severe COVID-19 symptoms, but the related mechanisms are unclear. A mean glucose level upon hospital admission >166 mg/dl correlates positively with acute respiratory distress syndrome in patients with hyperglycemia. The objective of this study was to evaluate the relationship between sustained hyperglycemia and the outcome of hospitalized patients with severe COVID-19. We also evaluated the effect of high glucose concentrations on the expression of angiotensin-converting enzyme 2 (ACE2). We carried out a case-control study with hospitalized patients with severe COVID-19 with and without sustained hyperglycemia. In a second stage, we performed in vitro assays evaluating the effects of high glucose concentrations on ACE2 gene expression. Fifty hospitalized patients with severe COVID-19 were included, of which 28 (56%) died and 22 (44%) recovered. Patients who died due to COVID-19 and COVID-19 survivors had a high prevalence of hyperglycemia (96.4% versus 90.9%), with elevated central glucose upon admission (197.7 mg/dl versus 155.9 mg/dl, p = 0.089) and at discharge (185.2 mg/dl versus 134 mg/dl, p = 0.038). The mean hypoxemia level upon hospital admission was 81% in patients who died due to COVID-19 complications and 88% in patients who survived (p = 0.026); at the time of discharge, hypoxemia levels were also different between the groups (68% versus 92%, p ≤ 0.001). In vitro assays showed that the viability of A549 cells decreased (76.41%) as the glucose concentration increased, and the ACE2 gene was overexpressed 9.91-fold after 72 h (p ≤ 0.001). The relationship between hyperglycemia and COVID-19 in hospitalized patients with COVID-19 plays an important role in COVID-19-related complications and the outcome for these patients. In patients with chronic and/or sustained hyperglycemia, the upregulation of ACE2, and its potential glycation and malfunction, could be related to complications observed in patients with COVID-19.
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16
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Mendes TB, Câmara-de-Souza AB, Halpern B. Hospital management of hyperglycemia in the context of COVID-19: evidence-based clinical considerations. Diabetol Metab Syndr 2022; 14:37. [PMID: 35246230 PMCID: PMC8895065 DOI: 10.1186/s13098-022-00808-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/18/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic led to an unprecedented crisis, and early on, it has been shown that diabetes is an important risk factor for complications and mortality in infected patients, as demonstrated by several studies. Moreover, hyperglycemia, regardless of whether patients have diabetes, is associated with poorer outcomes, which suggests that adequate monitoring and treatment of elevated glycemia in the hospital setting can improve patient outcomes. In patients with COVID-19, glycemic control may be impaired as a consequence of the infection itself (aggravating pre-existing diabetes and potentially precipitating new-onset diabetes), inflammation, or corticosteroid use-a well-established therapy to reduce COVID-19 complications, especially in the intensive care unit. This article reviews the link between diabetes and hyperglycemia, and COVID-19, with a brief review of potential mechanisms, along with emerging evidence on the effect of glycemic control on COVID-19 outcomes, especially in hospital settings.
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Affiliation(s)
- Thiago Bosco Mendes
- Department of Internal Medicine, Hospital das Clínicas, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Bruno Halpern
- Department of Endocrinology, Hospital 9 de Julho, Rua Alves Guimarães, 462, cj. 72, Pinheiros, São Paulo, SP, 05410-000, Brazil.
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17
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Vargas-Rodriguez JR, Garza-Veloz I, Flores-Morales V, Badillo-Almaraz JI, Rocha-Pizaña MR, Valdés-Aguayo JJ, Martinez-Fierro ML. Hyperglycemia and Angiotensin-Converting Enzyme 2 in Pulmonary Function in the Context of SARS-CoV-2 Infection. Front Med (Lausanne) 2022; 8:758414. [PMID: 35096863 PMCID: PMC8792738 DOI: 10.3389/fmed.2021.758414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/20/2021] [Indexed: 01/18/2023] Open
Abstract
Since the appearance of the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 in China, diabetes mellitus (DM) and hyperglycemia in patients infected with SARS-CoV, represent independent predictors of mortality. Therefore, metabolic control has played a major role in the prognosis of these patients. In the current pandemic of coronavirus disease 19 (COVID-19), multiple studies have shown that DM is one of the main comorbidities associated with COVID-19 and higher risk of complications and death. The incidence and prevalence of COVID-19 complications and death related with hyperglycemia in patients with or without DM are high. There are many hypotheses related with worse prognosis and death related to COVID-19 and/or hyperglycemia. However, the information about the interplay between hyperglycemia and angiotensin-converting enzyme 2 (ACE2), the critical receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the context of SARS-CoV-2 infection, is almost null, but there is enough information to consider the possible participation of hyperglycemia in the glycation of this protein, unleashing a pool of reactions leading to acute respiratory distress syndrome and death in patients with COVID-19. In this document we investigated the current evidence related with ACE2 as a key element within the pathophysiological mechanism related with hyperglycemia extrapolating it to context of SARS-CoV-2 infection and its relationship with worse prognosis and death for COVID-19.
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Affiliation(s)
- Jose R Vargas-Rodriguez
- Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ Siglo XXI, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Idalia Garza-Veloz
- Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ Siglo XXI, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Virginia Flores-Morales
- Laboratorio de Sintesis Asimetrica y Bioenergetica, Ingenieria Quimica, Unidad Academica de Ciencias Quimicas, Campus UAZ Siglo XXI, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Jose I Badillo-Almaraz
- Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ Siglo XXI, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Maria R Rocha-Pizaña
- Escuela de Ingenieria y Ciencias, Tecnologico de Monterrey Campus Puebla, Puebla, Mexico
| | - José J Valdés-Aguayo
- Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ Siglo XXI, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
| | - Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ Siglo XXI, Universidad Autonoma de Zacatecas, Zacatecas, Mexico
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18
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Santos AP, Couto CF, Pereira SS, Monteiro MP. Is Serotonin the Missing Link between COVID-19 Course of Severity in Patients with Diabetes and Obesity? Neuroendocrinology 2022; 112:1039-1045. [PMID: 35066497 PMCID: PMC9059061 DOI: 10.1159/000522115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022]
Abstract
COVID-19 is an intriguing infectious condition with multisystemic manifestations and variable outcomes that are influenced by the concomitant presence of non-communicable diseases, such as obesity, diabetes, and cardiovascular disease, which were previously well established epidemics and therefore are considered global syndemics. Although an enormous progress towards understanding mechanisms of SARS-CoV-2 infection leading to COVID-19 has been made, there are still many areas of uncertainty to clarify. Systemic diseases are characterized by common links that allow integrating apparently unrelated disease manifestations. The authors launch the provocative hypothesis that serotonin is the putative mediator linking the lung, gut, cardiac, neurological, and other systemic manifestations that characterize severe COVID-19 in individuals with diabetes and obesity. In support of a role for serotonin in the mechanisms leading to disease severity are the similarities between acute and post-acute COVID-19 manifestations and neuroendocrine tumors presenting with carcinoid syndrome. Scientific discussion is set by highlighting the available clues that support this working hypothesis to trigger future research aimed at unravelling the molecular pathways underlying SARS-CoV-2 infection that are still far from being fully disclosed.
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Affiliation(s)
- Ana Paula Santos
- Portuguese Oncology Institute of Porto (IPO Porto), Department of Endocrinology, Porto, Portugal
- Portuguese Oncology Institute of Porto (IPO Porto), Clinical Research Unit, Research Center of IPO Porto (CI-IPOP), Porto, Portugal
- Precancerous and Early Cancer Management Group, Research Center of IPO Porto (CI-IPOP), RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | | | - Sofia Silva Pereira
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine, UMIB ICBAS, University of Porto, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar (ICBAS), Department of Anatomy, University of Porto, Porto, Portugal
| | - Mariana Pereira Monteiro
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine, UMIB ICBAS, University of Porto, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar (ICBAS), Department of Anatomy, University of Porto, Porto, Portugal
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19
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Gorjão R, Hirabara S, Masi L, Serdan T, Gritte R, Hatanaka E, Souza-Siqueira T, Pithon-Curi A, Lima TD, Pithon-Curi T, Marchini J, Machado M, Souza H, Curi R. Poor prognosis indicators of type-2 diabetic COVID-19 patients. Braz J Med Biol Res 2022; 55:e11819. [PMID: 35766706 PMCID: PMC9224823 DOI: 10.1590/1414-431x2022e11819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Diabetes is associated with a worse prognosis and a high risk of morbidity and mortality in COVID-19 patients. We aimed to evaluate the main factors involved in the poor prognosis in diabetic patients. A total of 984 patients diagnosed with COVID-19 admitted to the hospital were included in this study. Patients were first divided into type-2 diabetic (DM+) and non-diabetic (DM–) groups. The participants were analyzed based on the National Early Warning Score (NEWS) and on the Quick-Sequential Organ Failure Assessment (qSOFA) to find the best prognostic risk score for our study. The DM+ and DM– groups were divided into non-severe and severe groups. Comparative and correlative analyses were used to identify the physiological parameters that could be employed for creating a potential risk indicator for DM+ COVID-19 patients. We found a poorer prognosis for the DM+ COVID-19 patients with a higher ICU admission rate, mechanical ventilation rate, vasopressor use, dialysis, and longer treatment times compared with the DM– group. DM+ COVID-19 patients had increased plasma glucose, lactate, age, urea, NEWS, and D-dimer levels, herein referred to as the GLAUND set, and worse prognosis and outcomes when compared with infected DM– patients. The NEWS score was a better indicator for assessing COVID-19 severity in diabetic patients than the q-SOFA score. In conclusion, diabetic COVID-19 patients should be assessed with the NEWS score and GLAUND set for determining their prognosis COVID-19 prognosis.
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Affiliation(s)
- R. Gorjão
- Universidade Cruzeiro do Sul, Brasil
| | | | - L.N. Masi
- Universidade Cruzeiro do Sul, Brasil
| | - T.D.A. Serdan
- Universidade Cruzeiro do Sul, Brasil; New York University, USA
| | | | | | | | | | | | | | | | | | | | - R. Curi
- Universidade Cruzeiro do Sul, Brasil; Instituto Butantan, Brasil
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20
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O’Neill L, Chumbler NR. Risk Factors for COVID-19 Hospitalization in School-Age Children. Health Serv Res Manag Epidemiol 2022; 9:23333928221104677. [PMID: 35706910 PMCID: PMC9189522 DOI: 10.1177/23333928221104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction With the recent emergence of the Omicron variant, there has been a rapid and alarming increase in the number of COVID-19 cases among pediatric populations. Yet few US pediatric cohort studies have characterized the clinical features of children with severe COVID-19. The objective of this study was to identify those chronic comorbidities that increase the risk of hospitalization for pediatric populations with severe COVID-19. Methods A retrospective cohort study that utilized the Texas Inpatient Public Use Data file was conducted. The study included 1187 patients (ages 5 to 19) from 164 acute-care Texas hospitals with the primary or secondary ICD-10CM diagnosis code U07.1 (COVID-19, virus identified). The baseline comparison group included 38 838 pediatric patients who were hospitalized in 2020. Multivariable binary logistic regression, controlling for patient characteristics, sociodemographic factors, and health insurance, was used to estimate the adjusted risk of hospitalization for COVID-19. Results Obesity and type 1 diabetes increased the risk of hospitalization with COVID-19 among both children (5-12 years) and adolescents (13-19 years). Adolescents with morbid obesity were 10 times more likely to have severe COVID-19 (p < 0.001). Regardless of age, single-parent households (%) for the patient's zip code was associated with an increased risk of hospitalization with COVID-19 (AOR = 1.02, CI: 1.01-1.03, p < 0.01). Other risk factors included chronic kidney disease (p < 0.05), male gender (p < 0.001), Medicaid (p < 0.001), and charity care (p < 0.001). Conclusion Pediatric providers and public health officials should consider the need to tailor clinical management and mitigation efforts for pediatric populations with identifiable risk factors for severe COVID-19. These findings can be used to improve risk communication with families of children with underlying medical conditions and to prioritize prevention measures, including vaccinations.
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Affiliation(s)
- Liam O’Neill
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Neale R. Chumbler
- Department of Diagnostic and Health Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN, USA
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21
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García Ulloa AC, Tron-Gómez MS, Díaz-Pineda M, Hernández-Juárez D, Landa-Anell MV, Melgarejo-Hernández MA, Hernández-Jiménez S. Maintenance of Self-Care Activities During COVID-19 Lockdown in Patients with Type 2 Diabetes That Received a Comprehensive Care Program Training. Diabetes Metab Syndr Obes 2022; 15:2857-2865. [PMID: 36160467 PMCID: PMC9504530 DOI: 10.2147/dmso.s379547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2020, several countries established a global emergency state. Lockdowns restricted people's lifestyles and daily activities to prevent coronavirus spread. These measures hindered diabetes mellitus control and lifestyle changes. This study aims to evaluate if attending a multidisciplinary program before the pandemic helped maintain a good metabolic state, lifestyle modifications, and mental health in patients with diabetes mellitus during the COVID-19 lockdown. METHODS Patients included in this study attended a multidisciplinary program, with <5 years of diagnosis of type 2 diabetes, without disabling complications, between 18-70 years old. The complete lockdown occurred from February 27, 2020, to May 31, 2020. The first patient (non-COVID) to return to the center for face-to-face consultation was in March 2021. Consultations in 2019 were face-to-face and changed to a virtual modality during 2020. We analyzed metabolic, lifestyle, mental health, and diabetes education parameters. RESULTS A total of 133 patients with type 2 diabetes mellitus were included with complete information in visits before and during the lockdown. Metabolic parameters and self-care measures (nutrition plan, foot evaluation, and self-glucose monitoring) evaluated on our patients had no change during the lockdown. We found a significant increase in the time patients spent sitting during the day (p<0.05). Barriers to exercise increased during lockdown, being joint pain (3.8% to 12.0%, p<0.01) and lack of time to exercise (4.5% to 7.5%, p=0.33) being the most common. There was no significant difference in symptoms of anxiety and depression, quality of life, and empowerment. CONCLUSION A multidisciplinary diabetes mellitus program, including diabetes education for self-care activities, positively impacts patients, maintaining good outcomes despite lockdown difficulties.
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Affiliation(s)
- Ana C García Ulloa
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maria S Tron-Gómez
- Faculty of Health Sciences, Universidad Anáhuac México Norte, Huixquilucan, Mexico
| | - Michelle Díaz-Pineda
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana Hernández-Juárez
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María V Landa-Anell
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marco A Melgarejo-Hernández
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sergio Hernández-Jiménez
- Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Correspondence: Sergio Hernández-Jiménez, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Centro de Atención Integral del Paciente con Diabetes, Vasco de Quiroga No. 15, Belisario Domínguez, Colonia Sección XVI, Tlalpan, Mexico City, 14080, Mexico, Tel +1 52 55 54870900 (5045); +1 52 55 55737378, Email
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22
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Kifle ZD, Woldeyohanis AE, Demeke CA. A review on protective roles and potential mechanisms of metformin in diabetic patients diagnosed with COVID-19. Metabol Open 2021; 12:100137. [PMID: 34664036 PMCID: PMC8516148 DOI: 10.1016/j.metop.2021.100137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/12/2021] [Indexed: 12/21/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19), is currently the leading threat to public health and a huge challenge to the healthcare systems across the globe and caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Obesity, a state of chronic inflammation, and diabetes mellitus are risk factors for severe SARS-CoV-2. Metformin is one of the most commonly used antidiabetic medications that displayed immunomodulatory activity through AMP-activated protein kinase. Metformin has sex-specific immunomodulatory and cytokine-reducing activities. Therefore, this review aimed to summarize the protective roles of Metformin and its possible molecular mechanisms for use in COVID-19 patients. To include studies, publications related to Metformin and its possible molecular mechanisms for COVID-19 were searched from the databases such as Web of Science, PubMed, Medline, Elsevier, Google Scholar, and SCOPUS, via English key terms. Maintaining proper blood glucose levels using oral antidiabetic drugs like Metformin reduced the detrimental effects of COVID-19 by different possible mechanisms such as Metformin-mediated anti-inflammatory and immunomodulatory activities; effect on viral entry and ACE2 stability; inhibition of virus infection; alters virus survival and endosomal pH; mTOR inhibition; and influence on gut microbiota. Fascinatingly, in diabetic patients with COVID-19, treatment with Metformin was associated with a noticeable reduction in mortality rates and disease severity among infected patients. Metformin was comprehensively investigated for its anti-inflammatory, antiviral capabilities, immunomodulatory, and antioxidant, which would elucidate its capability to confer vascular and cardiopulmonary protection in COVID-19.
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Affiliation(s)
- Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alem Endeshaw Woldeyohanis
- Department of Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Abiyu Demeke
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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23
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Preventing the Next Pandemic: The Case for Investing in Circulatory Health - A Global Coalition for Circulatory Health Position Paper. Glob Heart 2021; 16:66. [PMID: 34692391 PMCID: PMC8516006 DOI: 10.5334/gh.1077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments.
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Demidova TY, Lobanova KG, Perekhodov SN, Antsiferov MB, Oynotkinova OS. [Retrospective analysis of clinical outcomes of patients with COVID-19 depending on receiving antihypertensive, lipid-lowering and antihypertensive therapy]. TERAPEVT ARKH 2021; 93:1193-1202. [PMID: 36286821 DOI: 10.26442/00403660.2021.10.201072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The main factors that increase the risk of cardiovascular accidents and mortality among patients with COVID-19 include hyperglycemia, arterial hypertension and dyslipidemia. Therefore, all patients with COVID-19 and metabolic syndrome should receive antihypertensive (AHT), hypolipidemic (GLT) and hypoglycemic therapy (GGT). Currently, there is a limited number of studies regarding the effectiveness and safety of this therapy in patients with COVID-19. AIM Evaluate the clinical outcomes of patients with COVID-19, depending on the recipient of AHT, GLT and GGT. MATERIALS AND METHODS A retrospective analysis of the clinical outcomes "discharged/died" of 1753 patients with COVID-19 was carried out depending on the received AHT, GLT and GGT. RESULTS A significant reduction in the risk of mortality among patients with COVID-19 was observed during therapy with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers ACE inhibitors/ARBs (OR 0.39, 95% CI 0.210.72; p0.05) and b-adrenergic blockers b-AB (OR 0.53, 95% CI 0.281; p0.05). At the same time, against the background of therapy with ACE inhibitors/ARBs and b-ABs, the chance of mortality decreased more significantly among patients with type 2 diabetes mellitus (T2DM) compared with patients without T2DM. Diuretic therapy was associated with a 3-fold increase in the chances of death: OR 3.33, 95% CI 1.884.79; p0.05. Statin therapy did not affect clinical outcomes in COVID-19 patients. On the background of therapy with oral hypoglycemic drugs, the risk of mortality decreased 5-fold (OR 0.19, 95% CI 0.070.54; p0.05). Against the background of insulin therapy, there was an increase in mortality risk by 2.8 times (OR 2.81, 95% CI 1.55.29; p0.05). CONCLUSION A significant reduction in mortality among patients with COVID-19 was observed during therapy with ACEI/ARB, b-AB, and oral hypoglycemic therapy. Increased risk of death was associated with insulin therapy and diuretic therapy.
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Affiliation(s)
- T Y Demidova
- Pirogov Russian National Research Medical University
| | - K G Lobanova
- Pirogov Russian National Research Medical University
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25
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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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Risk Factors for SARS-CoV-2 Infection Severity in Abu Dhabi. J Epidemiol Glob Health 2021; 11:344-353. [PMID: 34734381 PMCID: PMC8381146 DOI: 10.1007/s44197-021-00006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Prediction models are essential for informing screening, assessing prognosis, and examining options for treatment. This study aimed to assess the risk of SARS-CoV-2 infection severity in the Abu Dhabi population. Methods This is a mixed retrospective cohort study and case–control study to explore the associated factors of receiving treatment in the community, being hospitalized, or requiring complex hospital care among patients with a diagnosis of SARS-CoV-2. Of 641 patients included, 266 were hospitalized; 135 were hospitalized and either died or required complex care, i.e., required ICU admission, intubation, or oxygen and 131 did not develop severe disease requiring complex care. The third group (“controls”) were 375 patients who were not hospitalized. Logistic regression analyses were used to study predictors of disease severity. Results Among hospitalized patients older age and low oxygen saturation at admission were the consistent and strongest predictors of an adverse outcome. Risk factors for the death in addition to age and low oxygen saturation were elevated white blood count and low reported physical activity. Chronic kidney disease and diabetes were also associated with more severe disease in logistic regression. The mortality rate among those with less than 30 min per week of physical activity was 4.9%, while the mortality rate was 0.35% for those with physical activity > 30 min at least once a week. The interval from the onset of symptoms to admission and mortality was found to have a significant inverse relationship, with worse survival for shorter intervals. Conclusion Oxygen saturation is an important measure that should be introduced at screening sites and used in the risk assessment of patients with SARS-CoV-2. In addition, an older age was a consistent factor in all adverse outcomes, and other factors, such as low physical activity, elevated WBC, CKD, and DM, were also identified as risk factors.
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Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168470. [PMID: 34444219 PMCID: PMC8394531 DOI: 10.3390/ijerph18168470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 12/28/2022]
Abstract
People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of coronaviruses either on PWUD, or on services targeted to PWUD. We report the findings of a systematic review of empirical evidence from studies which have examined the impact of coronaviruses (Severe Acute Respiratory Syndrome (SARS-CoV-1) and Middle Eastern Respiratory Syndrome (MERS-CoV) and COVID-19) on PWUD or on service responses to them. Five databases were searched (MEDLINE, PsycINFO, CINAHL, ASSIA and EMBASE) as well as COVID-19 specific databases. Inclusion criteria were studies reporting any impact of SARS, MERS or COVID-19 or any service responses to those, published between January 2000 and October 2020. Weight of Evidence judgements and quality assessment were undertaken. In total, 27 primary studies were included and grouped by seven main themes: treatment/recovery services; emergency medical settings; low-threshold services; prison setting, PWUD/substance use disorder (SUD) diagnosis; people with SUD and HIV; ‘Sexual minority’ men. Overall, research in the area was scant, and of average/poor quality. More robust research is required to inform on-going and future responses to coronavirus epidemics for PWUD.
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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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Hariyanto TI, Lugito NPH, Yanto TA, Siregar JI, Kurniawan A. Insulin therapy and outcome from coronavirus disease 2019 (COVID-19): A Systematic Review, Meta-Analysis, and Meta-Regression. Endocr Metab Immune Disord Drug Targets 2021; 22:481-489. [PMID: 34250875 DOI: 10.2174/1871530321666210709164925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Currently, the relationship between insulin therapy and COVID-19 outcome is not yet established. Our study aims to evaluate the possible association between insulin and the poor composite development of COVID-19. METHODS We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 12th, 2020. All articles published on COVID-19 and insulin were retrieved. Statistical analysis was done using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software. RESULTS Our pooled analysis showed that insulin use was associated with poor composite development of COVID-19 [OR 2.06 (95% CI 1.70 - 2.48), p < 0.00001, I2 = 83%, random-effect modelling], and its subgroup which comprised of risk of COVID-19 [OR 1.70 (95% CI 1.40 - 2.08), p < 0.00001, I2 = 34%, random-effect modelling], severe COVID-19 [OR 2.30 (95% CI 1.60 - 3.30), p < 0.00001, I2 = 88%, random-effect modelling], and mortality [OR 2.14 (95% CI 1.47 - 3.10), p < 0.0001, I2 = 85%, random-effect modelling]. Meta-regression showed that the association was influenced by age (p = 0.008), but not by diabetes (p = 0.423), and cardiovascular disease (p = 0.086). CONCLUSION Physicians should be more aware and take extra precautions with diabetes patients who use insulin therapy.
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Affiliation(s)
- Timotius Ivan Hariyanto
- Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Nata Pratama Hardjo Lugito
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Theo Audi Yanto
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Jeremia Immanuel Siregar
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Andree Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
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Raghavan A, Nanditha A, Satheesh K, Susairaj P, Vinitha R, Chandrasekaran S, Palaniappan T, Thillai Vallal S, Subair Khan A, Snehalatha C, Ramachandran A. Profile and prognosis of patients hospitalized for COVID-19 virus infection with and without diabetes - An observational study from South India. Diabetes Metab Syndr 2021; 15:102143. [PMID: 34186345 PMCID: PMC8146270 DOI: 10.1016/j.dsx.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We studied the profile and outcome of patients hospitalized for coronavirus disease-19 (COVID-19) infection with and without type 2 diabetes (T2DM). METHODS In this observational study, clinical details of patients with COVID-19, identified by Reverse Transcription - Polymerase Chain Reaction admitted to 4 hospitals in Chennai, Tamil Nadu, India were collected from May to November 2020. A total of 845 (n = 423 with diabetes, n = 422 without diabetes) were selected for the analysis. Clinical details, biochemical and radiological investigations, diabetes treatment, intensive care, mortality and other adverse outcomes were recorded. Patients with clinical history of T2DM, glycosylated haemoglobin (HbA1c) of ≥6.5% (48 mmol/mol) and/or random blood glucose ≥200 mg/dl (11.1 mmol/l) were included. Statistical analyses were done using chi-square or 't' test and multiple logistic regression analysis. RESULTS At admission, patients with T2DM were older (p < 0.0001), had higher co-morbidities such as coronary artery disease (p = 0.02), hypertension (p < 0.0001), hypothyroidism (p = 0.03) and renal disorders (p = 0.01) than non-diabetes persons. Requirement for intensive care was higher among them. Acute renal injury or failure, pneumonia and myocardial infarction developed in higher percentage of T2DM. Mortality was significantly higher in T2DM (10.2% vs 5.9%, p = 0.02). However, in the multiple logistic regression analysis, only age (p < 0.0001) and renal disorders (p = 0.002) were significantly associated with mortality. CONCLUSION Our study showed that mortality was associated with higher age and renal disorders but did not show an association with diabetes, among patients hospitalized for COVID-19 infection.
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Affiliation(s)
- Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | | | | | | | | | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
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Cardoza-Jiménez KJ, Carranza-Zavala B, Manrique-Franco K, Espinoza-Morales F, Mejia CR. Daily glucose variation influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru. Diabetes Metab Syndr 2021; 15:102188. [PMID: 34217143 PMCID: PMC8239208 DOI: 10.1016/j.dsx.2021.102188] [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: 05/17/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/29/2022]
Abstract
AIM The pandemic has generated the need for COVID-19 patients to be treated as best as possible; however, the effect of these treatments on glycemic control has not yet been taken into account. This article aims to determine whether the daily variation of glucose is influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru. METHODOLOGY A prospective cohort study was undertook, in which glucose was measured four times a day in 53 patients hospitalized due to COVID-19. These values were associated with the use of corticosteroids and adjusted for other socio-educational variables, all by means of PA-GEE models. RESULTS Nested multivariate analysis of daily glucose variation found that those using corticosteroids increased the daily average glucose as well as the first and last glucose measurements, this is, at 6am and 10pm, respectively (all p-values <0.026). An increase in glucose levels was also observed in those with diabetes (all p-values <0.001). In contrast, we found that there was a decrease in the last glucose measurement of the day in obese patients (p-value = 0.044). CONCLUSIONS The patients who used corticosteroids for the treatment of COVID-19 increased the average glucose per day, especially in the first and last measurement.
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Affiliation(s)
| | | | | | - Frank Espinoza-Morales
- Physician Nutrition Specialist - Center for Applied Diabetes Technologies (CAVIMEDIC), Lima, Peru.
| | - Christian R Mejia
- Translational Medicine Research Center, Universidad Norbert Wiener, Lima, Peru.
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Varghese E, Samuel SM, Liskova A, Kubatka P, Büsselberg D. Diabetes and coronavirus (SARS-CoV-2): Molecular mechanism of Metformin intervention and the scientific basis of drug repurposing. PLoS Pathog 2021; 17:e1009634. [PMID: 34157054 PMCID: PMC8219155 DOI: 10.1371/journal.ppat.1009634] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19), caused by a new strain of coronavirus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was declared a pandemic by WHO on March 11, 2020. Soon after its emergence in late December 2019, it was noticed that diabetic individuals were at an increased risk of COVID-19-associated complications, ICU admissions, and mortality. Maintaining proper blood glucose levels using insulin and/or other oral antidiabetic drugs (such as Metformin) reduced the detrimental effects of COVID-19. Interestingly, in diabetic COVID-19 patients, while insulin administration was associated with adverse outcomes, Metformin treatment was correlated with a significant reduction in disease severity and mortality rates among affected individuals. Metformin was extensively studied for its antioxidant, anti-inflammatory, immunomodulatory, and antiviral capabilities that would explain its ability to confer cardiopulmonary and vascular protection in COVID-19. Here, we describe the various possible molecular mechanisms that contribute to Metformin therapy's beneficial effects and lay out the scientific basis of repurposing Metformin for use in COVID-19 patients.
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Affiliation(s)
- Elizabeth Varghese
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Samson Mathews Samuel
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Alena Liskova
- Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Dietrich Büsselberg
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
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Yang Y, Cai Z, Zhang J. DPP-4 inhibitors may improve the mortality of coronavirus disease 2019: A meta-analysis. PLoS One 2021; 16:e0251916. [PMID: 34015003 PMCID: PMC8136680 DOI: 10.1371/journal.pone.0251916] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
Aims DPP-4 inhibitors are predicted to exert a protective effect on the progression of coronavirus disease 2019 (COVID-19). We conducted this meta-analysis to investigate this hypothesis. Methods Four databases, namely, PubMed, Web of Science, EMBASE and the Cochrane Library, were used to identify studies on DPP-4 and COVID-19. The outcome indicators were the mortality of COVID-19. Funnel plots, Begg’s tests and Egger’s tests were used to assess publication bias. Results Four articles were included with a total of 1933 patients with COVID-19 and type 2 diabetes. The use of DPP-4 inhibitors was negatively associated with the risk of mortality (odds ratio (OR) = 0.58 95% confidence interval (CI), 0.34–0.99). Conclusions DPP-4 inhibitors may improve the mortality of patients with COVID-19 and type 2 diabetes. As few relevant studies are available, more large-scale studies need to be performed.
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Affiliation(s)
- Yan Yang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zixin Cai
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- * E-mail:
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Pathan F, Selim S, Fariduddin M, Rahman MH, Ashrafuzzaman SM, Afsana F, Qureshi NK, Hossain T, Saifuddin M, Kamrul-Hasan AB, Mir AS. Bangladesh Endocrine Society (BES) Position Statement for Management of Diabetes and Other Endocrine Diseases in Patients with COVID-19. Diabetes Metab Syndr Obes 2021; 14:2217-2228. [PMID: 34040407 PMCID: PMC8140905 DOI: 10.2147/dmso.s293688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The year 2020 witnessed a largely unprecedented pandemic of coronavirus disease (COVID-19), caused by SARS COV-2. Many people with COVID-19 have comorbidities, including diabetes, hypertension and cardiovascular diseases, which are significantly associated with worse outcomes. Moreover, COVID-19 itself is allied with deteriorating hyperglycemia. Therefore, Bangladesh Endocrine Society has formulated some practical recommendations for management of diabetes and other endocrine diseases in patients with COVID-19 for use in both primary and specialist care settings. OBJECTIVE The objective of the article is to develop a guideline to protect the vulnerable group with utmost preference - the elderly and those with comorbid conditions. Therefore, to ensure the adequate protective measures and timely treatment for COVID-19 patients with diabetes, other endocrine diseases or any other comorbidities. CONSIDERING AND MONITORING ISSUES The risk of a fatal outcome from COVID-19 may be up to 50% higher in patients with diabetes than in non-diabetics.Patients with diabetes and COVID had CFR 7.3-9.2%, compared with 0.9-1.4% in patients without comorbidities.Diabetic ketoacidosis may be one of the causes of mortality in COVID-19.There is wide fluctuation of blood glucose in these patients, probably due to irregular diet, reduced exercise, increased glucocorticoids secretion, and use of glucocorticoids. HbA1c should be <7.0% for the majority of the patients, this target may be relaxed in appropriate clinical settings.More emphasis should be given on day-to-day blood glucose levels. Hypoglycemia (<3.9 mmol/l) must be avoided.Frequent monitoring of blood glucose is needed in critically ill patients. CONCLUSION The fight against COVID-19 has been proven to be a challenging one. Therefore, all healthcare personnel should make the best use of updated knowledge and skills to ensure adequate protective measures and timely treatment for COVID-19 patients with diabetes, other endocrine diseases or any other comorbidities.
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Affiliation(s)
- Faruque Pathan
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - S M Ashrafuzzaman
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Faria Afsana
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | | | - Tanjina Hossain
- Department of Endocrinology, Green Life Medical College Hospital, Dhaka, Bangladesh
| | - M Saifuddin
- Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | - Ahmed Salam Mir
- Department of Endocrinology, BIHS General Hospital, Dhaka, Bangladesh
| | - On behalf of the BES Diabetes and COVID Task Force
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Bangladesh Endocrine Society, Dhaka, Bangladesh
- National Healthcare Network (NHN) Uttara EC, Dhaka, Bangladesh
- Department of Endocrinology, Green Life Medical College Hospital, Dhaka, Bangladesh
- Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh
- Mymensingh Medical College Hospital, Dhaka, Bangladesh
- Department of Endocrinology, BIHS General Hospital, Dhaka, Bangladesh
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Covichem: A biochemical severity risk score of COVID-19 upon hospital admission. PLoS One 2021; 16:e0250956. [PMID: 33956870 PMCID: PMC8101934 DOI: 10.1371/journal.pone.0250956] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/17/2021] [Indexed: 12/20/2022] Open
Abstract
Clinical and laboratory predictors of COVID-19 severity are now well described and combined to propose mortality or severity scores. However, they all necessitate saturable equipment such as scanners, or procedures difficult to implement such as blood gas measures. To provide an easy and fast COVID-19 severity risk score upon hospital admission, and keeping in mind the above limits, we sought for a scoring system needing limited invasive data such as a simple blood test and co-morbidity assessment by anamnesis. A retrospective study of 303 patients (203 from Bordeaux University hospital and an external independent cohort of 100 patients from Paris Pitié-Salpêtrière hospital) collected clinical and biochemical parameters at admission. Using stepwise model selection by Akaike Information Criterion (AIC), we built the severity score Covichem. Among 26 tested variables, 7: obesity, cardiovascular conditions, plasma sodium, albumin, ferritin, LDH and CK were the independent predictors of severity used in Covichem (accuracy 0.87, AUROC 0.91). Accuracy was 0.92 in the external validation cohort (89% sensitivity and 95% specificity). Covichem score could be useful as a rapid, costless and easy to implement severity assessment tool during acute COVID-19 pandemic waves.
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Racine-Brzostek SE, Yang HS, Jack GA, Chen Z, Chadburn A, Ketas TJ, Francomano E, Klasse PJ, Moore JP, McDonough KA, Girardin RC, Dupuis AP, Payne AF, Ma LX, Sweeney J, Zhong E, Yee J, Cushing MM, Zhao Z. Postconvalescent SARS-CoV-2 IgG and Neutralizing Antibodies are Elevated in Individuals with Poor Metabolic Health. J Clin Endocrinol Metab 2021; 106:e2025-e2034. [PMID: 33524125 PMCID: PMC7928889 DOI: 10.1210/clinem/dgab004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Comorbidities making up metabolic syndrome (MetS), such as obesity, type 2 diabetes, and chronic cardiovascular disease can lead to increased risk of coronavirus disease-2019 (COVID-19) with a higher morbidity and mortality. SARS-CoV-2 antibodies are higher in severely or critically ill COVID-19 patients, but studies have not focused on levels in convalescent patients with MetS, which this study aimed to assess. METHODS This retrospective study focused on adult convalescent outpatients with SARS-CoV-2 positive serology during the COVID-19 pandemic at NewYork Presbyterian/Weill Cornell. Data collected for descriptive and correlative analysis included SARS-COV-2 immunoglobin G (IgG) levels and history of MetS comorbidities from April 17, 2020 to May 20, 2020. Additional data, including SARS-CoV-2 IgG levels, body mass index (BMI), hemoglobin A1c (HbA1c) and lipid levels were collected and analyzed for a second cohort from May 21, 2020 to June 21, 2020. SARS-CoV-2 neutralizing antibodies were measured in a subset of the study cohort. RESULTS SARS-CoV-2 IgG levels were significantly higher in convalescent individuals with MetS comorbidities. When adjusted for age, sex, race, and time duration from symptom onset to testing, increased SARS-CoV-2 IgG levels remained significantly associated with obesity (P < 0.0001). SARS-CoV-2 IgG levels were significantly higher in patients with HbA1c ≥6.5% compared to those with HbA1c <5.7% (P = 0.0197) and remained significant on multivariable analysis (P = 0.0104). A positive correlation was noted between BMI and antibody levels [95% confidence interval: 0.37 (0.20-0.52) P < 0.0001]. Neutralizing antibody titers were higher in COVID-19 individuals with BMI ≥ 30 (P = 0.0055). CONCLUSION Postconvalescent SARS-CoV-2 IgG and neutralizing antibodies are elevated in obese patients, and a positive correlation exists between BMI and antibody levels.
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Affiliation(s)
| | - He S Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Gwendolyne A Jack
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Thomas J Ketas
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, USA
| | - Erik Francomano
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, USA
| | - P J Klasse
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, USA
| | - John P Moore
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Alan P Dupuis
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Anne F Payne
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Lucy X Ma
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jacob Sweeney
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Elaine Zhong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jim Yee
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Correspondence: Zhen Zhao, PhD; 525 East 68th Street; F-701; New York, NY 10065;
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Driggin E, Maddox TM, Ferdinand KC, Kirkpatrick JN, Ky B, Morris AA, Mullen JB, Parikh SA, Philbin DM, Vaduganathan M. ACC Health Policy Statement on Cardiovascular Disease Considerations for COVID-19 Vaccine Prioritization: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021; 77:1938-1948. [PMID: 33587998 PMCID: PMC7880623 DOI: 10.1016/j.jacc.2021.02.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Li Y, Zhang Y, Lu R, Dai M, Shen M, Zhang J, Cui Y, Liu B, Lin F, Chen L, Han D, Fan Y, Zeng Y, Li W, Li S, Chen X, Li H, Pan P. Lipid metabolism changes in patients with severe COVID-19. Clin Chim Acta 2021; 517:66-73. [PMID: 33639119 PMCID: PMC7903909 DOI: 10.1016/j.cca.2021.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 02/09/2023]
Abstract
Background We investigated the dynamic changes in lipid profiles and their correlations with disease severity and clinical outcome in patients with severe COVID-19. Methods We retrospectively reviewed 519 severe COVID-19 patients with confirmed outcomes (discharged or deceased), admitted to the West Court of Union Hospital in Wuhan, China, between 29 January and 8 April 2020. Results Altogether, 424 severe COVID-19 patients, including 34 non-survivors and 390 survivors, were included in the final analyses. During hospitalization, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (apoA-I) showed an increasing trend in survivors, but showed a downward trend in non-survivors. The serum concentrations of HDL-C and apoA-I were inversely correlated with C-reactive protein (CRP), length of hospital stay of survivors, and disease severity scores. For in-hospital deaths, the areas under the receiver operating characteristic curves (AUCs) of the ratios of CRP/HDL-C and CRP/apoA-I at admission were 0.84 and 0.83, respectively. Moreover, patients with high ratios of CRP/HDL-C (>77.39) or CRP/apoA-I (>72.37) had higher mortality rates during hospitalization (log-rank p < 0.001). Logistic regression analysis demonstrated that hypertension, lactate dehydrogenase, SOFA score, and High CRP/HDL-C ratio were independent predictors of in-hospital mortality. Conclusions During severe COVID-19, HDL-C and apoA-I concentrations are dramatically decreased in non-survivors. Moreover, High CRP/HDL-C ratio is significantly associated with an increase in mortality and a poor prognosis.
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Affiliation(s)
- Yi Li
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Yan Zhang
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Rongli Lu
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Minhui Dai
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Minxue Shen
- Department of Dermatology, Central South University, Changsha 410008, China; Department of Social Medicine and Health Management, Central South University, Changsha 410008, China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital of Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| | - Yanhui Cui
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Ben Liu
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China; Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Fengyu Lin
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Lingli Chen
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Duoduo Han
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Yifei Fan
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Yanjun Zeng
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China
| | - Sha Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiang Chen
- Department of Dermatology, Central South University, Changsha 410008, China
| | - Haitao Li
- First Department of Thoracic Medicine, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Central South University, Changsha 410008, China.
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An investigation of risk factors of in-hospital death due to COVID-19: a case-control study in Rasht, Iran. Ir J Med Sci 2021; 190:1321-1333. [PMID: 33449333 PMCID: PMC7809240 DOI: 10.1007/s11845-020-02455-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/03/2020] [Indexed: 01/10/2023]
Abstract
Background Identifying the non-survived patients’ characteristics compared to survived subjects and introducing the critical risk factors of COVID-19 mortality would help enhance patients’ prognosis and treatment. Methods In the current case-control study, medical records of 103 non-survived COVID-19 patients (cases) and 147 sex-matched survivors (controls) who admitted to Razi University Hospital in Rasht, Guilan, Northern Iran from April 21 to August 21, 2020, were explored. Data on demographic, anthropometric, clinical, and laboratory assessment was extracted from the electronic medical records. To estimate the association between variables of interest and mortality odds due to COVID-19 logistic regression was carried out. Results The patients who died (mean age = 62.87 years) were older than the discharged patients (57.33 years; P value = 0.009). According to the results of multivariable regression adjusted for potential confounders, elevated BMI (OR = 2.49; 95% CI = 1.15–5.41), higher CRP levels (OR = 2.28; 95% CI = 1.08–4.78), increased FBS levels (OR = 2.88; 95% CI = 1.35–6.17), higher levels of total cholestrol (OR = 2.55; 95% CI = 1.19–5.45) and LDL (OR = 2.27; 95% CI = 1.07–4.79), elevated triglyceride (OR = 5.14; 95% CI = 2.28–11.56), and raised levels of D-dimer (OR = 5.68; 95% CI = 2.22–14.49) were identified as independent risk factors of COVID-19 mortality. No significant association was detected regarding HDL level, QTc interval or heart size, and COVID-19 fatality odds. Conclusion The present findings demonstrated that obesity, higher levels of CRP, blood sugar, D-dimer, and lipid markers were likely to be predictive factors of COVID-19-related mortality odds.
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Mekonnen CK, Ferede YM, Abate HK. Determinants of Dietary Adherence Among Type 2 Diabetes Patients Aimed COVID-19 at the University of Gondar Comprehensive Specialized Hospital. Diabetes Metab Syndr Obes 2021; 14:917-927. [PMID: 33688226 PMCID: PMC7936688 DOI: 10.2147/dmso.s297582] [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: 12/18/2020] [Accepted: 02/19/2021] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND People with diabetes are proving to be at higher risk of severe coronavirus infection than the general population. Non-adherence to dietary recommendation is a critical problem in individuals with type 2 diabetes; particularly, in the era of coronavirus. This study aimed to explore determinants that affect adherence to the recommendations of diet during coronavirus pandemic. OBJECTIVE This study aimed to determine dietary adherence among diabetes type 2 patients aimed at coronavirus pandemic and its associated factors. METHODS An institutional-based cross-sectional study was conducted among type 2 diabetes patients on follow-up. Systematic random sampling was employed to get representative study participants. Dietary adherence was dichotomized and with logistic regression analysis to assess the association between dependent and explanatory variables. The degree of association was interpreted by using both crude odds ratios and adjusted odds ratios with 95% confidence intervals and P-values <0.05 were considered statistically significant. RESULTS In this study, 576 participants took part with a 99.3% response rate. The dietary adherence was found to be 48.3% with [95% CI (44.1-52.4)]. The educational level of College and above was [AOR=3.64, 95% CI (1.59-8.34)], being a government-employed [AOR=2.38, 95% CI (1.13-4.99)], being urban [AOR=1.30, 95% CI (1.09-2.42)], family size of less than five [AOR=1.27, 95% CI (1.08-1.97)], medium level of wealth-status[AOR=2.26, 95% CI (1.67-4.54)], family history of diabetes [AOR=2.18, 95% CI (1.14-4.19)], duration of diabetes more than 15 years [AOR=5.39, 95% CI (1.57-18.52)], and knowledge related to coronavirus [AOR=4.33,95% CI (2.71-6.92)] were significantly associated with adherence to the dietary recommendation. CONCLUSION The dietary adherence was relatively low aimed at coronavirus pandemic. Knowledge about COVID-19 was found significantly associated with dietary adherence. RECOMMENDATIONS There has to be a strong commitment to aware the community to minimize the risk of coronavirus severity among diabetes patients. This could be through adherence to dietary recommendations of particularly in the era of coronavirus pandemic.
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Affiliation(s)
- Chilot Kassa Mekonnen
- Department of Medical, Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Chilot Kassa Mekonnen Email
| | - Yohannes Mulu Ferede
- Department of Medical, Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailemichael Kindie Abate
- Department of Medical, Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lin L, Chen Z, Ding T, Liu H, Zhou F, Huang X, Zhang X, Liu W, Zhang BH, Yuan Y, Zhang P, Zhang XJ, She ZG, Cai J, Chen W, Li H. Newly-Diagnosed Diabetes and Sustained Hyperglycemia are Associated with Poorer Outcomes in COVID-19 Inpatients Without Pre-Existing Diabetes. Diabetes Metab Syndr Obes 2021; 14:4469-4482. [PMID: 34795494 PMCID: PMC8593357 DOI: 10.2147/dmso.s332819] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/09/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To analyze the impact of hyperglycemia on the clinical outcome of COVID-19 in patients with newly diagnosed diabetes (NDD). PATIENTS AND METHODS We performed a retrospective study of 3114 cases of COVID-19 without pre-existing diabetes, 351 of which had NDD, in Hubei Province, China. The Cox regression model was used to calculate the risk of adverse clinical outcomes comparing the NDD vs non-NDD group before and after propensity score-matched (PSM) analysis. Patients with NDD were further divided into a sustained hyperglycemia group, a fluctuating group, and a remitted group based on their blood glucose levels during hospitalization as well as into hypoglycemic agent users and nonusers. RESULTS Compared to the non-NDD individuals, individuals with NDD had a significantly increased risk of all-cause mortality (adjusted HR after PSM, 2.65; 95% CI, 1.49-4.72; P = 0.001) and secondary outcomes involving organ damage during the 28-day follow-up period. Subgroup analyses indicated that among individuals with NDD, the individuals with remitted hyperglycemia had the lowest 28-day mortality, whereas those with sustained hyperglycemia had the highest (IRR 24.27; 95% CI, 3.21-183.36; P < 0.001). Moreover, individuals treated with hypoglycemic agents had significantly lower all-cause mortality than those not treated with hypoglycemic agents (IRR 0.08; 95% CI, 0.01-0.56; P < 0.001). CONCLUSION Our study reinforces the clinical message that NDD is strongly associated with poor outcomes in COVID-19 patients. Furthermore, resolved hyperglycemia in the later phase of the disease and the use of hypoglycemic agents were associated with improved prognosis in patients with NDD.
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Affiliation(s)
- Lijin Lin
- Department of Endocrinology, Huanggang Central Hospital, Huanggang, People’s Republic of China
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
| | - Ze Chen
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Ting Ding
- Department of Endocrinology, Huanggang Central Hospital, Huanggang, People’s Republic of China
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
| | - Hui Liu
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Neonatology of Gastroenterology, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan, People’s Republic of China
| | - Feng Zhou
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xuewei Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
| | - Xingyuan Zhang
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Weifang Liu
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Bing-Hong Zhang
- Neonatology Department, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Peng Zhang
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Xiao-Jing Zhang
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Basic Medical School of Wuhan University, Wuhan, People’s Republic of China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
| | - Jingjing Cai
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Wenping Chen
- Department of Endocrinology, Huanggang Central Hospital, Huanggang, People’s Republic of China
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
| | - Hongliang Li
- Huanggang Institute of Translational Medicine, Huanggang, People’s Republic of China
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal of Wuhan University, Wuhan, People’s Republic of China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
- Correspondence: Hongliang Li; Wenping Chen Email ;
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Petrie JR, Boyle JG, Ali K, Smith C, Morrison D, Kar P. A post COVID-19 'Marshall Plan' for type 2 diabetes. Diabet Med 2021; 38:e14439. [PMID: 33107107 PMCID: PMC7645873 DOI: 10.1111/dme.14439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022]
Affiliation(s)
| | - James G. Boyle
- University of GlasgowGlasgowUK
- NHS Greater Glasgow and ClydeGlasgowUK
| | | | | | | | - Partha Kar
- Portsmouth Hospitals NHS TrustGlasgowUK
- NHS EnglandGlasgowUK
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Singh AK, Singh R, Saboo B, Misra A. Non-insulin anti-diabetic agents in patients with type 2 diabetes and COVID-19: A Critical Appraisal of Literature. Diabetes Metab Syndr 2021; 15:159-167. [PMID: 33352455 PMCID: PMC7832723 DOI: 10.1016/j.dsx.2020.12.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Several observational studies have recently reported the outcomes of non-insulin anti-diabetic agents (ADA) in patients with T2DM and coronavirus disease 2019 (COVID-19). We sought to review the literature to appraise the clinicians on these outcomes. METHODS A literature search using the specific keywords was carried out in the database of PubMed, MedRxiv and Google Scholar up till December 11, 2020 applying Boolean method. Full text of all the relevant articles that reported the outcomes of ADA in patients with T2DM and COVID-19 were retrieved. Subsequently, an appraisal of literature report was narratively presented. RESULTS Available studies that reported the outcomes of ADA are either case series or retrospective cohorts or prospective observational studies, in absence of the randomized controlled trials (RCTs). Results from these observational studies suggest that amongst all the non-insulin ADA, metformin users prior to the hospitalization had improved outcomes compared to the non-users. Data for dipeptidyl-peptidase-4 inhibitors (DPP-4i) are encouraging although inconsistent. No documentation of any harm or benefit has been observed for sulfonylureas (SUs), sodium glucose co-transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide receptor agonists (GLP-1RAs). No data is yet available for pioglitazone. CONCLUSION Metformin and DPP-4i should be continued in patients with T2DM until hospitalization or unless contraindicated. No evidence of harm suggests that SUs, SGLT-2i or GLP-1RAs may not be stopped unless very sick, hospitalized or contraindicated. The results from RCTs are needed to claim any meaningful benefit with either metformin or DPP-4i in patients with T2DM and COVID-19.
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Affiliation(s)
| | - Ritu Singh
- G.D Hospital & Diabetes Institute, Kolkata, India
| | | | - Anoop Misra
- Fortis CDOC Hospital for Diabetes and Allied Science, Chirag Enclave, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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44
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Chawla M, Jain SM, Kesavadev J, Makkar BM, Viswanathan V, Tiwaskar M, Sosale AR, Negalur V, Modi KD, Gupta M, Kumar S, Ramakrishnan S, Deka N, Roy N. Insulinization in T2DM with Basal Analogues During COVID-19 Pandemic: Expert Opinion from an Indian Panel. Diabetes Ther 2021; 12:133-142. [PMID: 33314000 PMCID: PMC7733136 DOI: 10.1007/s13300-020-00979-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022] Open
Abstract
The ongoing global pandemic of the coronavirus disease 2019 (COVID-19) has placed a severe strain on the management of chronic conditions like diabetes. Optimal glycemic control is always important, but more so in the existing environment of COVID-19. In this context, timely insulinization to achieve optimal glycemic control assumes major significance. However, given the challenges associated with the pandemic like restrictions of movement and access to healthcare resources, a simple and easy way to initiate and optimize insulin therapy in people with uncontrolled diabetes is required. With this premise, a group of clinical experts comprising diabetologists and endocrinologists from India discussed the challenges and potential solutions for insulin initiation, titration, and optimization in type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic and how basal insulin can be a good option in this situation owing to its unique set of advantages like lower risk of hypoglycemia, ease of training, need for less monitoring, better adherence, flexibility of using oral antidiabetic drugs, and improved quality of life compared to other insulin regimens. The panel agreed that the existing challenges should not be a reason to delay insulin initiation in people with uncontrolled T2DM and provided recommendations, which included potential solutions for initiating insulin in the absence or restriction of in-person consultations; the dose of insulin at initiation; the type of insulin preferred for simplified regimen and best practices for optimal titration to achieve glycemic targets during the pandemic. Practical and easily implementable tips for patients and involvement of stakeholders (caregivers and healthcare providers) to facilitate insulin acceptance were also outlined by the expert panel. Simplified and convenient insulin regimens like basal insulin analogues are advised during and following the pandemic in order to achieve glycemic control in people with uncontrolled T2DM.
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Affiliation(s)
- Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, Maharashtra, India.
| | - Sunil M Jain
- TOTALL Diabetes and Hormone Institute, Indore, Madhya Pradesh, India
| | - Jothydev Kesavadev
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | - Brij M Makkar
- Dr. Makkar's Diabetes and Obesity Centre, New Delhi, India
| | | | | | - Aravind R Sosale
- Diacon Hospital (Diabetes Care and Research Centre), Bangalore, India
| | - Vijay Negalur
- Dr. Negalur's Diabetes and Thyroid Specialities Center, Thane, India
| | | | | | - Surinder Kumar
- Department of Endocrinology, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Nirmalya Roy
- KPC Medical College and Hospital, Kolkata, India
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Kyazze AP, Bongomin F, Ninsiima S, Nattabi G, Nabakka W, Kukunda R, Odanga H, Ssekamatte P, Baluku JB, Kibirige D, Andia-Biraro I. Optimizing diabetes mellitus care to improve COVID-19 outcomes in resource-limited settings in Africa. Ther Adv Infect Dis 2021; 8:20499361211009380. [PMID: 33996072 PMCID: PMC8107937 DOI: 10.1177/20499361211009380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/23/2021] [Indexed: 12/30/2022] Open
Abstract
Diabetes mellitus (DM) is an important risk factor for both severe disease and death due to coronavirus-2019 (COVID-19). About 19 million of the 463 million persons living with DM (PLWD) globally are found in sub-Saharan Africa (SSA). The dual burden of DM and poverty in SSA, coupled with the rising number of cases of COVID-19 in this region, predisposes PLWD to inadequate care and poor glycemic controls due to the disruption to the economy and the healthcare system. The risk of acquisition of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) among PLWD is the same as those in the general population. Therefore, the standard preventive measures outlined by the World Health Organization must be strictly adhered to. In addition, maintaining adequate glycemic control is associated with better outcomes in DM patients with COVID-19. In SSA, adequate supply of DM medication while patients stay at home is crucial to minimize routine hospital visits since DM clinics are usually overcrowded and have longer waiting times, which may maximize risk of SARS-CoV-2 transmission to PLWD across the region. Psychosocial support to improve adherence to anti-hyperglycemic medications may improve COVID-19 outcomes. Trained healthcare professionals should diagnose and evaluate severity comprehensively as well as evaluate the need for in-patient care for PLWD with COVID-19 irrespective of disease severity. Due to the increased risk of severe disease, a multi-disciplinary approach to the management of COVID-19 in PLWD should preferably be in a setting where close monitoring is available, typically a health facility, even for mild disease that may require home management according to local guidelines. In conclusion, DM complicates COVID-19 outcomes and the on-going COVID-19 pandemic adversely affects DM care at individual and global public health levels. PLWD should be prioritized as COVID-19 vaccines are being rolled out.
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Affiliation(s)
- Andrew Peter Kyazze
- Department of Medicine, School of Medicine,
Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Bongomin
- Department of Medicine, School of Medicine,
Makerere University College of Health Sciences, Kampala, UgandaDepartment of
Medical Microbiology & Immunology, Faculty of Medicine, Gulu University,
Gulu, Uganda
| | - Sandra Ninsiima
- Department of Medicine, School of Medicine,
Makerere University College of Health Sciences, Kampala, Uganda
| | - Gloria Nattabi
- Department of Medicine, School of Medicine,
Makerere University College of Health Sciences, Kampala, Uganda
| | - Winnie Nabakka
- Department of Medicine, Uganda Martyrs Hospital
Lubaga, Kampala, Uganda
| | - Rebecca Kukunda
- Department of Medicine, Uganda Martyrs Hospital
Lubaga, Kampala, Uganda
| | - Henry Odanga
- Department of Medicine, Uganda Martyrs Hospital
Lubaga, Kampala, Uganda
| | - Phillip Ssekamatte
- Department of Immunology and Molecular Biology,
School of Biomedical Sciences, Makerere University College of Health
Sciences, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of pulmonology, Mulago National
Referral Hospital, Kampala, UgandaDirectorate of Programs, Mildmay
Uganda
| | - Davis Kibirige
- Department of Medicine, Uganda Martyrs
Hospital Lubaga, Kampala, UgandaMedical Research Council/Uganda Virus
Research Institute and the London School of Hygiene and Tropical Medicine
Uganda Research Unit, Entebbe, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, School of Medicine,
Makerere University College of Health Sciences, Kampala, UgandaMedical
Research Council/Uganda Virus Research Institute and the London School of
Hygiene and Tropical Medicine Uganda Research Unit, Entebbe,
UgandaDepartment of Clinical Research, Faculty of Infectious and Tropical
Disease (ITD), London School of Hygiene and Tropical Medicine, London,
UK
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Higher Mortality and Intensive Care Unit Admissions in COVID-19 Patients with Liver Enzyme Elevations. Microorganisms 2020; 8:microorganisms8122010. [PMID: 33339330 PMCID: PMC7766471 DOI: 10.3390/microorganisms8122010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study is to evaluate if an independent association exists between liver enzyme elevations (LEE) and the risk of mortality or intensive care unit (ICU) admissions in patients with COVID-19. This was a single-center observational study, recruiting all consecutive adults with COVID-19. The elevation of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) to the highest level between COVID-19 diagnosis and hospital discharge was categorized according to a standardized toxicity grade scale. In total, 799 patients were included in this study, 39% of which were female, with a mean age of 69.9 (±16.0) years. Of these patients, 225 (28.1%) developed LEE of grade ≥2 after a median of three days (interquartile range (IQR): 0–8 days) from the diagnosis of COVID-19, and they were estimated to have a higher hazard of death or ICU admission (adjusted hazard ratio (aHR): 1.46, 95% confidence interval (CI): 1.14–1.88). The clinical and laboratory variables associated with the development of LEE were male sex, higher respiratory rate, higher gamma glutamyl transpeptidase (GGT) and lower albumin levels at baseline. Among the analyzed treatments, steroids, tocilizumab and darunavir/ritonavir correlated with LEE. In conclusion, LEE were associated with mortality and ICU admission among COVID-19 patients. While the origin of LEE is probably multifactorial, LEE evaluation could add information to the clinical and laboratory variables that are commonly evaluated during the course of COVID-19.
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Singh AK, Misra A. Impact of COVID-19 and comorbidities on health and economics: Focus on developing countries and India. Diabetes Metab Syndr 2020; 14:1625-1630. [PMID: 32891011 PMCID: PMC7451213 DOI: 10.1016/j.dsx.2020.08.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Presence of comorbidities in patients with Coronavirus disease 2019 (COVID-19) have often been associated with increased in-hospital complications and mortality. Intriguingly, several developed countries with a higher quality of life have relatively higher mortality with COVID-19, compared to the middle- or low-income countries. Moreover, certain ethnic groups have shown a higher predilection to contract COVID-19, with heightened mortality. We sought to review the available literature with regards to impact of COVID-19 and comorbidities on the health and economics, especially in context to the developing countries including India. METHODS A Boolean search was carried out in PubMed, MedRxiv and Google Scholar databases up till August 23, 2020 using the specific keywords, to find the prevalence of comorbidities and its outcome in patients with COVID-19. RESULTS All available evidence consistently suggests that presence of comorbidities is associated with a poor outcome in patients with COVID-19. Diabetes prevalence is highest in Indian COVID-19 patients, compared to other countries. Majority of the patients with COVID-19 are asymptomatic ranging from 26 to 76%. CONCLUSIONS Universal masking is the need of hour during unlock period. Low-income countries such as India, Brazil and Africa with less resources and an average socio-economic background, must adopt a strict policy for an affordable testing programs to trace, test, identify and home quarantine of asymptomatic cases. Despite the huge number of COVID-19 patients, India still has low volume research at the moment.
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Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India.
| | - Anoop Misra
- Fortis-C-DOC Center of Excellence for Diabetes, Metabolic Disease and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
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Scheen AJ. Metformin and COVID-19: From cellular mechanisms to reduced mortality. DIABETES & METABOLISM 2020; 46:423-426. [PMID: 32750451 PMCID: PMC7395819 DOI: 10.1016/j.diabet.2020.07.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is associated with both poorer clinical outcomes during the COVID-19 pandemic and an increased risk of death in such hospitalized patients. While the role of glucose control has been emphasized to improve the prognosis, the impact of different glucose-lowering agents remains largely unknown. Metformin remains the first-line pharmacological choice for the management of hyperglycaemia in T2DM. Because metformin exerts various effects beyond its glucose-lowering action, among which are anti-inflammatory effects, it may be speculated that this biguanide might positively influence the prognosis of patients with T2DM hospitalized for COVID-19. The present concise review summarizes the available data from observational retrospective studies that have shown a reduction in mortality in metformin users compared with non-users, and briefly discusses the potential underlying mechanisms that might perhaps explain this favourable impact. However, given the potential confounders inherently found in observational studies, caution is required before drawing any firm conclusions in the absence of randomized controlled trials.
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Affiliation(s)
- A J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, CHU Liège, and Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), Liège University, Liège, Belgium.
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49
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Zhu B, Jin S, Wu L, Hu C, Wang Z, Bu L, Sun H, Wang X, Qu S, Chen D. J-shaped association between fasting blood glucose levels and COVID-19 severity in patients without diabetes. Diabetes Res Clin Pract 2020; 168:108381. [PMID: 32853687 PMCID: PMC7445136 DOI: 10.1016/j.diabres.2020.108381] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 08/18/2020] [Indexed: 01/04/2023]
Abstract
AIMS Coronavirus disease 2019 (COVID-19) has become a recognized worldwide pandemic. Researchers now know that mortality from COVID-19 can be reduced through early prevention measures. This retrospective, multi-centered study of 293 COVID-19 patients without diabetes explores the association between fasting blood glucose (FBG) levels and the risk of COVID-19 disease progression, with the goal of providing clinical evidence for glycemic targets in patients. METHODS The multivariate stepwise binary logistic regression analysis was used to test the dose-response effects of FBG levels on the risk of severe and critical condition in COVID-19 patients. RESULTS FBG levels were plotted in quintiles with set at <4.74, 4.74-5.21, 5.21-5.78, 5.78-7.05, and ≧7.05 mmol/L. The constituent ratio of severe or critical cases in each FBG quintile was 20.7%, 1.7%, 13.8%, 27.1%, and 67.2%, respectively (P < 0.0001). When the second quintile was used as the reference, the adjusted odds ratios (AORs) (95%CI) for the risk of severe/critical condition in COVID-19 was 25.33 (2.77, 231.64), 1.00 (Reference), 3.13 (0.33, 29.67), 10.59 (1.23, 91.24), 38.93 (4.36, 347.48) per FBG quintile respectively (P < 0.001). CONCLUSIONS We provide evidence of J-shaped associations between FBG and risk of severe and critical condition in non-diabetes patients with COVID-19, with nadir at 4.74-5.78 mmol/L.
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Affiliation(s)
- Bing Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengwei Jin
- Department of Anaesthesia and Critical Care, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Lianpeng Wu
- Departments of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang, China
| | - Chenchan Hu
- Departments of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang, China
| | - Zhen Wang
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Le Bu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hang Sun
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xingchun Wang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Dong Chen
- Departments of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang, China.
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Al Hayek AA, Robert AA, Matar AB, Algarni A, Alkubedan H, Alharbi T, Al Amro A, Alrashidi SA, Al Dawish M. Risk factors for hospital admission among COVID-19 patients with diabetes. A study from Saudi Arabia. Saudi Med J 2020; 41:1090-1097. [PMID: 33026050 PMCID: PMC7841525 DOI: 10.15537/smj.2020.10.25419] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/16/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To elucidate the risk factors for hospital admission among COVID-19 patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective study was conducted at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 2020 and July 2020. Out of 7,260 COVID-19 patients, 920 were identified as T2DM. After the exclusion process, 806 patients with T2DM were included in this analysis. Patients' data were extracted from electronic medical records. A logistic regression model was performed to estimate the risk factors of hospital admission. Results: Of the total of 806 COVID-19 patients with T2DM, 48% were admitted in the hospital, 52% were placed under home isolation. Older age between 70-79 years (OR [odd ratio] 2.56; p=0.017), ≥80 years (OR 6.48; p=0.001) were significantly more likely to be hospitalized compared to less than 40 years. Similarly, patients with higher HbA1c level of ≥9% compared to less than 7%; (OR 1.58; p=0.047); patients with comorbidities such as, hypertension (OR 1.43; p=0.048), cardiovascular disease (OR 1.56; p=0.033), cerebrovascular disease (OR 2.38; p=0.016), chronic pulmonary disease (OR 1.51; p=0.018), malignancy (OR 2.45; p=0.025), chronic kidney disease (CKD) IIIa, IIIb, IV (OR 2.37; p=0.008), CKD V (OR 5.07; p=0.007) were significantly more likely to be hospitalized. Likewise, insulin-treated (OR 1.46; p=0.03) were more likely to require hospital admission compared to non-insulin treated patients. CONCLUSION Among COVID-19 patients with diabetes, higher age, high HbA1c level, and presence of other comorbidities were found to be significant risk factors for the hospital admission.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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