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Cilloniz C, Torres A. Diabetes Mellitus and Pneumococcal Pneumonia. Diagnostics (Basel) 2024; 14:859. [PMID: 38667504 PMCID: PMC11049506 DOI: 10.3390/diagnostics14080859] [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: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Currently, there are more than 500 million people suffering from diabetes around the world. People aged 65 years or older are the most affected by this disease, and it is estimated that approximately 96% of diabetes cases worldwide are type 2 diabetes. People with diabetes mellitus are at an increased risk of infections such as pneumonia, due to a series of factors that may contribute to immune dysfunction, including hyperglycemia, inhibition of neutrophil chemotaxis, impaired cytokine production, phagocytic cell dysfunction, altered T cell-mediated immune responses and the co-existence of chronic comorbidities. Rates of infection, hospitalization and mortality in diabetic patients are reported to be higher than in the general population. Research into the risk of infectious diseases such as pneumonia in these patients is very important because it will help improve their management and treatment.
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Affiliation(s)
- Catia Cilloniz
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Faculty of Health Sciences, Continental University, Huancayo 12001, Peru
| | - Antoni Torres
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Pulmonary Department, Hospital Clinic of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
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2
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Yuan S, He W, Liu B, Liu Z. Research Progress on the Weak Immune Response to the COVID-19 Vaccine in Patients with Type 2 Diabetes. Viral Immunol 2024; 37:79-88. [PMID: 38498797 DOI: 10.1089/vim.2023.0097] [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] [Indexed: 03/20/2024] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is generally susceptible to the population, highly infectious, rapidly transmitted, and highly fatal. There is a lack of specific drugs against the virus at present and vaccination is the most effective strategy to prevent infection. However, studies have found that some groups, particularly patients with diabetes, show varying degrees of weak immune reactivity to various COVID-19 vaccines, resulting in poor preventive efficacy against the novel coronavirus in patients with diabetes. Therefore, in this study, patients with type 2 diabetes mellitus (T2DM) who had weak immune response to the COVID-19 vaccine in recent years were analyzed. This article reviews the phenomenon, preliminary mechanism, and related factors affecting weak vaccine response in patients with T2DM, which is expected to help in the development of new vaccines for high-risk groups for COVID-19.
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Affiliation(s)
- Shiqi Yuan
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Wenwen He
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Bin Liu
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Zhuoran Liu
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
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Walker B, Stoecker C, Shao Y, Nauman E, Kabagambe EK, Shi L. Predictors of Telehealth Utilization and Subsequent Inpatient Stays and Emergency Visits During the COVID-19 Pandemic Among Patients with Type 2 Diabetes: Evidence from Louisiana. Telemed J E Health 2024; 30:278-283. [PMID: 37405746 DOI: 10.1089/tmj.2022.0509] [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] [Indexed: 07/06/2023] Open
Abstract
Objective: To understand which types of Medicare patients with diabetes disproportionately used telehealth during the coronavirus disease 2019 pandemic and how their characteristics mediated their inpatient and emergency department (ED) utilization. Methods: Logistic regression analyses were used to measure the associations between patient characteristics and telehealth utilization using electronic health records among Medicare patients with diabetes (n = 31,654). Propensity score matching was used to examine the relative impact of telehealth use in conjunction with race, ethnicity, and age on inpatient and ED outcomes. Results: Telehealth was associated with age (75-84 vs. 65-74; odds ratio [OR] = 0.810, p < 0.01), gender (female: OR = 1.148, p < 0.01), and chronic diseases (e.g., lung disease: OR = 1.142; p < 0.01). Black patients using telehealth were less likely to visit the ED (estimate = -0.018; p = 0.08), whereas younger beneficiaries using telehealth were less likely to experience an inpatient stay (estimate = -0.017; p = 0.06). Conclusions: Telehealth expansion particularly benefited the clinically vulnerable but saw uneven use and uneven benefit along sociodemographic lines. Clinical Trial Registration Number: NCT03136471.
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Affiliation(s)
- Brigham Walker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yixue Shao
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Elizabeth Nauman
- Louisiana Public Health Institute (LPHI), New Orleans, Louisiana, USA
| | - Edmond K Kabagambe
- Penn Medicine Lancaster General Health Research Institute, Lancaster, Pennsylvania, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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4
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Binsaleh NK, Eltayeb R, Sherwani S, Almishaal AA, Hindi EA, Qanash H, Bazaid AS, Alharbi AO, Bazaid MB, Altamimi SA. Comparison of Hematological Parameters Between Survivors and Non-Survivors COVID-19 Patients in Saudi Arabia. Int J Gen Med 2023; 16:3955-3962. [PMID: 37670931 PMCID: PMC10476863 DOI: 10.2147/ijgm.s421418] [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: 05/15/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023] Open
Abstract
Objective Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a communicable disease transmitted through the respiratory route and bodily contact. The severity of infection and mortality rate of COVID-19 cases was significantly high in the initial stages of the pandemic. This study aims to investigate the hematological profile of COVID-19 survivors and non-survivors. Methods This is a single-center retrospective study. A total of 108 hospitalized patients with laboratory-confirmed COVID-19 at East Jeddah Hospital between April and August 2020 were categorized into two groups based on outcome as survivors (n = 54) and non-survivors (n = 54). Hematological parameters and clinical profiles were analyzed and compared between the two groups. Results The mean age and standard deviation of the survived (30-71 years) and non-survived (33-83) groups was 53 ± 10.8 and 57.9 ± 12.2 years, respectively, with no statistically significant difference in age between groups (p = 0.0513). Non-survivors had a significantly longer median length of stay in the intensive care unit (ICU) (7 days, IQR: 4.24 to 12) compared to survivors COVID-19 patients (5 days, IQR: 0 to 11.75) (p = 0.0151). For the survivors group, the participant's age positively correlated with the length of hospital stay (r(52) = 0.21, p = 0.0005) and ICU length of stay r(52) = 0.18, p = 0.001). The median red blood cells (RBC) counts were significantly higher in the survived group (4.56x109/L, IQR: 4.02 to 5.11) in comparison with the non-survived (4.23x109/L, IQR: 3.75 to 4.23) group (p = 0.0011). All COVID-19 patients exhibited lymphocytopenia and a significant negative correlation was observed between the lymphocyte values and length of hospital stay among the survived group (p < 0.001) as well as length of ICU stay among the survived group (p < 0.0480). Disease-related mortality was significantly associated with reduced white blood cells (WBCs) (8.5×109/L, IQR: 6.1 to 11.7) and reduced basophils (0.09%, IQR: 0.02 to 0.19). Additionally, statistically significant differences were found between the survived and non-survived groups with respect to prothrombin time (PT) (12.5 sec. vs 14 sec., p < 0.0001) and partial thromboplastin time (PTT) (31.8 sec. vs 40 sec., p = 0.0008). Conclusion Hematological parameters can serve as valuable indicators to identify patients with severe COVID-19 and expected poor-prognosis/outcomes upon hospital admission. Cell counts of lymphocytes, WBCs, basophils and parameters such as PT and PTT can serve as clinical indicators to assess disease severity and predict progression to critical illness.
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Affiliation(s)
- Naif K Binsaleh
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha'il, Hail, Saudi Arabia
- Medical and Diagnostic Research Centre, University of Ha’il, Hail, 55476, Saudi Arabia
| | - Reem Eltayeb
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha'il, Hail, Saudi Arabia
| | - Subuhi Sherwani
- Medical and Diagnostic Research Centre, University of Ha’il, Hail, 55476, Saudi Arabia
- Department of Biology, College of Sciences, University of Hail, Hail, Saudi Arabia
| | - Ali A Almishaal
- Department of Speech-Language Pathology and Audiology, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Emad A Hindi
- Department of Clinical Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Husam Qanash
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha'il, Hail, Saudi Arabia
- Medical and Diagnostic Research Centre, University of Ha’il, Hail, 55476, Saudi Arabia
| | - Abdulrahman S Bazaid
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha'il, Hail, Saudi Arabia
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Widhani A, Koesnoe S, Maria S, Widjanarko AL, Karjadi TH, Hasibuan AS, Yunihastuti E, Rengganis I, Djauzi S. Factors Related to Severity, Hospitalization, and Mortality of COVID-19 Infection among Patients with Autoimmune Diseases. Trop Med Infect Dis 2023; 8:tropicalmed8040227. [PMID: 37104352 PMCID: PMC10145988 DOI: 10.3390/tropicalmed8040227] [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: 03/28/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
Patients with an autoimmune disease could be at higher risk of a poor outcome when contracting COVID-19 infection due to aberrant immune responses and use of immunosuppressant therapies for chronic autoimmune treatment. Here, we conducted a retrospective study to identify the factors related to severity, hospitalization, and mortality among patients with autoimmune diseases. We found 165 cases of patients with pre-existing autoimmune diseases who had contracted COVID-19 between March 2020 and September 2022. Data on demographical characteristics; autoimmune diagnosis and treatment; COVID-19 vaccination status; and time, severity, and outcome of COVID-19 infection were collected. Most of the subjects were female (93.3%) and autoimmune diagnoses included systemic lupus erythematosus (54.5%), Sjogren's syndrome (33.5%), antiphospholipid syndrome (23%), vasculitis (5.5%), autoimmune thyroid disease (3.6%), rheumatoid arthritis (3.03%), and inflammatory bowel disease (3.03%) among other autoimmune diseases. There were four COVID-19-related deaths in this study. Factors associated with moderate to severe COVID-19 infection in patients with autoimmune diseases included not being vaccinated against COVID-19, taking a steroid of ≥10 mg prednisone-equivalent per day, and having a cardiovascular disease. Taking a steroid of ≥10 mg prednisone-equivalent per day was also associated with hospitalization in the event of COVID-19 infection, while cardiovascular diseases also showed a significant correlation to mortality in patients with autoimmune diseases who had been hospitalized with COVID-19 infection.
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Affiliation(s)
- Alvina Widhani
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Department of Internal Medicine, Universitas Indonesia Hospital, Depok 16424, Indonesia
| | - Sukamto Koesnoe
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Suzy Maria
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Annisa Layalia Widjanarko
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Teguh Harjono Karjadi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Anshari Saifuddin Hasibuan
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Evy Yunihastuti
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Iris Rengganis
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Samsuridjal Djauzi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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Walker B, Stoecker C, Shao Y, Nauman E, Fort D, Shi L. Telehealth and Medicare Type 2 Diabetes Care Outcomes: Evidence From Louisiana. Med Care 2023; 61:S77-S82. [PMID: 36893422 PMCID: PMC9994566 DOI: 10.1097/mlr.0000000000001724] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND At the onset of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services broadened access to telehealth. This provided an opportunity to test whether diabetes, a risk factor for COVID-19 severity, can be managed with telehealth services. OBJECTIVE The objective of this study was to examine the impacts of telehealth on diabetes control. RESEARCH DESIGN A doubly robust estimator combined a propensity score-weighting strategy with regression controls for baseline characteristics using electronic medical records data to compare outcomes in patients with and without telehealth care. Matching on preperiod trajectories in outpatient visits and weighting by odds were used to ensure comparability between comparators. SUBJECTS Medicare patients with type 2 diabetes in Louisiana between March 2018 and February 2021 (9530 patients with a COVID-19 era telehealth visit and 20,666 patients without one). MEASURES Primary outcomes were glycemic levels and control [ie, hemoglobin A1c (HbA1c) under 7%]. Secondary outcomes included alternative HbA1c measures, emergency department visits, and inpatient admissions. RESULTS Telehealth was associated with lower pandemic era mean A1c values [estimate=-0.080%, 95% confidence interval (CI): -0.111% to -0.048%], which translated to an increased likelihood of having HbA1c in control (estimate=0.013; 95% CI: 0.002-0.024; P<0.023). Hispanic telehealth users had relatively higher COVID-19 era HbA1c levels (estimate=0.125; 95% CI: 0.044-0.205; P<0.003). Telehealth was not associated with differences in the likelihood of having an emergency department visits (estimate=-0.003; 95% CI: -0.011 to 0.004; P<0.351) but was associated with more the likelihood of having an inpatient admission (estimate=0.024; 95% CI: 0.018-0.031; P<0.001). CONCLUSION Telehealth use among Medicare patients with type 2 diabetes in Louisiana stemming from the COVID-19 pandemic was associated with relatively improved glycemic control.
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Affiliation(s)
- Brigham Walker
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- ConcertAI, Cambridge, MA
| | - Charles Stoecker
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Yixue Shao
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | | | - Lizheng Shi
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Integrated Diabetes Self-Management (IDSM) mobile application to improve self-management and glycemic control among patients with Type 2 Diabetes Mellitus (T2DM) in Indonesia: A mixed methods study protocol. PLoS One 2022; 17:e0277127. [PMID: 36441733 PMCID: PMC9704669 DOI: 10.1371/journal.pone.0277127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/21/2022] [Indexed: 11/29/2022] Open
Abstract
The number of patients with diabetes in Indonesia reach 19,47 million in 2021, mostly is caused by the adoption of sedentary and unhealthy lifestyles. Continuous self-management is important in diabetes care. It requires optimal coordination and communication between patients, families, and health care provider. The use of communication technology could be solution to the problem. This study aims to initiate an android-based mobile apps technology as a tool for patient, family, and healthcare provider to optimize patient with T2DM treatment. This study will be conducted in Public Health Centers (PHCs) in Yogyakarta using an exploratory sequential mixed-methods design which is divided into three phases. The first phase will use qualitative descriptive methods. Patients with T2DM, families, nurses, physicians and Health Social Security Agency officers in Indonesia will be involved in a focus group discussion (FGD) and in-depth interviews to understand their needs in optimizing the treatment. The second phase will be the development of an android-based application on the first phase results. The apps will be usability tested by involving experts (heuristic evaluation) and users (think aloud method) to ensure that the apps really meet targeted user's need. In the third phase, we will collect feedback from user after using this apps for three months. The effectiveness of the apps will be measured by self-management improvement and glycemic control of patients with T2DM. The non-equivalent control group design will be applied using a pre-repeated post-test control group. The result of this study will be an Android-based Application which will be called Integrated Diabetes Self-Management (IDSM) app to optimize the implementation of diabetes self-management which can improve glycemic control of patients with T2DM as one of the indicators of the Indonesian Chronic Disease Management Program at PHCs.
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Rizzo M, Cosentino F, Mantzoros C. Biosimilar and generic formulations of novel antidiabetic drugs: the role of liraglutide in clinical pharmacology of type 2 diabetes. Expert Rev Clin Pharmacol 2022; 15:795-797. [PMID: 35924858 DOI: 10.1080/17512433.2022.2108400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Palermo, Italy
| | - Francesco Cosentino
- Division of Cardiology, Department of Medicine, Karolinska Institute and Karolinska University Hospital, University of Stockholm, Stockholm, Sweden
| | - Christos Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
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Duksal F, Burnik C, Mermer M, Yavuz S. Evaluation of the Effect of Biochemistry Parameters on the Clinical Course in COVID-19 Patients Who Received Tocilizumab Treatment. South Med J 2022; 115:435-440. [PMID: 35777750 PMCID: PMC9232244 DOI: 10.14423/smj.0000000000001419] [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: 01/08/2023]
Abstract
OBJECTIVES Patients who develop cytokine storm while they have coronavirus disease 2019 (COVID-19) experience more severe symptoms. This article aims to evaluate the effect of biochemical parameters on the clinical course of the disease in patients treated with tocilizumab (TCZ) due to cytokine storm. METHODS Medical documents of patients with COVID-19 were searched retrospectively. Patients who entered cytokine storm were classified as group 1 and divided into two subgroups as patients who were followed up in the ward and in the intensive care unit (ICU). Less severe COVID-19 patients who did not enter cytokine storm were included in the control group as group 2. RESULTS A total of 522 patients with COVID-19 infection were included in the study. The mean age was 62.0 ± 15.6 years, and the majority were male (64.4%). Hypertension and diabetes mellitus were the two most common diseases, seen in 50.8% and 29.9%, respectively. There were 392 patients with TCZ application (group 1) and 130 patients without TCZ (group 2). Significantly higher serum glucose, magnesium, and sodium and lower calcium levels were present in group 1 than in group 2 (<0.001). Hypocalcemia, hypernatremia, hypermagnesemia, and hyperkalemia were more frequently detected in the ICU compared with the patients treated in the wards (P = 0.001, P < 0.001, P = 0.039, and P < 0.001, respectively). CONCLUSIONS Following up closely electrolyte disturbances may support patient survival and decrease the probability of ICU necessity. This approach should be taken before the development of important disorders to be effective in the treatment process of the main disease.
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Affiliation(s)
- Faysal Duksal
- From the Department of Chest Diseases and Tuberculosis; Beyhekim Research and Training Hospital, Konya, Turkey, and the Department of Chest Diseases and Tuberculosis, Konya City Hospital, Konya, Turkey
| | - Cengiz Burnik
- From the Department of Chest Diseases and Tuberculosis; Beyhekim Research and Training Hospital, Konya, Turkey, and the Department of Chest Diseases and Tuberculosis, Konya City Hospital, Konya, Turkey
| | - Mehmet Mermer
- From the Department of Chest Diseases and Tuberculosis; Beyhekim Research and Training Hospital, Konya, Turkey, and the Department of Chest Diseases and Tuberculosis, Konya City Hospital, Konya, Turkey
| | - Serkan Yavuz
- From the Department of Chest Diseases and Tuberculosis; Beyhekim Research and Training Hospital, Konya, Turkey, and the Department of Chest Diseases and Tuberculosis, Konya City Hospital, Konya, Turkey
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10
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Sharma P, Behl T, Sharma N, Singh S, Grewal AS, Albarrati A, Albratty M, Meraya AM, Bungau S. COVID-19 and diabetes: Association intensify risk factors for morbidity and mortality. Biomed Pharmacother 2022; 151:113089. [PMID: 35569351 PMCID: PMC9080053 DOI: 10.1016/j.biopha.2022.113089] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023] Open
Abstract
Diabetes is a condition that affects a large percentage of the population and it is the leading cause of a wide range of costly complications. Diabetes is linked to a multi-fold increase in mortality and when compared to non-diabetics, the intensity and prevalence of COVID-19 ailment among diabetic individuals are more. Since its discovery in Wuhan, COVID-19 has grown rapidly and shown a wide range of severity. Temperature, lymphopenia, non-productive cough, dyspnoea, and tiredness are recognized as the characteristic of individuals infected with COVID-19 disease. In COVID-19 patients, diabetes and other related comorbidities are substantial predictors of disease and mortality. According to a recent study, SARS-CoV-2 (the virus responsible for covid-19 disease) may also lead to direct pancreatic harm, which could aggravate hyperglycemia and potentially cause the establishment of diabetes in formerly non-diabetic individuals. This bidirectional association of COVID-19 and diabetes load the burden on health care professionals throughout the world. It is recommended that gliptin medications be taken moderately, blood glucose levels must be kept under control, ACE inhibitors should be used in moderation, decrease the number of avoidable hospitalizations, nutritional considerations, and some other prevention measures, such as immunization, are highly recommended. SARS-CoV-2 may cause pleiotropic changes in glucose homeostasis, which could exacerbate the pathophysiology of pre-existing diabetes or result in new disease processes.
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Affiliation(s)
- Prateek Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India,Government Pharmacy College, Nagrota Bagwan, Kangra, Himachal Pradesh, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India,Corresponding author
| | - Neelam Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | | | - Ali Albarrati
- Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Mohammed Albratty
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Abdulkarim M. Meraya
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania,Doctoral School of Biomedical Sciences, University of Oradea, Oradea, Romania,Corresponding author at: Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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11
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Aljuaid M, Alotair H, Alnajjar F, Alonazi W, Sharaf H, Sheshah E, Alashgar L, Alshaikh M. Risk factors associated with in-hospital mortality patients with COVID-19 in Saudi Arabia. PLoS One 2022; 17:e0270062. [PMID: 35749537 PMCID: PMC9231697 DOI: 10.1371/journal.pone.0270062] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/02/2022] [Indexed: 12/15/2022] Open
Abstract
Risk factors for in-hospital mortality of COVID-19 patients in Saudi Arabia have not been well studied. Previous reports from other countries have highlighted the effect of age, gender, clinical presentation and health conditions on the outcome of COVID-19 patients. Saudi Arabia has a different epidemiological structure with a predominance of young population, which calls for separate study. The objective of this study is to assess the predictors of mortality among hospitalized patients with COVID-19 in Saudi Arabia. This is a retrospective observational cohort study of hospitalized adult COVID-19 patients at two tertiary hospitals in Saudi Arabia between May to July 2020. Electronic charts were retrospectively reviewed comparing survivors and non-survivors in terms of demographic and clinical variables and comorbid conditions. A total of 564 hospitalized patients with COVID-19 were included in the study. The overall in-hospital mortality rate was 20%. The non-survivors were significantly older than survivors (59.4 ± 13.7 years and 50.5 ± 13.9 years respectively P< 0.001). Diabetes mellitus, hypertension, heart failure and ischemic heart disease were more prevalent among non-survivors (P< 0.001). The mean values of glycosylated hemoglobin HgA1C, D-dimer, ferritin, lactate dehydrogenase LDH, Alanin aminotransferase ALT and creatinine were significantly higher among non-survivors (P < 0.05). Multivariate logistic regression analysis revealed that age (aOR = 1.04; 95% CI 1.02-1.08; P < 0.01), chronic kidney disease (aOR = 4.04; 95% CI 1.11-14.77; P < 0.05), acute respiratory distress syndrome ARDS (aOR = 14.53; 95% CI 5.42-38.69; P < 0.01), Mechanical Ventilation (aOR = 10.57; 95% CI 5.74-23.59; P < 0.01), Shock (aOR = 3.85; 95% CI 1.02-14.57; P < 0.05), admission to intensive care unit (ICU) (aOR = 0.12; 95% CI 0.04-0.33; P < 0.01) and length of stay (aOR = 0.96; 95% CI 0.93-0.99; P < 0.05) were significant contributors towards mortality. The in-hospital mortality rate of COVID-19 patients admitted to tertiary hospitals in Saudi Arabia is high. Older age, chronic kidney disease and ARDS were the most important predictors of mortality.
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Affiliation(s)
- Mohammed Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Hadil Alotair
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Farrah Alnajjar
- Yanbu General Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Wadi Alonazi
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Hanaa Sharaf
- Department of Cytogenetics Laboratory, Ministry of Health, Riyadh, Saudi Arabia
| | - Eman Sheshah
- Department of Internal Medicine, King Salman Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Lolwah Alashgar
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mashael Alshaikh
- Department of Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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12
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Kushkestani M, Parvani M, Kazemzadeh Y. SARS-COV-2 in Type 2 Diabetic Patients: Possible Roles of Exercise Training as a Medicine. Curr Diabetes Rev 2022; 18:e010921196029. [PMID: 34468301 DOI: 10.2174/1573399817666210901121824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 01/08/2023]
Abstract
SARS-COV-2 is the novel type of beta coronavirus that was first evolved in December 2019 in Wuhan, China. People with type 2 diabetes are the most vulnerable group to SARS-COV-2 and its associated complications. Many factors such as medication, pathophysiologic-induced compensatory mechanisms, and alterations in protein expression and immune system function can all contribute to severe outcomes in diabetics. In this review article, we first described the possible mechanisms of increased risk and more severe complications rate of SARS-COV-2 in diabetic patients. Secondly, we discussed the crucial role of exercise in diabetic patients in balancing the RAS system (ACE2/ACE). Finally, we examine the possible roles of acute and chronic exercise in reducing SARS-COV-2 severe outcomes in people with diabetes in accordance with the latest evidence. We concluded that regular exercise (especially moderate-intensity exercise) can play a role in immune- enhancing, anti-inflammatory, and anti-oxidant activities and can balance the ACE2/ACE ratio (decreasing ANG2 levels) in diabetic subjects.
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Affiliation(s)
- Mehdi Kushkestani
- Faculty of Physical Education and Sport Sciences, Allameh Tabataba\'i University, Tehran, Iran
| | - Mohsen Parvani
- Faculty of Physical Education and Sport Sciences, Allameh Tabataba\'i University, Tehran, Iran
| | - Yaser Kazemzadeh
- Department of Physiology Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
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13
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Huang X, Zhang KJ, Jiang JJ, Jiang SY, Lin JB, Lou YJ. Identification of Crucial Genes and Key Functions in Type 2 Diabetic Hearts by Bioinformatic Analysis. Front Endocrinol (Lausanne) 2022; 13:801260. [PMID: 35242109 PMCID: PMC8885996 DOI: 10.3389/fendo.2022.801260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes (T2D) patients with SARS-CoV-2 infection hospitalized develop an acute cardiovascular syndrome. It is urgent to elucidate underlying mechanisms associated with the acute cardiac injury in T2D hearts. We performed bioinformatic analysis on the expression profiles of public datasets to identify the pathogenic and prognostic genes in T2D hearts. Cardiac RNA-sequencing datasets from db/db or BKS mice (GSE161931) were updated to NCBI-Gene Expression Omnibus (NCBI-GEO), and used for the transcriptomics analyses with public datasets from NCBI-GEO of autopsy heart specimens with COVID-19 (5/6 with T2D, GSE150316), or dead healthy persons (GSE133054). Differentially expressed genes (DEGs) and overlapping homologous DEGs among the three datasets were identified using DESeq2. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes analyses were conducted for event enrichment through clusterProfile. The protein-protein interaction (PPI) network of DEGs was established and visualized by Cytoscape. The transcriptions and functions of crucial genes were further validated in db/db hearts. In total, 542 up-regulated and 485 down-regulated DEGs in mice, and 811 up-regulated and 1399 down-regulated DEGs in human were identified, respectively. There were 74 overlapping homologous DEGs among all datasets. Mitochondria inner membrane and serine-type endopeptidase activity were further identified as the top-10 GO events for overlapping DEGs. Cardiac CAPNS1 (calpain small subunit 1) was the unique crucial gene shared by both enriched events. Its transcriptional level significantly increased in T2D mice, but surprisingly decreased in T2D patients with SARS-CoV-2 infection. PPI network was constructed with 30 interactions in overlapping DEGs, including CAPNS1. The substrates Junctophilin2 (Jp2), Tnni3, and Mybpc3 in cardiac calpain/CAPNS1 pathway showed less transcriptional change, although Capns1 increased in transcription in db/db mice. Instead, cytoplasmic JP2 significantly reduced and its hydrolyzed product JP2NT exhibited nuclear translocation in myocardium. This study suggests CAPNS1 is a crucial gene in T2D hearts. Its transcriptional upregulation leads to calpain/CAPNS1-associated JP2 hydrolysis and JP2NT nuclear translocation. Therefore, attenuated cardiac CAPNS1 transcription in T2D patients with SARS-CoV-2 infection highlights a novel target in adverse prognostics and comprehensive therapy. CAPNS1 can also be explored for the molecular signaling involving the onset, progression and prognostic in T2D patients with SARS-CoV-2 infection.
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Affiliation(s)
- Xin Huang
- Cardiovascular Key Laboratory of Zhejiang Province, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Biotherapy Research Center, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Xin Huang, ; Yi-jia Lou,
| | - Kai-jie Zhang
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Chu Kochen Honors College, Zhejiang University, Hangzhou, China
| | - Jun-jie Jiang
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Chu Kochen Honors College, Zhejiang University, Hangzhou, China
| | - Shou-yin Jiang
- Department of Emergency Medicine, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jia-bin Lin
- Clinical Research Center, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi-jia Lou
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- *Correspondence: Xin Huang, ; Yi-jia Lou,
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14
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Lucena JGSD, Azevedo TFD, Matias LDM, Nunes WDB, Costa MML, Andrade LLD. FACTORS ASSOCIATED WITH RESILIENCE IN PEOPLE WITH DIABETES DURING THE SOCIAL DISTANCING PERIOD IMPOSED BY THE COVID-19 PANDEMIC. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to verify the association of socioeconomic and clinical data and behavioral habits with the resilience level in people with Diabetes Mellitus during social distancing in the pandemic caused by the new coronavirus disease. Method: a cross-sectional, analytical and exploratory study. The population consisted of users monitored in the Family Health Strategy, diagnosed with Diabetes Mellitus, in the municipality of Cuité, Paraíba, Brazil. The sample consisted of 300 participants. The data were collected between November 2020 and February 2021 and operationalized through two forms: one containing socioeconomic and clinical aspects, as well as behavioral habits; and another that was part of the Connor Davidson Resilience Scale for Brazil, consisting of 25 items divided into four factors, namely: tenacity, adaptability, tolerance, dependence on external support, and intuition. In the bivariate analysis, the Pearson's Chi-square and Fisher's Exact tests were performed, and the prevalence ratio was calculated, along with the respective 95% confidence intervals. Finally, Poisson Regression with robust variance was applied. Results: the prevalence of having high resilience levels was 43% higher in people under 60 years old, 39% higher in Evangelicals, 36% higher in people who consumed alcoholic beverages and 29% higher in people who practiced some physical activity. Conclusion: an association was evidenced between socioeconomic/clinical data and behavioral habits and a high resilience level; such findings lead to the elaboration of inclusive actions during the pandemic, especially considering the emotional and social aspects, in order to suggest the creation of care strategies aimed at mental health.
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Affiliation(s)
| | | | | | - Waleska de Brito Nunes
- Universidade Federal de Campina Grande, Brasil; Universidade Federal do Rio Grande do Norte, Brasil
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15
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Belikina DV, Malysheva ES, Petrov AV, Nekrasova TA, Nekaeva ES, Lavrova AE, Zarubina DG, Atduev KA, Magomedova DM, Strongin LG. COVID-19 in Patients with Diabetes: Clinical Course, Metabolic Status, Inflammation, and Coagulation Disorder. Sovrem Tekhnologii Med 2021; 12:6-16. [PMID: 34796000 PMCID: PMC8596266 DOI: 10.17691/stm2020.12.5.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 01/08/2023] Open
Abstract
The aim of the investigation was to study the clinical course of COVID-19 in the presence of diabetes mellitus (DM) and elucidate possible mechanisms of their mutual aggravation. Materials and Methods The study included 64 patients with COVID-19; of them, 32 were with DM (main group) and 32 were DM-free (control group). The groups were formed according to the "case-control" principle. During hospitalization, the dynamics of clinical, glycemic, and coagulation parameters, markers of systemic inflammation, as well as kidney and liver functions were monitored and compared. Results Among patients with DM, the course of viral pneumonia was more severe, as evidenced by a 2.2-fold higher number of people with extensive (>50%) lung damage (p=0.05), an increased risk of death according to the CURB-65 algorithm (1.3-fold, p=0.043), and a longer duration of insufficient blood oxygen saturation (p=0.0004). With the combination of COVID-19 and DM, hyperglycemia is persistent, without pronounced variability (MAGE - 1.5±0.6 mmol/L), the levels of C-reactive protein (p=0.028), creatinine (p=0.035), and fibrinogen (p=0.013) are higher, manifestations of hypercoagulability persist longer, including slower normalization of antithrombin III (p=0.012), fibrinogen (p=0.037), and D-dimer (p=0.035). Conclusion The course of COVID-19 in patients with DM is associated with a high severity and extension of pneumonia, persistent decrease in oxygen supply, high hyperglycemia, accelerated renal dysfunction, systemic inflammation, and hypercoagulability.
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Affiliation(s)
- D V Belikina
- PhD Student, Department of Endocrinology and Internal Medicine; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - E S Malysheva
- Assistant, Department of Endocrinology and Internal Medicine; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A V Petrov
- Associate Professor, Department of Endocrinology and Internal Medicine; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - T A Nekrasova
- Professor, Department of Endocrinology and Internal Medicine; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - E S Nekaeva
- Head of the Emergency Department; Infection Hospital for Patients with Novel Coronavirus Infection (COVID-19) at the Institute of Pediatrics of the University Hospital, Privolzhsky Research Medical University, 22, Bldg 1, Semashko St., Nizhny Novgorod, 603950, Russia
| | - A E Lavrova
- Head of the Department of Pediatrics; Infection Hospital for Patients with Novel Coronavirus Infection (COVID-19) at the Institute of Pediatrics of the University Hospital, Privolzhsky Research Medical University, 22, Bldg 1, Semashko St., Nizhny Novgorod, 603950, Russia
| | - D G Zarubina
- Student, Medical Faculty;Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - K A Atduev
- Student, Medical Faculty;Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - D M Magomedova
- Student, Medical Faculty;Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - L G Strongin
- Professor, Head of the Department of Endocrinology and Internal Medicine Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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16
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Rizzo M, Nauck MA, Mantzoros CS. Incretin-based therapies in 2021 - Current status and perspectives for the future. Metabolism 2021; 122:154843. [PMID: 34333000 PMCID: PMC8321622 DOI: 10.1016/j.metabol.2021.154843] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy; Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.
| | - Christos S Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
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17
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Skrajnowska D, Brumer M, Kankowska S, Matysek M, Miazio N, Bobrowska-Korczak B. Covid 19: Diet Composition and Health. Nutrients 2021; 13:2980. [PMID: 34578858 PMCID: PMC8472186 DOI: 10.3390/nu13092980] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 12/29/2022] Open
Abstract
The virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the disease coronavirus disease 2019 (COVID-19). The cumulative number of cases reported globally is now nearly 197 million and the number of cumulative deaths is 4.2 million (26 July to 1 August 2021). Currently we are focusing primarily on keeping a safe distance from others, washing our hands, and wearing masks, and the question of the effects of diet and diet-dependent risk factors remains outside the center of attention. Nevertheless, numerous studies indicate that diet can play an important role in the course of COVID-19. In this paper, based on select scientific reports, we discuss the structure and replication cycle of SARS-CoV-2, risk factors, dietary standards for sick patients, and the roles of the microbiome and dietary components supporting the immune system in preventing COVID-19.
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Affiliation(s)
| | | | | | | | | | - Barbara Bobrowska-Korczak
- Department of Bromatology, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (D.S.); (M.B.); (S.K.); (M.M.); (N.M.)
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18
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Hakim A, Hasan MM, Hasan M, Lokman SM, Azim KF, Raihan T, Chowdhury PA, Azad AK. Major Insights in Dynamics of Host Response to SARS-CoV-2: Impacts and Challenges. Front Microbiol 2021; 12:637554. [PMID: 34512561 PMCID: PMC8424194 DOI: 10.3389/fmicb.2021.637554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), a pandemic declared by the World Health Organization on March 11, 2020, is caused by the infection of highly transmissible species of a novel coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As of July 25, 2021, there are 194,372,584 cases and 4,167,937 deaths with high variability in clinical manifestations, disease burden, and post-disease complications among different people around the globe. Overall, COVID-19 is manifested as mild to moderate in almost 90% of the cases and only the rest 10% of the cases need hospitalization. However, patients with older age and those having different comorbidities have made worst the pandemic scenario. The variability of pathological consequences and clinical manifestations of COVID-19 is associated with differential host-SARS-CoV-2 interactions, which are influenced by the factors that originated from the SARS-CoV-2 and the host. These factors usually include the genomic attributes and virulent factors of the SARS-CoV-2, the burden of coinfection with other viruses and bacteria, age and gender of the individuals, different comorbidities, immune suppressions/deficiency, genotypes of major histocompatibility complex, and blood group antigens and antibodies. We herein retrieved and reviewed literatures from PubMed, Scopus, and Google relevant to clinical complications and pathogenesis of COVID-19 among people of different age, sex, and geographical locations; genomic characteristics of SARS-CoV-2 including its variants, host response under different variables, and comorbidities to summarize the dynamics of the host response to SARS-CoV-2 infection; and host response toward approved vaccines and treatment strategies against COVID-19. After reviewing a large number of published articles covering different aspects of host response to SARS-CoV-2, it is clear that one aspect from one region is not working with the scenario same to others, as studies have been done separately with a very small number of cases from a particular area/region of a country. Importantly, to combat such a pandemic as COVID-19, a conclusive understanding of the disease dynamics is required. This review emphasizes on the identification of the factors influencing the dynamics of host responses to SARS-CoV-2 and offers a future perspective to explore the molecular insights of COVID-19.
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Affiliation(s)
- Al Hakim
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md. Mahbub Hasan
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, London, United Kingdom
| | - Mahmudul Hasan
- Department of Pharmaceutical and Industrial Biotechnology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Syed Mohammad Lokman
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Kazi Faizul Azim
- Department of Microbial Biotechnology, Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Topu Raihan
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Abul Kalam Azad
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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19
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Viurcos-Sanabria R, Escobedo G. Immunometabolic bases of type 2 diabetes in the severity of COVID-19. World J Diabetes 2021; 12:1026-1041. [PMID: 34326952 PMCID: PMC8311488 DOI: 10.4239/wjd.v12.i7.1026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/16/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 and type 2 diabetes (T2D) have now merged into an ongoing global syndemic that is threatening the lives of millions of people around the globe. For this reason, there is a deep need to understand the immunometabolic bases of the main etiological factors of T2D that affect the severity of COVID-19. Here, we discuss how hyperglycemia contributes to the cytokine storm commonly associated with COVID-19 by stimulating monocytes and macrophages to produce interleukin IL-1β, IL-6, and TNF-α in the airway epithelium. The main mechanisms through which hyperglycemia promotes reactive oxygen species release, inhibition of T cell activation, and neutrophil extracellular traps in the lungs of patients with severe SARS-CoV-2 infection are also studied. We further examine the molecular mechanisms by which proinflammatory cytokines induce insulin resistance, and their deleterious effects on pancreatic β-cell exhaustion in T2D patients critically ill with COVID-19. We address the effect of excess glucose on advanced glycation end product (AGE) formation and the role of AGEs in perpetuating pneumonia and acute respiratory distress syndrome. Finally, we discuss the contribution of preexisting endothelial dysfunction secondary to diabetes in the development of neutrophil trafficking, vascular leaking, and thrombotic events in patients with severe SARS-CoV-2 infection. As we outline here, T2D acts in synergy with SARS-CoV-2 infection to increase the progression, severity, and mortality of COVID-19. We think a better understanding of the T2D-related immunometabolic factors that contribute to exacerbate the severity of COVID-19 will improve our ability to identify patients with high mortality risk and prevent adverse outcomes.
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Affiliation(s)
| | - Galileo Escobedo
- Laboratorio de Proteómica, Dirección de Investigación, Hospital General de Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
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20
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Insuela DBR, Ferrero MR, Gonçalves-de-Albuquerque CF, Chaves ADS, da Silva AYO, Castro-Faria-Neto HC, Simões RL, Barja-Fidalgo TC, Silva PMRE, Martins MA, Silva AR, Carvalho VF. Glucagon Reduces Neutrophil Migration and Increases Susceptibility to Sepsis in Diabetic Mice. Front Immunol 2021; 12:633540. [PMID: 34295325 PMCID: PMC8290340 DOI: 10.3389/fimmu.2021.633540] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
Sepsis is one of the most common comorbidities observed in diabetic patients, associated with a deficient innate immune response. Recently, we have shown that glucagon possesses anti-inflammatory properties. In this study, we investigated if hyperglucagonemia triggered by diabetes might reduce the migration of neutrophils, increasing sepsis susceptibility. 21 days after diabetes induction by intravenous injection of alloxan, we induced moderate sepsis in Swiss-Webster mice through cecum ligation and puncture (CLP). The glucagon receptor (GcgR) antagonist des-his1-[Glu9]-glucagon amide was injected intraperitoneally 24h and 1h before CLP. We also tested the effect of glucagon on CXCL1/KC-induced neutrophil migration to the peritoneal cavity in mice. Neutrophil chemotaxis in vitro was tested using transwell plates, and the expression of total PKA and phospho-PKA was evaluated by western blot. GcgR antagonist restored neutrophil migration, reduced CFU numbers in the peritoneal cavity and improved survival rate of diabetic mice after CLP procedure, however, the treatment did no alter hyperglycemia, CXCL1/KC plasma levels and blood neutrophilia. In addition, glucagon inhibited CXCL1/KC-induced neutrophil migration to the peritoneal cavity of non-diabetic mice. Glucagon also decreased the chemotaxis of neutrophils triggered by CXCL1/KC, PAF, or fMLP in vitro. The inhibitory action of glucagon occurred in parallel with the reduction of CXCL1/KC-induced actin polymerization in neutrophils in vitro, but not CD11a and CD11b translocation to cell surface. The suppressor effect of glucagon on CXCL1/KC-induced neutrophil chemotaxis in vitro was reversed by pre-treatment with GcgR antagonist and adenylyl cyclase or PKA inhibitors. Glucagon also increased PKA phosphorylation directly in neutrophils in vitro. Furthermore, glucagon impaired zymosan-A-induced ROS production by neutrophils in vitro. Human neutrophil chemotaxis and adherence to endothelial cells in vitro were inhibited by glucagon treatment. According to our results, this inhibition was independent of CD11a and CD11b translocation to neutrophil surface or neutrophil release of CXCL8/IL-8. Altogether, our results suggest that glucagon may be involved in the reduction of neutrophil migration and increased susceptibility to sepsis in diabetic mice. This work collaborates with better understanding of the increased susceptibility and worsening of sepsis in diabetics, which can contribute to the development of new effective therapeutic strategies for diabetic septic patients.
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Affiliation(s)
| | - Maximiliano Ruben Ferrero
- Laboratory of Inflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Cassiano Felippe Gonçalves-de-Albuquerque
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Laboratory of Immunopharmacology, Biomedical Institute, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amanda da Silva Chaves
- Laboratory of Inflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Hugo Caire Castro-Faria-Neto
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Laboratory of Inflammation, National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Rio de Janeiro, Brazil
| | - Rafael Loureiro Simões
- Laboratory of Cellular and Molecular Pharmacology, Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thereza Christina Barja-Fidalgo
- Laboratory of Cellular and Molecular Pharmacology, Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marco Aurélio Martins
- Laboratory of Inflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Adriana Ribeiro Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Laboratory of Inflammation, National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Rio de Janeiro, Brazil
| | - Vinicius Frias Carvalho
- Laboratory of Inflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Laboratory of Inflammation, National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Rio de Janeiro, Brazil
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21
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Palaiodimos L, Chamorro-Pareja N, Karamanis D, Li W, Zavras PD, Chang KM, Mathias P, Kokkinidis DG. Diabetes is associated with increased risk for in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis comprising 18,506 patients. Hormones (Athens) 2021; 20:305-314. [PMID: 33123973 PMCID: PMC7595056 DOI: 10.1007/s42000-020-00246-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/16/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Infectious diseases are more frequent and can be associated with worse outcomes in patients with diabetes. The aim of this study was to systematically review and conduct a meta-analysis of the available observational studies reporting the effect of diabetes on mortality among hospitalized patients with COVID-19. METHODS The Medline, Embase, Google Scholar, and medRxiv databases were reviewed for identification of eligible studies. A random effects model meta-analysis was used, and I2 was utilized to assess the heterogeneity. In-hospital mortality was defined as the endpoint. Sensitivity, subgroup, and meta-regression analyses were performed. RESULTS A total of 18,506 patients were included in this meta-analysis (3713 diabetics and 14,793 non-diabetics). Patients with diabetes were associated with a higher risk of death compared with patients without diabetes (OR 1.65; 95% CI 1.35-1.96; I2 77.4%). The heterogeneity was high. A study-level meta-regression analysis was performed for all the important covariates, and no significant interactions were found between the covariates and the outcome of mortality. CONCLUSION This meta-analysis shows that that the likelihood of death seems to be higher in diabetic patients hospitalized with COVID-19 compared with non-diabetic patients. Further studies are needed to assess whether this association is independent or not, as well as to investigate the role of adequate glycemic control prior to infection with COVID-19.
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Affiliation(s)
- Leonidas Palaiodimos
- Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NW Building, 8th Floor, 111 East 210th Str., Bronx, NY, 10467, USA.
- Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA.
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA.
| | - Natalia Chamorro-Pareja
- Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Dimitrios Karamanis
- Department of Economics, University of Piraeus, 72 Ellis Str., Piraeus, 18546, Attica, Greece
| | - Weijia Li
- Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Phaedon D Zavras
- Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Kai Ming Chang
- Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
- Division of Infectious Disease, Northwell Health, New Hyde Park, NY, USA
| | - Priyanka Mathias
- Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
- Division of Endocrinology, Montefiore Medical Center, 111 East 210th Str., Bronx, NY, 10467, USA
| | - Damianos G Kokkinidis
- Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
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22
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Mahrooz A, Muscogiuri G, Buzzetti R, Maddaloni E. The complex combination of COVID-19 and diabetes: pleiotropic changes in glucose metabolism. Endocrine 2021; 72:317-325. [PMID: 33886062 PMCID: PMC8060688 DOI: 10.1007/s12020-021-02729-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/09/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Angiotensin converting enzyme 2 (ACE2) is the door for SARS-CoV-2, expressed in critical metabolic tissues. So, it is rational that the new virus causes pleiotropic alterations in glucose metabolism, resulting in the complication of pre-existing diabetes's pathophysiology or creating new disease mechanisms. However, it seems that less attention has been paid to this issue. This review aimed to highlight the importance of long-term consequences and pleiotropic alterations in glucose metabolism following COVID-19 and emphasize the need for basic and clinical research in metabolism and endocrinology. RESULTS SARS-CoV-2 shifts cellular metabolism from oxidative phosphorylation to glycolysis, which leads to a decrease in ATP generation. Together with metabolic imbalance, the impaired immune system elevates the susceptibility of patients with diabetes to this deadly virus. SARS-CoV-2-induced metabolic alterations in immune cells can result in hyper inflammation and a cytokine storm. Metabolic dysfunction may affect therapies against SARS-CoV-2 infection. The effective control of metabolic complications could prove useful therapeutic targets for combating COVID-19. It is also necessary to understand the long-term consequences that will affect patients with diabetes who survived COVID-19. CONCLUSIONS Since the pathophysiology of COVID-19 is still mostly unknown, identifying the metabolic mechanisms contributing to its progression is essential to provide specific ways to prevent and improve this dangerous virus's detrimental effects. The findings show that the new virus may induce new-onset diabetes with uncertain metabolic and clinical features, supporting a potential role of COVID-19 in the development of diabetes.
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Affiliation(s)
- Abdolkarim Mahrooz
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
- Diabetes Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Giovanna Muscogiuri
- Sezione di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II Napoli, Napoli, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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23
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Dietary obesity in mice is associated with lipid deposition and metabolic shifts in the lungs sharing features with the liver. Sci Rep 2021; 11:8712. [PMID: 33888788 PMCID: PMC8062462 DOI: 10.1038/s41598-021-88097-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
Obesity is associated with both chronic and acute respiratory illnesses, such as asthma, chronic obstructive pulmonary disease (COPD) or increased susceptibility to infectious diseases. Anatomical but also systemic and local metabolic alterations are proposed contributors to the pathophysiology of lung diseases in the context of obesity. To bring perspective to this discussion, we used NMR to compare the obesity-associated metabolomic profiles of the lung with those of the liver, heart, skeletal muscles, kidneys, brain and serum from male C57Bl/6J mice fed with a high-fat and high-sucrose (HFHSD) diet vs. standard (SD) chow for 14 weeks. Our results showed that the lung was the second most affected organ after the liver, and that the two organs shared reduced one-carbon (1C) metabolism and increased lipid accumulation. Altered 1C metabolism was found in all organs and in the serum, but serine levels were increased only in the lung of HFHSD compared to SD. Lastly, tricarboxylic acid (TCA)-derived metabolites were specifically and oppositely regulated in the serum and kidneys but not in other organs. Collectively, our data highlighted that HFHSD induced specific metabolic changes in all organs, the lung being the second most affected organ, the main alterations affecting metabolite concentrations of the 1C pathway and, to a minor extend, TCA. The absolute metabolite quantification performed in this study reveals some metabolic specificities affecting both the liver and the lung, that may reveal common metabolic determinants to the ongoing pathological process.
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24
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Wibisono AH, Kurniasih D, Sumartiyah E, Putri RN, Kurnia DA, Gultom Y, Dahlia D. Developing the hypoglycemia-nursing early warning score system (Hy-NEWSS): A pilot study. J Public Health Res 2021; 10. [PMID: 33855390 PMCID: PMC8129759 DOI: 10.4081/jphr.2021.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Severe hypoglycemia occurs in 6% of type 2 DM patients with a 6 to 7% mortality rate. Amidst the COVID-19 pandemic, there has been a higher rate of fatality among diabetes patients, at least 22% of COVID-19 deaths in Wuhan, China. Furthermore, the condition impairs physiological defense against recurrent hypoglycemia in the future. Accordingly, the innovation in this study aims to prevent severe hypoglycemia among type 2 patients through early risk screening, the use of preventative protocols, and patient and family empowerment. This intervention bundle is called Hypoglycemia-Nursing Early Warning Score System (Hy-NEWSS). Design and Methods: The innovation was implemented in inpatient and outpatient settings, within two weeks with the following sequence: i) internal training, ii) Hy-NEWSS implementation, iii) outcomes evaluation. Results: Of the twenty-eight patients involved in the study, 3 patients (19%) had a high risk of hypoglycemia, while the remaining had a low risk for the condition. However, at the end of the study there was no event of severe hypoglycemia (0%), and only 1 event (6.33%) of mild hypoglycemia. The results also showed that the accuracy of nurses in implementing the protocols was 93% and that during the evaluation, 95.62% of the responses of the nurses from the inpatient and outpatient settings were positive. Finally, the scores of the sensitivity and specificity evaluation were 99% and 88%, respectively. Conclusion: It may be concluded from this initial study that Hy-NEWSS is effective in preventing severe hypoglycemia, accurate in identifying patient risk level for the condition, and has high applicability to be implemented in hospital settings. Significance for public health Hypoglycemia is a deteriorating problem and affects type 2 diabetes patients in both hospital and community settings. Furthermore, its incidence was reported to be significantly higher in patients undertaking insulin therapy, especially those suffering from other chronic comorbidities. Currently, there is no standardized prevention protocol for hypoglycemia. Therefore, this study describes an initial effort in developing an evidence-based intervention bundle to prevent the condition.
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Affiliation(s)
| | | | - Eti Sumartiyah
- Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta.
| | | | | | - Yunisar Gultom
- Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta.
| | - Debie Dahlia
- Faculty of Nursing, University of Indonesia, Depok.
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25
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Ciardullo S, Zerbini F, Perra S, Muraca E, Cannistraci R, Lauriola M, Grosso P, Lattuada G, Ippoliti G, Mortara A, Manzoni G, Perseghin G. Impact of diabetes on COVID-19-related in-hospital mortality: a retrospective study from Northern Italy. J Endocrinol Invest 2021; 44:843-850. [PMID: 32776197 PMCID: PMC7415410 DOI: 10.1007/s40618-020-01382-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of pre-existing diabetes on in-hospital mortality in patients admitted for Coronavirus Disease 2019 (COVID-19). METHODS This is a single center, retrospective study conducted at Policlinico di Monza hospital, located in the Lombardy region, Northern Italy. We reviewed medical records of 373 consecutive adult patients who were hospitalized with COVID-19 between February 22 and May 15, 2020. Data were collected on diabetes status, comorbid conditions and laboratory findings. Multivariable logistic regression was performed to evaluate the effect of diabetes on in-hospital mortality after adjustment for potential confounding variables. RESULTS Mean age of the patients was 72 ± 14 years (range 17-98), 244 (65.4%) were male and 69 (18.5%) had diabetes. The most common comorbid conditions were hypertension (237 [64.8%]), cardiovascular disease (140 [37.7%]) and malignant neoplasms (50 [13.6%]). In-hospital death occurred in 142 (38.0%) patients. In the multivariable model older age (Relative Risk [RR] 1.06 [1.04-1. 09] per year), diabetes (RR 1.56 [1.05-2.02]), chronic obstructive pulmonary disease (RR 1.82 [1.13-2.35]), higher values of lactic dehydrogenase and C-reactive protein were independently associated with in-hospital mortality. CONCLUSION In this retrospective single-center study, diabetes was independently associated with a higher in-hospital mortality. More intensive surveillance of patients with this condition is to be warranted.
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Affiliation(s)
- S Ciardullo
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - F Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - S Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - E Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - R Cannistraci
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - M Lauriola
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - P Grosso
- Department of Anesthesiology and Intensive Care, Policlinico di Monza, Monza, Italy
| | - G Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Ippoliti
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Mortara
- Department of Clinical Cardiology, Policlinico di Monza, Monza, Italy
| | - G Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Perseghin
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
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26
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Li G, Chen Z, Lv Z, Li H, Chang D, Lu J. Diabetes Mellitus and COVID-19: Associations and Possible Mechanisms. Int J Endocrinol 2021; 2021:7394378. [PMID: 33859687 PMCID: PMC8025139 DOI: 10.1155/2021/7394378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/02/2020] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a recently emerged disease with formidable infectivity and high mortality. Emerging data suggest that diabetes is one of the most prevalent comorbidities in patients with COVID-19. Although their causal relationship has not yet been investigated, preexisting diabetes can be considered as a risk factor for the adverse outcomes of COVID-19. Proinflammatory state, attenuation of the innate immune response, possibly increased level of ACE2, along with vascular dysfunction, and prothrombotic state in people with diabetes probably contribute to higher susceptibility for SARS-CoV-2 infection and worsened prognosis. On the other hand, activated inflammation, islet damage induced by virus infection, and treatment with glucocorticoids could, in turn, result in impaired glucose regulation in people with diabetes, thus working as an amplification loop to aggravate the disease. Therefore, glycemic management in people with COVID-19, especially in those with severe illness, is of considerable importance. The insights may help to reduce the fatality in the effort against COVID-19.
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Affiliation(s)
- Gerui Li
- Department of Geratology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Ze Chen
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Zhan Lv
- Department of Geratology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Hang Li
- Department of Geratology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Danqi Chang
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Jinping Lu
- Department of Geratology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
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27
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Wang J, Meng W. COVID-19 and diabetes: the contributions of hyperglycemia. J Mol Cell Biol 2021; 12:958-962. [PMID: 33002109 PMCID: PMC7543402 DOI: 10.1093/jmcb/mjaa054] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Jing Wang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Wen Meng
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
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28
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Gvozdanović Z, Farčić N, Šimić H, Buljanović V, Gvozdanović L, Katalinić S, Pačarić S, Gvozdanović D, Dujmić Ž, Miškić B, Barać I, Prlić N. The Impact of Education, COVID-19 and Risk Factors on the Quality of Life in Patients with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2332. [PMID: 33673454 PMCID: PMC7956830 DOI: 10.3390/ijerph18052332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The aim of this study was to examine the impact of education, coronavirus disease 2019 (COVID-19), and risk factors on the quality of life in patients with type 2 diabetes. METHODS A prospective study was conducted in three phases: before education, after education, and in the period of pandemic coronavirus disease 2019 (COVID-19). The subjects were diabetics on oral therapy. To determine the quality of life index, a standardized Ferrans and Powers survey questionnaire was used. RESULTS A total of 205 participants took part in the study, of which 111 (54.1%) were men and 94 (46%) women. Participants were enrolled in the study between January 2019 and September 2020. Glycated hemoglobin values were significantly higher before education compared to post-education and at the time of COVID-19 (Friedman test, p = 0.002), and body mass index was significantly lower after education compared to values before education (Friedman test, p = 0.008). The quality of life was significantly lower in all domains in the COVID-19 period (Friedman test, p < 0.001). CONCLUSIONS A significant predictor of worse assessment of overall quality of life was male gender and rural place of residence. Disease duration of up to 5 years was a significant predictor of worse assessment in the psychological/spiritual domain, while being married was a predictor of better assessment of the quality of life in the family domain. The education of diabetics brought an increase in the health and quality of life while the coronavirus disease pandemic had negative consequences on the same parameters. We consider it necessary to systematically educate diabetics about the comorbidity of COVID-19.
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Affiliation(s)
- Zvjezdana Gvozdanović
- General Hospital Našice, Našice 31 500, Croatia; (Z.G.); (H.Š.); (V.B.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Nikolina Farčić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- Department of Surgery, University Hospital Centre Osijek, Osijek 31 000, Croatia
| | - Hrvoje Šimić
- General Hospital Našice, Našice 31 500, Croatia; (Z.G.); (H.Š.); (V.B.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Vikica Buljanović
- General Hospital Našice, Našice 31 500, Croatia; (Z.G.); (H.Š.); (V.B.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
| | - Lea Gvozdanović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
| | - Sven Katalinić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
| | - Stana Pačarić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (L.G.); (S.K.); (S.P.)
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- Department of Surgery, University Hospital Centre Osijek, Osijek 31 000, Croatia
| | - Domagoj Gvozdanović
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Željka Dujmić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- General Hospital “Dr. Josip Benčević” Slavonski Brod, Slavonski Brod 35 000, Croatia
| | - Blaženka Miškić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
- General Hospital “Dr. Josip Benčević” Slavonski Brod, Slavonski Brod 35 000, Croatia
| | - Ivana Barać
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
| | - Nada Prlić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (D.G.); (Ž.D.); (B.M.); (I.B.); (N.P.)
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Park SC, Won SY, Kim NH, Choi H, Youk TM, Lee HJ, Jeon HH. Risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections: a nationwide population-based study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:211. [PMID: 33708838 PMCID: PMC7940880 DOI: 10.21037/atm-20-5958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) has rapidly turned into a public health emergency worldwide; however, the risk factors for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been well-described. We aimed to identify the clinical risk factors for SARS-CoV-2 infections in Korea, where social distancing and face masks have been strongly recommended. Methods The data of individuals who underwent the reverse transcription polymerase chain reaction test for SARS-CoV-2 between January 3 and May 31, 2020 were retrieved from the Health Insurance Review and Assessment Service dataset. We used multivariable logistic regression models to identify the risk factors for SARS-CoV-2 infections in the population. Results We retrieved the results of 219,729 SARS-CoV-2 tests, of which 7,333 were positive results. In the multivariable analysis, female sex was associated with a higher risk of testing positive for SARS-CoV-2 [odds ratio (OR) =1.30, 95% confidence interval (CI): 1.24–1.37, P<0.0001]. Additionally, populations living in areas that had large outbreaks of COVID-19 were at an increased risk of testing positive for SARS-CoV-2 (OR =6.87, 95% CI: 6.55–7.21, P<0.0001). The odds of a positive test were greater for the Medical Aid beneficiaries (OR =1.99, 95% CI: 1.82–2.18, P<0.0001) than for the National Health Insurance beneficiaries. Individuals with diabetes mellitus (DM) were more likely to test positive (OR =1.15, 95% CI: 1.07–1.24, P=0.0002). Conclusions Women, individuals living in areas with large outbreaks of COVID-19, Medical Aid beneficiaries, and individuals with DM might have greater risks of contracting SARS-CoV-2 infections despite practicing social distancing and using face masks.
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Affiliation(s)
- Seon Cheol Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun Young Won
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Na Hye Kim
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Heun Choi
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Tae Mi Youk
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Statistics, Korea University, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic Korea
| | - Han Ho Jeon
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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30
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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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31
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Affiliation(s)
- Angeliki M Angelidi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece
| | - Eleftheria Katechaki
- Agricultural Cooperatives' Union of Aeghion, Corinthou 201, Aeghion 25100, Greece
| | - Emilio Ros
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona 08036, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Christos S Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA 02115, USA.
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Wee AKH. COVID-19's toll on the elderly and those with diabetes mellitus - Is vitamin B12 deficiency an accomplice? Med Hypotheses 2021; 146:110374. [PMID: 33257090 PMCID: PMC7659645 DOI: 10.1016/j.mehy.2020.110374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/20/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023]
Abstract
COVID-19 exacts a disproportionate toll on both the elderly and those with diabetes; these patients are more likely to require costly intensive care, longer hospitalisation, and die from complications. Nations would thus find it extremely difficult to either lift or sustain socially, economically, and politically damaging restrictions that keep this group of people safe. Without a vaccine, there is thus an urgent need to identify potential modifiable risk factors which can help manage overall fatality or recovery rates. Case fatality rates are highly variable between (and even within) nations; nutritional differences have been proposed to account significantly for this disparity. Indeed, vitamin B12 deficiency is a common denominator between the elderly and those with diabetes. The question on hand thus lies on whether managing B12 deficiencies will impact COVID-19 fatality outcome or recovery rates. Herein, we review the latest evidence that shows that B12 deficiency associates in multiple areas very similar to where COVID-19 exerts its damaging effects: immunologically; microbiologically; haematologically; and through endothelial cell signalling-supporting the hypothesis that B12 deficiency is a potential modifiable risk factor in our fight against COVID-19.
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Affiliation(s)
- Andrew Kien Han Wee
- SingHealth Polyclinics, Marine Parade Polyclinic, Blk 80 Marine Parade Central, #01-792, Singapore 440080, Singapore; SingHealth Duke-NUS Medical School, Family Medicine Academic Clinical Programme ("FM ACP"), Office of Academic & Clinical Development, 8 College Road, Singapore 169857, Singapore.
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Tejera-Perez C, Moreno-Pérez Ó, Rios J, Reyes-García R. People living with type 1 diabetes point of view in COVID-19 times (COVIDT1 study): Disease impact, health system pitfalls and lessons for the future. Diabetes Res Clin Pract 2021; 171:108547. [PMID: 33278422 PMCID: PMC7711176 DOI: 10.1016/j.diabres.2020.108547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
AIMS To analyse the effects of confinement among people with type 1 diabetes (T1D) and their caregivers over the course of the COVID-19 crisis and to evaluate contemporary changes in medical assistance and patient preferences. METHODS An observational cross-sectional study designed as a self-reported web-based survey was conducted over the course of the COVID-19 pandemic. RESULTS A total of 769 subjects participated in the survey (603 people with T1D and 166 caregivers). Changes in glycaemic control were reported in 66% of cases, weight gain in 40.4% of cases and decreased exercise levels in 65.4% of cases. Of the cohort, 53% maintained contact with the healthcare team, and 23% received specific information related to COVID-19. Emotional support was requested by 17% of respondents. Regarding telemedicine, 97.9% agreed with its use with the following preferences regarding the future: telephone call (84.5%), video-call (60.6%) and platform devices (39.7%). CONCLUSIONS Over the course of the COVID-19 pandemic, at least two-thirds of people with T1D underwent changes in the management of their condition. Almost all participants agreed with the concept of telemedicine, favouring telephone and video calls as their preferred means of communication.
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Affiliation(s)
- Cristina Tejera-Perez
- Unidad de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, Spain.
| | - Óscar Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine department, Miguel Hernández University, Elche, Spain.
| | - Jose Rios
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona.
| | - Rebeca Reyes-García
- Unidad de Endocrinología y Nutrición. Hospital Universitario Torrecárdenas, Almería, Spain. CIBERFES, Instituto de Salud Carlos III.
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Tabish TA, Hamblin MR. Multivalent nanomedicines to treat COVID-19: A slow train coming. NANO TODAY 2020; 35:100962. [PMID: 32922510 PMCID: PMC7473256 DOI: 10.1016/j.nantod.2020.100962] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/09/2020] [Accepted: 08/25/2020] [Indexed: 05/05/2023]
Abstract
The high transmission rate and serious consequences of the unprecedented COVID-19 pandemic make it challenging and urgent to identify viral pathogens and understand their intrinsic resistance mechanisms, to pave the way for new approaches to combat severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Multivalent interactions are responsible for performing a broad range of biological functions in normal cells, such as cell-cell communication and adhesion. Multivalency underlies the reversibility of ligand-receptor interactions during infections. Previous studies into multivalent nanomedicines used against viruses, have revealed their ability, not only to probe the molecular processes of viral infections, but also to target pathogen-host cell binding with minimal collateral damage to normal cells. Nanomedicines are comparable in size to viruses and to cell receptor complexes (that mediate viral uptake), and can function as safe and accurate armoured vehicles to facilitate the transport of anti-viral drugs. Multivalent nanomedicines can be designed to avoid binding to extracellular serum proteins, and ultimately lead to destruction of the viruses. This brief perspective highlights the potential of innovative smart and safe multivalent nanomedicines that could target multiple viral factors involved in infections at cellular levels. For instance it is possible to target viral spike protein mediated entry pathways, as well as viral replication and cell lysis. Nanomedicine-based approaches could open new opportunities for anti-coronavirus therapies.
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Affiliation(s)
- Tanveer A Tabish
- UCL Cancer Institute, University College London, London, WC1E 6DD, UK
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, 2028, South Africa
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Milionis C, Milioni SO. A brief analysis and hypotheses about the risk of COVID-19 for people with type 1 and type 2 diabetes mellitus. J Diabetes Metab Disord 2020; 19:2035-2039. [PMID: 32837957 PMCID: PMC7370870 DOI: 10.1007/s40200-020-00592-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/11/2023]
Abstract
COVID-19 is an infectious respiratory disease which firstly occurred in Wuhan, China and evolved rapidly around the globe. The causative pathogen is a novel coronavirus called SARS-CoV-2 with genomic similarities with SARS-CoV and MERS-CoV. The disease is transmitted among humans either through direct contact or via droplets from sneeze or cough. Most infected persons remain asymptomatic or mildly symptomatic, but some patients may develop severe clinical features, including pneumonia, respiratory failure, sepsis and even death. People of advanced age and/or with underlying diseases (including diabetes mellitus) are at greater risk. The innate and adaptive immune system are responsible for protecting the body against viral infection. Nevertheless, it is assumed that SARS-CoV-2 interferes with the immune system through immunomodulating mechanisms which intensify its pathogenesis. A delayed or reduced response of the innate immune system is critical for the development of pathogenesis of the virus. People with diabetes are more likely to develop severe symptoms of COVID-19. The present article speculates that special aspects of the immune dysfunction caused by chronic hyperglycaemia is the main reason for this susceptibility.
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Affiliation(s)
- Charalampos Milionis
- General Maternity Hospital “Elena Venizelou”, Elena Venizelou square 2, 11523 Athens, Greece
| | - Stella Olga Milioni
- General Maternity Hospital “Elena Venizelou”, Elena Venizelou square 2, 11523 Athens, Greece
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Paoli A, Gorini S, Caprio M. The dark side of the spoon - glucose, ketones and COVID-19: a possible role for ketogenic diet? J Transl Med 2020; 18:441. [PMID: 33218357 PMCID: PMC7677746 DOI: 10.1186/s12967-020-02600-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease (COVID-19) is posing a serious challenge to the health-care systems worldwide, with an enormous impact on health conditions and loss of lives. Notably, obesity and its related comorbidities are strictly related with worse clinical outcomes of COVID-19 disease. Recently, there is a growing interest in the clinical use of ketogenic diets (KDs), particularly in the context of severe obesity with related metabolic complications. KDs have been proven effective for a rapid reduction of fat mass, preserving lean mass and providing an adequate nutritional status. In particular, the physiological increase in plasma levels of ketone bodies exerts important anti-inflammatory and immunomodulating effects, which may reveal as precious tools to prevent infection and potential adverse outcomes of COVID-19 disease. We discuss here the importance of KDs for a rapid reduction of several critical risk factors for COVID-19, such as obesity, type 2 diabetes and hypertension, based on the known effects of ketone bodies on inflammation, immunity, metabolic profile and cardiovascular function. We do believe that a rapid reduction of all modifiable risk factors, especially obesity with its metabolic complications, should be a pillar of public health policies and interventions, in view of future waves of SARS-CoV-2 infection.
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Affiliation(s)
- Antonio Paoli
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Stefania Gorini
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy. .,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166, Rome, Italy.
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Biscetti F, Rando MM, Nardella E, Cecchini AL, Bruno P, Landolfi R, Flex A. Cardiovascular Disease and SARS-CoV-2: the Role of Host Immune Response Versus Direct Viral Injury. Int J Mol Sci 2020; 21:ijms21218141. [PMID: 33143371 PMCID: PMC7663579 DOI: 10.3390/ijms21218141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
The 2019 novel coronavirus [2019-nCoV], which started to spread from December 2019 onwards, caused a global pandemic. Besides being responsible for the severe acute respiratory syndrome 2 [SARS-CoV-2], the virus can affect other organs causing various symptoms. A close relationship between SARS-CoV-2 and the cardiovascular system has been shown, demonstrating an epidemiological linkage between SARS-CoV-2 and cardiac injury. There are emerging data regarding possible direct myocardial damage by 2019-nCoV. In this review, the most important available evidences will be discussed to clarify the precise mechanisms of cardiovascular injury in SARS-CoV-2 patients, even if further researches are needed.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-06-3015-4518
| | - Maria Margherita Rando
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | - Elisabetta Nardella
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | | | - Piergiorgio Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Cardiac Surgery Unit, 00168 Roma, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Cardiac Surgery Unit, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, 00168 Roma, Italy
- Cardiac Surgery Unit, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Predictors of mortality in patients with COVID-19-a systematic review. Eur J Integr Med 2020; 40:101226. [PMID: 33101547 PMCID: PMC7568488 DOI: 10.1016/j.eujim.2020.101226] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
Introduction In the current COVID-19 pandemic, disease diagnosis is essential for optimal management and timely isolation of infected cases in order to prevent further spread. The aim of this study was to systematically review the assessment of risk and model the predictors of mortality in COVID-19 patients. Methods A systematic search was conducted of PubMed, Scopus, Embase, Google Scholar, and Web of Science databases. Variables associated with hospital mortality using bivariate analysis were included as potential independent predictors associated with mortality at the p < 0.05 levels. Results We included 114 studies accounting for 310,494 patients from various parts of the world. For the purpose of this analysis, we set a cutoff point of 10% for the mortality percentages. High mortality rates were defined as higher than 10% of confirmed positive cases and were given a score of two, while low mortality (<10%) was assigned the score of one. We then analyzed the associations between 72 variables and the observed mortality rates. These variables included a large range of related variables such as demographics, signs and symptoms and related morbidities, vital signs, laboratory findings, imaging studies, underlying diseases, and the status of countries' income, based on the United Nation's classifications. Conclusion Findings suggest that older age, hypertension, and diabetes mellitus conferred a significant increased risk of mortality among patients with COVID-19. In the multivariate analysis, only diabetes mellitus demonstrated an independent relationship with increased mortality. Further studies are needed to ascertain the relationship between possible risk factors with COVID-19 mortality.
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Pla B, Arranz A, Knott C, Sampedro M, Jiménez S, Hernando I, Marazuela M. Impact of COVID-19 Lockdown on Glycemic Control in Adults with Type 1 Diabetes Mellitus. J Endocr Soc 2020; 4:bvaa149. [PMID: 33173841 PMCID: PMC7641317 DOI: 10.1210/jendso/bvaa149] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023] Open
Abstract
Aim To examine the impact of the lockdown caused by the COVID-19 pandemic on both the glycemic control and the daily habits of a group of patients with type 1 diabetes mellitus (T1DM) using flash continuous glucose monitoring devices (flash CGMs). Methods Retrospective analysis based on all the information gathered in virtual consultations from a cohort of 50 adult patients with T1DM with follow-up at our site. We compared their CGM metrics during lockdown with their own previous data before the pandemic occurred, as well as the potential psychological and therapeutic changes. Results We observed a reduction of average glucose values: 160.26 ± 22.55 mg/dL vs 150 ± 20.96 mg/dL, P = .0009; estimated glycosylated hemoglobin: 7.21 ± 0.78% vs 6.83 ± 0.71%, P = .0005; glucose management indicator 7.15 ± 0.57% vs 6.88 ± 0.49%; P = .0003, and glycemic variability: 40.74 ± 6.66 vs 36.43 ± 6.09 P < .0001. Time in range showed an improvement: 57.46 ± 11.85% vs a 65.76 ± 12.09%, P < .0001, without an increase in percentage of time in hypoglycemia. Conclusions COVID-19 lockdown was associated with an improvement in glycemic control in patients with T1DM using CGMs.
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Affiliation(s)
- Begoña Pla
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alfonso Arranz
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carolina Knott
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miguel Sampedro
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sara Jiménez
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Iñigo Hernando
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Monica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Shivane VK, Lila AR, Bandgar TR. Type 2 diabetic Asian Indians and COVID-19: Lessons learnt so far from the ongoing pandemic. J Postgrad Med 2020; 66:179-181. [PMID: 33037170 PMCID: PMC7819390 DOI: 10.4103/jpgm.jpgm_602_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- V K Shivane
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - A R Lila
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - T R Bandgar
- Department of Endocrinology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Doupis J, Avramidis K. Managing Diabetes During the COVID-19 Pandemic. EUROPEAN ENDOCRINOLOGY 2020; 16:85-87. [PMID: 33117436 PMCID: PMC7572158 DOI: 10.17925/ee.2020.16.2.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected almost every country in the world and has changed the way we access healthcare. People with pre-existing conditions, such as diabetes, are at high risk of a severe disease course and it is essential that, as well as good hygiene and social distancing measures, blood glucose is carefully monitored, as chronic hyperglycaemia can lead to immune dysfunction. People with diabetes should be encouraged to continue medication prescribed for hypertension, diabetes or dyslipidaemia. Furthermore, patients with diabetes and COVID-19 infection should follow their usual antidiabetic treatment with the exception of sodium-glucose cotransporter-2 inhibitors. As the current pandemic situation has rendered some patients unable to access routine healthcare, telehealth may help those with travel restrictions.
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Affiliation(s)
- John Doupis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, Attiki, Greece
| | - Konstantinos Avramidis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, Attiki, Greece
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Polyzos SA, Mantzoros CS. Making progress in nonalcoholic fatty liver disease (NAFLD) as we are transitioning from the era of NAFLD to dys-metabolism associated fatty liver disease (DAFLD). Metabolism 2020; 111S:154318. [PMID: 32707055 PMCID: PMC7372254 DOI: 10.1016/j.metabol.2020.154318] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/14/2022]
Abstract
• This is a special issue of “Metabolism” dedicated to nonalcoholic fatty liver disease. • Experts in the field provide an overview of recent progress and developments in NAFLD and offer their expert opinion on future directions. • NAFLD remains a highly prevalent disease without an approved treatment.
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Affiliation(s)
- Stergios A Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Christos S Mantzoros
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA.
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Distinguishable Immunologic Characteristics of COVID-19 Patients with Comorbid Type 2 Diabetes Compared with Nondiabetic Individuals. Mediators Inflamm 2020; 2020:6914878. [PMID: 33061829 PMCID: PMC7542493 DOI: 10.1155/2020/6914878] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/09/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has threatened every civilian as a global pandemic. The immune system poses the critical interactive chain between the human body and the virus. Here, we make efforts to examine whether comorbidity with type 2 diabetes (T2D) affects the immunological response in COVID-19 patients. Methods We conducted a retrospective pilot study investigating immunological characteristics of confirmed cases of COVID-19 with or without comorbid T2D. Two subcohorts of sex- and age-matched participants were eligible for data analysis, of which 33 participants were with T2D and the remaining 37 were nondiabetic (NDM). Cellular immunity was assessed by flow cytometric determination of surface markers including CD3, CD4, CD8, CD19, CD16, and CD56 in peripheral blood. Levels of C reactive protein, immunoglobulin (IgG, IgM, IgA, and IgE), and complements (C3, C4) were detected by rate nephelometry immunoassay. And Th1/Th2 cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) were detected by Cytometric Bead Array. Results Neutrophil counts were found to be significantly higher in the T2D group than in the NDM group and had a significant relevance with clinical severity. Lymphocyte frequencies showed no significant differences in the two groups. However, the proportions and absolute counts of T, Tc, Th, and NK cells decreased in both groups to different degrees. An abnormal increase in neutrophil count and a decrease in lymphocyte subpopulations may represent risk factors of COVID-19 severity. The level of IgG, IgM, IgA, C3, and C4 showed no significant difference between the two groups, while the IgE levels were higher in the T2D group than in the NDM group (p < 0.05). Th1 cytokines including IFN-γ, TNF-α, and IL-6, as well as CRP, appeared significantly higher in the T2D group. Conclusions The COVID-19 patients comorbid with T2D demonstrated distinguishable immunological parameters, which represented clinical relevancies with the predisposed disease severity in T2D.
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COVID-19: Proposing a Ketone-Based Metabolic Therapy as a Treatment to Blunt the Cytokine Storm. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:6401341. [PMID: 33014275 PMCID: PMC7519203 DOI: 10.1155/2020/6401341] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
Human SARS-CoV-2 infection is characterized by a high mortality rate due to some patients developing a large innate immune response associated with a cytokine storm and acute respiratory distress syndrome (ARDS). This is characterized at the molecular level by decreased energy metabolism, altered redox state, oxidative damage, and cell death. Therapies that increase levels of (R)-beta-hydroxybutyrate (R-BHB), such as the ketogenic diet or consuming exogenous ketones, should restore altered energy metabolism and redox state. R-BHB activates anti-inflammatory GPR109A signaling and inhibits the NLRP3 inflammasome and histone deacetylases, while a ketogenic diet has been shown to protect mice from influenza virus infection through a protective γδ T cell response and by increasing electron transport chain gene expression to restore energy metabolism. During a virus-induced cytokine storm, metabolic flexibility is compromised due to increased levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS) that damage, downregulate, or inactivate many enzymes of central metabolism including the pyruvate dehydrogenase complex (PDC). This leads to an energy and redox crisis that decreases B and T cell proliferation and results in increased cytokine production and cell death. It is hypothesized that a moderately high-fat diet together with exogenous ketone supplementation at the first signs of respiratory distress will increase mitochondrial metabolism by bypassing the block at PDC. R-BHB-mediated restoration of nucleotide coenzyme ratios and redox state should decrease ROS and RNS to blunt the innate immune response and the associated cytokine storm, allowing the proliferation of cells responsible for adaptive immunity. Limitations of the proposed therapy include the following: it is unknown if human immune and lung cell functions are enhanced by ketosis, the risk of ketoacidosis must be assessed prior to initiating treatment, and permissive dietary fat and carbohydrate levels for exogenous ketones to boost immune function are not yet established. The third limitation could be addressed by studies with influenza-infected mice. A clinical study is warranted where COVID-19 patients consume a permissive diet combined with ketone ester to raise blood ketone levels to 1 to 2 mM with measured outcomes of symptom severity, length of infection, and case fatality rate.
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Soliman AT, Prabhakaran Nair A, Al Masalamani MS, De Sanctis V, Abu Khattab MA, Alsaud AE, Sasi S, Ali EA, Ola A H, Iqbal FM, Nashwan AJ, Fahad J, El Madhoun I, Yassin MA. Prevalence, clinical manifestations, and biochemical data of type 2 diabetes mellitus versus nondiabetic symptomatic patients with COVID-19: A comparative study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020010. [PMID: 32921708 PMCID: PMC7716959 DOI: 10.23750/abm.v91i3.10214] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is a scarcity of data regarding the effect of Type 2 diabetes mellitus (T2DM) and associated comorbidities on the clinical presentation and outcome of symptomatic patients with -COVID-19 infection in comparison with non-diabetic patients. AIM OF THE STUDY We described and compared the clinical presentation and radiological and hematological data of a cohort of symptomatic COVID19 positive T2DM diabetic patients (n = 59) versus another cohort of non-diabetic symptomatic COVID19 positive patients (n =244) diagnosed at the same time from January 2020 to May 2020. Associated comorbidities were -assessed, and the Charlson Comorbidity Index was calculated. The outcomes including duration of hospitalization, duration of Intensive Care Unit (ICU) stay, duration of mechanical ventilation, and duration of O2 -supplementation were assessed. RESULTS Prevalence of T2DM in symptomatic COVID19 positive patients was 59/303 (=19.5%). Diabetic patients had higher prevalence of hypertension, chronic kidney disease (CKD) and cardiac dysfunction [coronary heart disease (CHD)], and congestive heart failure (CHF). Charlson Comorbidity score was significantly higher in the T2DM patients (2.4± 1.6) versus the non-diabetic -patients (0.28 ± 0.8; p: < 0.001). Clinically and radiologically, T2DM patients had significantly higher percentage of pneumonia, severe pneumonia and ARDS versus the non-diabetic patients. Hematologically, diabetic patients had significantly higher C-reactive protein (CRP), higher absolute neutrophilic count (ANC) and lower counts of lymphocytes and eosinophils compared to non-diabetic patients. They had significantly higher systolic and diastolic blood pressures, longer duration of hospitalization, ICU stay, mechanical ventilation and oxygen therapy. CRP was correlated significantly with the duration of stay in the ICU and the duration for oxygen supplementation (r = 0.37 and 0.42 respectively; p: <0.01). CONCLUSIONS T2DM patients showed higher inflammatory response to COVID 19 with higher absolute neutrophilic count (ANC) and CRP with lower lymphocytic and eosinophilic counts. Diabetic patients had more comorbidities and more aggressive course of the disease with higher rate of ICU admission and longer need for hospitalization and oxygen use.
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Affiliation(s)
- Ashraf T Soliman
- Pediatric and Endocrinology, Hamad General Hospital, Doha, Qatar .
| | | | - Muna S Al Masalamani
- Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar.
| | | | | | - Arwa E Alsaud
- Department of Endocrinology and Diabetes, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Sreethish Sasi
- Internal Medicine Dept., Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Elrazi A Ali
- Internal Medicine Dept., Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Hassan Ola A
- Medical Resident, Family Medicine, Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Fatima M Iqbal
- Infectious Diseases, Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Abdulqadir J Nashwan
- Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Jesin Fahad
- Quality Management Data Analyst, Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar.
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46
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Chamorro-Pareja N, Parthasarathy S, Annam J, Hoffman J, Coyle C, Kishore P. Letter to the editor: Unexpected high mortality in COVID-19 and diabetic ketoacidosis. Metabolism 2020; 110:154301. [PMID: 32589899 PMCID: PMC7311346 DOI: 10.1016/j.metabol.2020.154301] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Natalia Chamorro-Pareja
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Sahana Parthasarathy
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Jayabhargav Annam
- Division of Infectious Diseases, Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Julie Hoffman
- Division of Infectious Diseases, Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Christine Coyle
- Division of Infectious Diseases, Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Preeti Kishore
- Division of Endocrinology, Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America.
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47
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Scheen AJ, Marre M, Thivolet C. Prognostic factors in patients with diabetes hospitalized for COVID-19: Findings from the CORONADO study and other recent reports. DIABETES & METABOLISM 2020; 46:265-271. [PMID: 32447101 PMCID: PMC7241378 DOI: 10.1016/j.diabet.2020.05.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus is challenging in the context of the COVID-19 pandemic. The prevalence of diabetes patients hospitalized in intensive care units for COVID-19 is two- to threefold higher, and the mortality rate at least double, than that of non-diabetes patients. As the population with diabetes is highly heterogeneous, it is of major interest to determine the risk factors of progression to a more serious life-threatening COVID-19 infection. This brief review discusses the main findings of CORONADO, a prospective observational study in France that specifically addressed this issue as well as related observations from other countries, mainly China and the US. Some prognostic factors beyond old age have been identified: for example, an increased body mass index is a major risk factor for requiring respiratory assistance. Indeed, obesity combines several risk factors, including impaired respiratory mechanics, the presence of other comorbidities and inappropriate inflammatory responses, partly due to ectopic fat deposits. While previous diabetic microvascular (renal) and macrovascular complications also increase risk of death, the quality of past glucose control had no independent influence on hospitalized diabetes patient outcomes, but whether the quality of glucose control might modulate risk of COVID-19 in non-hospitalized diabetes patients is still unknown. In addition, no negative signs regarding the use of RAAS blockers and DPP-4 inhibitors and outcomes of COVID-19 could be identified. Hyperglycaemia at the time of hospital admission is associated with poor outcomes, but it may simply be considered a marker of severity of the infection. Thus, the impact of glucose control during hospitalization on outcomes related to COVID-19, which was not investigated in the CORONADO study, is certainly deserving of specific investigation.
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Affiliation(s)
- A J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, Liège, Belgium.
| | - M Marre
- UMR_S 1138, Metabolic Inflammation in Diabetes and its Complications, Cordeliers Research Centre, 75006 PARIS, France; President of the FFRD and the Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - C Thivolet
- President of the SFD and DIAB-eCARE, Centre for Diabetes, Hospices Civils de Lyon, University of Lyon, Lyon, France
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48
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Dalamaga M, Karampela I, Mantzoros CS. Commentary: Phosphodiesterase 4 inhibitors as potential adjunct treatment targeting the cytokine storm in COVID-19. Metabolism 2020; 109:154282. [PMID: 32497535 PMCID: PMC7263254 DOI: 10.1016/j.metabol.2020.154282] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023]
Abstract
The most severe presentation of COVID-19 is characterized by a hyperinflammatory state attributed to the massive pro-inflammatory cytokine release, called "cytokine storm". Several specific anti-inflammatory/immunosuppressive agents are being evaluated by ongoing clinical trials; however, there is currently insufficient evidence for their efficacy and safety in COVID-19 treatment. Given the role of phosphodiesterase 4 (PDE) 4 and cyclic adenosine monophosphate in the inflammatory response, we hypothesize that selective PDE4 inhibition may attenuate the cytokine storm in COVID-19, through the upstream inhibition of pro-inflammatory molecules, particularly TNF-α, and the regulation of the pro-inflammatory/anti-inflammatory balance. Conversely, other anti-cytokine agents lead to the downstream inhibition of specific targets, such as IL-1, IL-6 or TNF-α, and may not be efficient in blocking the cytokine storm, once it has been triggered. Due to their mechanism of action targeting an early stage of the inflammatory response and ameliorating lung inflammation, we believe that selective PDE4 inhibitors may represent a promising treatment option for the early phase of COVID-19 pneumonia before the cytokine storm and severe multiorgan dysfunction take place. Furthermore, PDE4 inhibitors present several advantages including an excellent safety profile; the oral route of administration; the convenient dosing; and beneficial metabolic properties. Interestingly, obesity and diabetes mellitus type 2 have been reported to be risk factors for the severity of COVID-19. Therefore, randomized clinical trials of PDE4 inhibitors are necessary to explore their potential therapeutic effect as an adjunct to supportive measures and other therapeutic regiments.
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Affiliation(s)
- Maria Dalamaga
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece.
| | - Irene Karampela
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece; Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Chaidari, Greece
| | - Christos S Mantzoros
- Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
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49
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Giorgi M, Cardarelli S, Ragusa F, Saliola M, Biagioni S, Poiana G, Naro F, Massimi M. Phosphodiesterase Inhibitors: Could They Be Beneficial for the Treatment of COVID-19? Int J Mol Sci 2020; 21:ijms21155338. [PMID: 32727145 PMCID: PMC7432892 DOI: 10.3390/ijms21155338] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
In March 2020, the World Health Organization declared the severe acute respiratory syndrome corona virus 2 (SARS-CoV2) infection to be a pandemic disease. SARS-CoV2 was first identified in China and, despite the restrictive measures adopted, the epidemic has spread globally, becoming a pandemic in a very short time. Though there is growing knowledge of the SARS-CoV2 infection and its clinical manifestations, an effective cure to limit its acute symptoms and its severe complications has not yet been found. Given the worldwide health and economic emergency issues accompanying this pandemic, there is an absolute urgency to identify effective treatments and reduce the post infection outcomes. In this context, phosphodiesterases (PDEs), evolutionarily conserved cyclic nucleotide (cAMP/cGMP) hydrolyzing enzymes, could emerge as new potential targets. Given their extended distribution and modulating role in nearly all organs and cellular environments, a large number of drugs (PDE inhibitors) have been developed to control the specific functions of each PDE family. These PDE inhibitors have already been used in the treatment of pathologies that show clinical signs and symptoms completely or partially overlapping with post-COVID-19 conditions (e.g., thrombosis, inflammation, fibrosis), while new PDE-selective or pan-selective inhibitors are currently under study. This review discusses the state of the art of the different pathologies currently treated with phosphodiesterase inhibitors, highlighting the numerous similarities with the disorders linked to SARS-CoV2 infection, to support the hypothesis that PDE inhibitors, alone or in combination with other drugs, could be beneficial for the treatment of COVID-19.
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Affiliation(s)
- Mauro Giorgi
- Department of Biology and Biotechnology “Charles Darwin”, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (S.B.); (G.P.)
- Correspondence: (M.G.); (M.M.)
| | - Silvia Cardarelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University, 00185 Rome, Italy; (S.C.); (F.N.)
| | - Federica Ragusa
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Michele Saliola
- Department of Biology and Biotechnology “Charles Darwin”, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (S.B.); (G.P.)
| | - Stefano Biagioni
- Department of Biology and Biotechnology “Charles Darwin”, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (S.B.); (G.P.)
| | - Giancarlo Poiana
- Department of Biology and Biotechnology “Charles Darwin”, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (S.B.); (G.P.)
| | - Fabio Naro
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University, 00185 Rome, Italy; (S.C.); (F.N.)
| | - Mara Massimi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Correspondence: (M.G.); (M.M.)
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50
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Koliaki C, Tentolouris A, Eleftheriadou I, Melidonis A, Dimitriadis G, Tentolouris N. Clinical Management of Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities and Concerns. J Clin Med 2020; 9:E2288. [PMID: 32708504 PMCID: PMC7408673 DOI: 10.3390/jcm9072288] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
The management of patients with diabetes mellitus (DM) in the era of the COVID-19 pandemic can be challenging. Even if they are not infected, they are at risk of dysregulated glycemic control due to the restrictive measures which compromise and disrupt healthcare delivery. In the case of infection, people with DM have an increased risk of developing severe complications. The major principles of optimal care for mild outpatient cases include a patient-tailored therapeutic approach, regular glucose monitoring and adherence to medical recommendations regarding lifestyle measures and drug treatment. For critically ill hospitalized patients, tight monitoring of glucose, fluids, electrolytes, pH and blood ketones is of paramount importance to optimize outcomes. All patients with DM do not have an equally increased risk for severity and mortality due to COVID-19. Certain clinical and biological characteristics determine high-risk phenotypes within the DM population and such prognostic markers need to be characterized in future studies. Further research is needed to examine which subgroups of DM patients are expected to benefit the most from specific antiviral, immunomodulatory and other treatment strategies in the context of patient-tailored precision medicine, which emerges as an urgent priority in the era of COVID-19.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Andreas Melidonis
- Hellenic Diabetes Association, 11528 Athens, Greece
- Cardiometabolic Department, Metropolitan Hospital, 18547 Neo Faliro, Greece
| | - George Dimitriadis
- Hellenic Diabetes Association, 11528 Athens, Greece
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Chaidari, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
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