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Pappachan JM, Fernandez CJ, Ashraf AP. Rising tide: The global surge of type 2 diabetes in children and adolescents demands action now. World J Diabetes 2024; 15:797-809. [PMID: 38766426 PMCID: PMC11099374 DOI: 10.4239/wjd.v15.i5.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/09/2024] [Accepted: 03/18/2024] [Indexed: 05/10/2024] Open
Abstract
Childhood-onset obesity has emerged as a major public healthcare challenge across the globe, fueled by an obesogenic environment and influenced by both genetic and epigenetic predispositions. This has led to an exponential rise in the incidence of type 2 diabetes mellitus in children and adolescents. The looming wave of diabetes-related complications in early adulthood is anticipated to strain the healthcare budgets in most countries. Unless there is a collective global effort to curb the devastation caused by the situation, the impact is poised to be pro-found. A multifaceted research effort, governmental legislation, and effective social action are crucial in attaining this goal. This article delves into the current epidemiological landscape, explores evidence concerning potential risks and consequences, delves into the pathobiology of childhood obesity, and discusses the latest evidence-based management strategies for diabesity.
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Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Cornelius James Fernandez
- Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Ambika P Ashraf
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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Kashfi K, Anbardar N, Asadipooya A, Asadipooya K. Type 1 Diabetes and COVID-19: A Literature Review and Possible Management. Int J Endocrinol Metab 2023; 21:e139768. [PMID: 38666042 PMCID: PMC11041820 DOI: 10.5812/ijem-139768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 04/28/2024] Open
Abstract
Context Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection normally damages the respiratory system but might likewise impair endocrine organs' function. Thyroid dysfunction and hyperglycemia are common endocrine complications of SARS-CoV-2 infection. The onset of type 1 diabetes (T1D) and associated complications, including diabetic ketoacidosis (DKA), hospitalization, and death, are thought to have increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to review the available data about the incidence rate of T1D and accompanying complications since the beginning of the COVID-19 pandemic. Evidence Acquisition A literature review was conducted using the electronic databases PubMed and Google Scholar. The keywords "T1D, T1DM, Type 1 DM or Type 1 Diabetes", "Coronavirus, SARS-CoV-2 or COVID-19" were used to search these databases. Titles and abstracts were screened for selection, and then relevant studies were reviewed in full text. Results A total of 25 manuscripts out of 304 identified studies were selected. There were 15 (60%) multicenter or nationwide studies. The data about the incidence rate of T1D, hospitalization, and death are not consistent across countries; however, DKA incidence and severity seem to be higher during the COVID-19 pandemic. The present study's data collection demonstrated that COVID-19 might or might not increase the incidence of T1D. Nevertheless, it is associated with the higher incidence and severity of DKA in T1D patients. This finding might indicate that antivirals are not fully protective against the endocrine complications of SARS-CoV-2 infection, which promotes the application of an alternative approach. Conclusions Combining medications that reduce SARS-CoV-2 entry into the cells and modulate the immune response to infection is an alternative practical approach to treating COVID-19.
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Affiliation(s)
- Kebria Kashfi
- Department of Clinical Medicine, Florida International University AUACOM, Florida, USA
| | - Narges Anbardar
- Department of Clinical Medicine, SMUSOM, Cleveland Clinic Lerner College of Medicine, Ohio, USA
| | - Artin Asadipooya
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Kamyar Asadipooya
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, Kentucky, USA
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Sherif ZA, Gomez CR, Connors TJ, Henrich TJ, Reeves WB. Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC). eLife 2023; 12:e86002. [PMID: 36947108 PMCID: PMC10032659 DOI: 10.7554/elife.86002] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023] Open
Abstract
COVID-19, with persistent and new onset of symptoms such as fatigue, post-exertional malaise, and cognitive dysfunction that last for months and impact everyday functioning, is referred to as Long COVID under the general category of post-acute sequelae of SARS-CoV-2 infection (PASC). PASC is highly heterogenous and may be associated with multisystem tissue damage/dysfunction including acute encephalitis, cardiopulmonary syndromes, fibrosis, hepatobiliary damages, gastrointestinal dysregulation, myocardial infarction, neuromuscular syndromes, neuropsychiatric disorders, pulmonary damage, renal failure, stroke, and vascular endothelial dysregulation. A better understanding of the pathophysiologic mechanisms underlying PASC is essential to guide prevention and treatment. This review addresses potential mechanisms and hypotheses that connect SARS-CoV-2 infection to long-term health consequences. Comparisons between PASC and other virus-initiated chronic syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome will be addressed. Aligning symptoms with other chronic syndromes and identifying potentially regulated common underlining pathways may be necessary for understanding the true nature of PASC. The discussed contributors to PASC symptoms include sequelae from acute SARS-CoV-2 injury to one or more organs, persistent reservoirs of the replicating virus or its remnants in several tissues, re-activation of latent pathogens such as Epstein-Barr and herpes viruses in COVID-19 immune-dysregulated tissue environment, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation dysregulation, dysfunctional brainstem/vagus nerve signaling, dysautonomia or autonomic dysfunction, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage specific patients.
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Affiliation(s)
- Zaki A Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of MedicineWashington, District of ColumbiaUnited States
| | - Christian R Gomez
- Division of Lung Diseases, National Institutes of Health (NIH), National Heart, Lung and Blood Institute (NHLBI)BethesdaUnited States
| | - Thomas J Connors
- Department of Pediatrics, Division of Critical Care, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's HospitalNew YorkUnited States
| | - Timothy J Henrich
- Division of Experimental Medicine, University of CaliforniaSan FranciscoUnited States
| | - William Brian Reeves
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of TexasSan AntonioUnited States
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Chandrashekhar Joshi S, Pozzilli P. COVID-19 induced Diabetes: A novel presentation. Diabetes Res Clin Pract 2022; 191:110034. [PMID: 35940303 PMCID: PMC9355745 DOI: 10.1016/j.diabres.2022.110034] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The COVID-19 pandemic disproportionately affected patients who had comorbid diabetes mellitus. COVID-19 patients with diabetes experience significantly higher rates of complications and mortality. COVID-induced diabetes is a novel phenomenon observed in critically ill patients. The aims of this review were to explore the literature about COVID-induced diabetes and the pathophysiological mechanisms that could lead to this novel presentation. METHODS A literature search was performed using PUBMED, Google Scholar, MEDLINE and Embase for original studies (meta-analyses, cross-sectional studies, case series, case reports) about new-onset diabetes following COVID infection, and the proposed biochemical pathways behind this presentation. It was assumed that the authors of the studies used the current diagnostic criteria for diagnosis of type 1 and type 2 diabetes. RESULTS COVID-19 causes dysregulation of glucose homeostasis leading to new-onset diabetes and hyperglycaemia. This is also seen in patients with no previous risk factors for diabetes mellitus. The atypical glycaemic parameters and increased rates of DKA suggest that COVID-induced diabetes is a novel form of diabetes. A spectrum of COVID-induced diabetes has also been noted. COVID-induced diabetes is associated with remarkably higher mortality rates and worse outcomes compared to COVID-19 patients with pre-existing diabetes. The novel presentation of COVID-induced diabetes could be due to beta cell damage and insulin resistance caused by SARS-CoV-2. CONCLUSION COVID-induced diabetes is essential to detect early, owing to its implications on prognosis. Further studies must include follow-up of these patients to better understand the trajectory of COVID-induced diabetes and the best management plan. It is also important to assess the beta cell function and insulin resistance of COVID-induced diabetes patients over time to better understand the underlying biochemical mechanisms.
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Affiliation(s)
| | - Paolo Pozzilli
- The Blizard Institute, Centre of Immunobiology, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, UK; Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Italy.
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Agathis NT, Womack LS, Webber BJ, Choudhary R, Wanga V, Ko JY, Dupont H, Imperatore G, Koumans EH, Saydah S, Kimball AA, Siegel DA. Children, adolescents, and young adults hospitalized with COVID-19 and diabetes in summer 2021. Pediatr Diabetes 2022; 23:961-967. [PMID: 35876454 PMCID: PMC9349842 DOI: 10.1111/pedi.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION More information is needed to understand the clinical epidemiology of children and young adults hospitalized with diabetes and COVID-19. We describe the demographic and clinical characteristics of patients <21 years old hospitalized with COVID-19 and either Type 1 or Type 2 Diabetes Mellitus (T1DM or T2DM) during peak incidence of SARS-CoV-2 infection with the B.1.617.2 (Delta) variant. METHODS This is a descriptive sub-analysis of a retrospective chart review of patients aged <21 years hospitalized with COVID-19 in six US children's hospitals during July-August 2021. Patients with COVID-19 and either newly diagnosed or known T1DM or T2DM were described using originally collected data and diabetes-related data specifically collected on these patients. RESULTS Of the 58 patients hospitalized with COVID-19 and diabetes, 34 had T1DM and 24 had T2DM. Of those with T1DM and T2DM, 26% (9/34) and 33% (8/24), respectively, were newly diagnosed. Among those >12 years old and eligible for COVID-19 vaccination, 93% were unvaccinated (42/45). Among patients with T1DM, 88% had diabetic ketoacidosis (DKA) and 6% had COVID-19 pneumonia; of those with T2DM, 46% had DKA and 58% had COVID-19 pneumonia. Of those with T1DM or T2DM, 59% and 46%, respectively, required ICU admission. CONCLUSION Our findings highlight the importance of considering diabetes in the evaluation of children and young adults presenting with COVID-19; the challenges of managing young patients who present with both COVID-19 and diabetes, particularly T2DM; and the importance of preventive actions like COVID-19 vaccination to prevent severe illness among those eligible with both COVID-19 and diabetes.
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Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Lindsay S. Womack
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Bryant J. Webber
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Rewa Choudhary
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Valentine Wanga
- Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaGA,COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Jean Y. Ko
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Hannah Dupont
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Giuseppina Imperatore
- Division of Diabetes TranslationNational Center for Chronic Disease Prevention and Health Promotion
| | - Emilia H. Koumans
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Sharon Saydah
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - Anne A. Kimball
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - David A. Siegel
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA,United States Public Health Service, Commissioned CorpsRockvilleMaryland
| | - the Pediatric COVID‐19 Hospital Investigation TeamGerdesMegan E.MPHShiDallas S.MD, PhDDulskiTheresa M.MD, MPHHsuSophiaMSN, MPHIduborOsatohamwen I.MDWendelArthur M.MDAndersonKristiMDBoylesTriciaMHAChiuSophia K.MDClickEleanor S.MD, PhDDa SilvaJulianaMDEvansMaryMDGoldJeremy A. W.MD, MSHastonJuliaMDLoganPamelaMD, MPH, MAMaloneySusan A.MDMartinezMarisolPharmDNatarajanPavithraBMBSSpicerKevin B.MD, PhDSwancuttMarkMDStevensValerie A.BrownJessicaPhDChandraGyanMBALightMeganMPHSchweitzerBethMSMorrisSapna BamrahMDBarrFrederick E.MDSnowdenJessicaMDKociolekLarry K.MDMcHughMatthewMPHWesselDavid L.MDSimpsonJoelle N.MDGormanKathleen C.MSNBreslinKristen A.MD, MPHDeBiasiRoberta L.MD, MSThompsonAaronMDKlineMark W.MDBoomJulie A.MDSinghIla R.MD, PhDDowlinMichaelWietechaMarkMS, MBA
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Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, is a global pandemic impacting 254 million people in 190 countries. Comorbidities, particularly cardiovascular disease, diabetes, and hypertension, increase the risk of infection and poor outcomes. SARS-CoV-2 enters host cells through the angiotensin-converting enzyme-2 receptor, generating inflammation and cytokine storm, often resulting in multiorgan failure. The mechanisms and effects of COVID-19 on patients with high-risk diabetes are not yet completely understood. In this review, we discuss the variety of coronaviruses, structure of SARS-CoV-2, mutations in SARS-CoV-2 spike proteins, receptors associated with viral host entry, and disease progression. Furthermore, we focus on possible mechanisms of SARS-CoV-2 in diabetes, leading to inflammation and heart failure. Finally, we discuss existing therapeutic approaches, unanswered questions, and future directions.
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Affiliation(s)
- Chandrakala Aluganti Narasimhulu
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States
| | - Dinender K Singla
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States
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Shafiee A, Teymouri Athar MM, Nassar M, Seighali N, Aminzade D, Fattahi P, Rahmannia M, Ahmadi Z. Comparison of COVID-19 outcomes in patients with Type 1 and Type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102512. [PMID: 35660932 PMCID: PMC9135641 DOI: 10.1016/j.dsx.2022.102512] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS This systematic review and meta-analysis aimed to evaluate the current evidence available to investigate clinical outcomes between patients with type 1 and type 2 diabetes. METHODS MEDLINE (Pubmed), Scopus, Web of Science, Cochrane library, Google scholar and Clinicaltrials.gov were searched. Randomized controlled trials (RCTs), non-randomized trials, and observational studies were eligible for inclusion. National Institutes of Health Quality Assessment Tool was used to assess the quality. Data were pooled by the Restricted-maximum-likelihood random-effects approach. RESULTS Total 11 studies comprising 7690415 individuals were included in this study. The log OR for the pooled data for all-cause mortality rate was -0.71 (95% CI: -1.38 to -0.03). Based on the pooled results, type 1 diabetic COVID-19 patients may have a better prognosis for mortality. There were no significant differences between groups in term of ICU-admission log OR -0.22 (95% CI: -0.81 to 0.37), and hospitalization log OR -0.48 (95% CI: -1.23 to 0.27). Based on our descriptives analyses after adjusting for age and comorbidities, the high-risk group in three studies was type 2 diabetes, and in five studies was type 1. Two studies reported no significant difference between these groups in relevant outcomes. CONCLUSION There were no significant differences in disease severity between type 1 and type 2 diabetes. Based on the unadjusted data available, the mortality rate for people with type 1 diabetes was shown to be lower than that for people with type 2. As data on these subjects is scarce, and the results obtained from studies are heterogeneous, further research with adequate sample sizes is needed to precisely compare the outcomes of COVID-19 between type 1 and type 2 diabetes.
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Affiliation(s)
- Arman Shafiee
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran.
| | | | - Mahmoud Nassar
- Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals / Queens, New York, USA
| | - Niloofar Seighali
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Dlnya Aminzade
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Fattahi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmannia
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadi
- Department of Basic Sciences and New Technologies, Electronical Branch, Islamic Azad University, Tehran, Iran
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