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Jeremiah SS, Moin ASM, Butler AE. Virus-induced diabetes mellitus: revisiting infection etiology in light of SARS-CoV-2. Metabolism 2024; 156:155917. [PMID: 38642828 DOI: 10.1016/j.metabol.2024.155917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
Diabetes mellitus (DM) is comprised of two predominant subtypes: type 1 diabetes mellitus (T1DM), accounting for approximately 5 % of cases worldwide and resulting from autoimmune destruction of insulin-producing β-cells, and type 2 (T2DM), accounting for approximately 95 % of cases globally and characterized by the inability of pancreatic β-cells to meet the demand for insulin due to a relative β-cell deficit in the setting of peripheral insulin resistance. Both types of DM involve derangement of glucose metabolism and are metabolic diseases generally considered to be initiated by a combination of genetic and environmental factors. Viruses have been reported to play a role as infectious etiological factors in the initiation of both types of DM in predisposed individuals. Among the reported viral infections causing DM in humans, the most studied include coxsackie B virus, cytomegalovirus and hepatitis C virus. The recent COVID-19 pandemic has highlighted the diabetogenic potential of SARS-CoV-2, rekindling interest in the field of virus-induced diabetes (VID). This review discusses the reported mechanisms of viral-induced DM, addressing emerging concepts in VID, as well as highlighting areas where knowledge is lacking, and further investigation is warranted.
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Affiliation(s)
| | - Abu Saleh Md Moin
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, Kingdom of Bahrain.
| | - Alexandra E Butler
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, Kingdom of Bahrain.
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2
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Singh R, Gholipourmalekabadi M, Shafikhani SH. Animal models for type 1 and type 2 diabetes: advantages and limitations. Front Endocrinol (Lausanne) 2024; 15:1359685. [PMID: 38444587 PMCID: PMC10912558 DOI: 10.3389/fendo.2024.1359685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Diabetes mellitus, commonly referred to as diabetes, is a group of metabolic disorders characterized by chronic elevation in blood glucose levels, resulting from inadequate insulin production, defective cellular response to extracellular insulin, and/or impaired glucose metabolism. The two main types that account for most diabetics are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), each with their own pathophysiological features. T1D is an autoimmune condition where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. This leads to lack of insulin, a vital hormone for regulating blood sugar levels and cellular glucose uptake. As a result, those with T1D depend on lifelong insulin therapy to control their blood glucose level. In contrast, T2DM is characterized by insulin resistance, where the body's cells do not respond effectively to insulin, coupled with a relative insulin deficiency. This form of diabetes is often associated with obesity, sedentary lifestyle, and/or genetic factors, and it is managed with lifestyle changes and oral medications. Animal models play a crucial role in diabetes research. However, given the distinct differences between T1DM and T2DM, it is imperative for researchers to employ specific animal models tailored to each condition for a better understanding of the impaired mechanisms underlying each condition, and for assessing the efficacy of new therapeutics. In this review, we discuss the distinct animal models used in type 1 and type 2 diabetes mellitus research and discuss their strengths and limitations.
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Affiliation(s)
- Raj Singh
- Department of Medicine, Division of Hematology, Oncology, & Cell Therapy, Rush University Medical Center, Chicago, IL, United States
| | - Mazaher Gholipourmalekabadi
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sasha H Shafikhani
- Department of Medicine, Division of Hematology, Oncology, & Cell Therapy, Rush University Medical Center, Chicago, IL, United States
- Cancer Center, Rush University Medical Center, Chicago, IL, United States
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3
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Loosen SH, Kostev K, Luedde T, Roderburg C. Infectious mononucleosis is associated with an increased incidence of NAFLD. Eur J Clin Invest 2023; 53:e13911. [PMID: 36409277 DOI: 10.1111/eci.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has become the leading cause of liver cirrhosis and hepatocellular carcinoma worldwide. Although various genetic and lifestyle-related risk factors have been identified, its pathophysiology has not yet been fully unravelled. While acute EBV infection in the setting of infectious mononucleosis can lead to acute hepatitis, the long-term hepatic sequelae of infectious mononucleosis are still poorly understood. METHODS This retrospective cohort study included 13,859 patients with and 13,859 matched individuals without infectious mononucleosis from the Disease Analyzer database (IQVIA). Multivariable Cox regression analyses were used to evaluate the association between infectious mononucleosis and NAFLD. RESULTS Within 10 years of the index date, 2.64% of patients with infectious mononucleosis and 1.78% of individuals without infectious mononucleosis had been diagnosed with NAFLD (p < .001). The incidence of NAFLD was 263.9 cases per 100,000 person-years among individuals with infectious mononucleosis and 164.5 cases per 100,000 person-years among those without. Multivariable regression analyses indicated that infectious mononucleosis was significantly associated with the incidence of NAFLD (HR: 1.73) both among women (HR: 1.73) and among men (HR: 1.70). In age-stratified analyses, the association between infectious mononucleosis and NAFLD was most pronounced for the groups aged between 41 and 50 years (HR: 2.94) and >50 years (HR: 2.68). CONCLUSION Infectious mononucleosis is significantly associated with the incidence of NAFLD in a large cohort from Germany. These findings suggest a pathophysiological involvement of EBV in the development of NAFLD and could stimulate research efforts to better understand the pathophysiology of this emerging global medical burden.
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Affiliation(s)
- Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Prosperi S, Chiarelli F. COVID-19 and diabetes in children. Ann Pediatr Endocrinol Metab 2022; 27:157-168. [PMID: 36203266 PMCID: PMC9537670 DOI: 10.6065/apem.2244150.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/22/2022] [Indexed: 01/08/2023] Open
Abstract
This review describes the impact of coronavirus disease 2019 (COVID-19) in children and adolescents, investigating changes in diabetes presentation during the COVID-19 pandemic, possible links between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and diabetes, and mechanisms of pancreatic β-cell destruction. Although glycemic control in individuals with already known diabetes mellitus did not worsen during the pandemic, there was a worrying increase in diabetic ketoacidosis in children with new-onset diabetes, probably due to containment measures and delayed access to emergency departments. Moreover, new evidence suggests that SARS-CoV-2 has the capacity to directly and indirectly induce pancreatic β-cell destruction, and the risk of newly diagnosed diabetes after COVID-19 increased in both children and adults. While long-term studies continue to follow children with SARS-CoV-2 infection, this review discusses available findings on the relationship between COVID-19 and diabetes. It is important to emphasize the need to maintain close links between families of children with chronic conditions and their pediatricians, as well as to promote early access to healthcare services, in order to reduce dangerous delays in diabetes diagnosis and prevent diabetic ketoacidosis.
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Affiliation(s)
| | - Francesco Chiarelli
- Address for correspondence: Francesco Chiarelli Department of Pediatrics, University of Chieti, Via dei Vestini, 5, I-66100 Chieti, Italy
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B DJ. Historical aspects and current understanding of the connections and implications of viruses and diabetes: A narrative review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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New-onset COVID-19-related diabetes: an early indicator of multi-organ injury and mortally of SARS-CoV-2 infection. CURRENT MEDICINE (CHAM, SWITZERLAND) 2022; 1:6. [PMID: 35673632 PMCID: PMC9132601 DOI: 10.1007/s44194-022-00006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/22/2022] [Indexed: 01/10/2023]
Abstract
Objective The pandemic of 2019 coronavirus (SARS-CoV-2) disease (COVID-19) has imposed a severe public health burden worldwide. Most patients with COVID-19 were mild. Severe patients progressed rapidly to critical condition including acute respiratory distress syndrome (ARDS), multi-organ failure and even death. This study aims to find early multi-organ injury indicators and blood glucose for predicting mortality of COVID-19. Methods Fasting blood glucose (FBG) ≥7.0 mmol/L for two times during hospitalization and without a history of diabetes were defined as new-onset COVID-19-related diabetes (CRD). Indicators of injuries for multiple organs, including the lung, heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting death. Results A total of 120 patients with a severity equal to or greater than Moderate were hospitalized. After excluding patients with history of diabetes, chronic heart, kidney, and liver disease, 69 patients were included in the final analysis. Of the 69 patients, 23 were Moderate, 20 were Severe, and 26 were Critical (including 16 deceased patients). Univariable analysis indicated that CRD, lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with death. Multivariable analysis indicated that CRD was an independent predictor for death (HR = 3.75, 95% CI 1.26–11.15). Abnormal glucose homeostasis or CRD occurred earlier than other indicators for predicting poor outcomes. Indicators of multiple organ injury were in parallel with the expression patterns of ACE2 (the SARS-CoV-2 receptor) in different organs including pancreatic islet. Conclusions New-onset COVID-19-related diabetes is an early indicator of multi-organ injury and predictor for poor outcomes and death in COVID-19 patients. As it is easy to perform for clinical practices and self-monitoring, glucose testing will be helpful for predicting poor outcomes to facilitate appropriate intensive care.
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Kayhan S, Hepsen S, Kalkisim HK, Sendur IN, Altay FA, Yalcindag A. The evaluation of pancreas β-cell autoantibodies in non-diabetic COVID-19 patients. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:459-465. [PMID: 35657130 PMCID: PMC10697637 DOI: 10.20945/2359-3997000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
Objective This study aims to evaluate potential pancreas endocrine damage due to SARS-CoV-2 by measuring β-cell autoantibodies in COVID-19 patients. Subjects and methods Between June and July 2020, 95 inpatients with a positive COVID-19 test result after polymerase-chain-reaction (PCR) and who met the inclusion criteria were enrolled in our study. Laboratory parameters that belong to glucose metabolism and β-cell autoantibodies, including anti-islet, anti-glutamic acid decarboxylase, and anti-insulin autoantibodies, were measured. β-cell autoantibodies levels of the patients were measured during COVID-19 diagnosis. Positive results were reevaluated in the 3rd month of control. Results In the initial evaluation, 4 (4.2%) patients were positive for anti-islet autoantibody. Only one (1.1%) patient was positive for anti-glutamic acid decarboxylase autoantibody. No patient had positive results for anti-insulin autoantibody. FPG, HbA1c, and C-peptide levels were similar in patients who were split into groups regarding the initial positive or negative status of anti-islet and anti-GAD autoantibodies (p>0.05). In the 3rd month after the initial measurements, anti-islet autoantibody positivity of 2 (50%) of 4 patients and anti-glutamic acid decarboxylase positivity of 1 (100%) patient were persistent. Finally, 3 (3.1%) patients in the whole group were positive for anti-islet autoantibody in the 3rd month of control. No difference was determined between the initial and the 3rd month of parameters of glucose metabolism. Conclusion Following an ongoing autoantibody positivity in the present study brings the mind that SARS-CoV-2 may be responsible for the diabetogenic effect. Clinicians should be aware of autoantibody-positive DM as a potential autoimmune complication in patients with SARS-CoV-2.
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Affiliation(s)
- Sanem Kayhan
- Department of Internal Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey,
| | - Sema Hepsen
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hatice Kozan Kalkisim
- Department of Internal Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Nahit Sendur
- Department of Internal Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Fatma Aybala Altay
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ali Yalcindag
- Department of Clinical Biochemistry, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Ali Kazem T, Zeylabi F, Filayih Hassan A, Paridar P, Pezeshki SP, Pezeshki SMS. Diabetes mellitus and COVID-19: review of a lethal interaction from the cellular and molecular level to the bedside. Expert Rev Endocrinol Metab 2022; 17:1-19. [PMID: 34781797 DOI: 10.1080/17446651.2022.2002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION While the main mode of transmission of coronavirus disease 2019 (COVID-19) is close contact with other individuals, the presence of chronic underlying diseases such as Diabetes Mellitus (DM) increases the chance of hospitalization and mortality rate due to infection. AREAS COVERED To investigate the effects of COVID-19 infection in DM patients, we reviewed literature from Google Scholar search engine and PubMed database from '2013 to 2020' using the terms "COVID-19; SARS-CoV-2; Diabetes mellitus; obesity; Angiotensin-converting enzyme 2; ACE2; Insulin and Metformin. Evidence suggests that COVID-19 exacerbates the course of diabetes. Presence of pro-inflammatory conditions, increased expression of receptors, and more difficult control of glucose levels in diabetics COVID-19 patients are some of the problems that diabetic patients may face. Also, psychological problems caused by the COVID-19 epidemic in diabetic patients is one of the most important problems in these patients, which is less covered. EXPERT OPINION DM is a strong and independent risk factor with a poor prognosis, which increases the risk of COVID-19 infection, the need for emergency services, the rate of hospitalization in the intensive care unit and also increases the mortality rate of COVID-19 patients.
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Affiliation(s)
| | - Fatemeh Zeylabi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Pouria Paridar
- Islamic Azad University, North-Tehran Branch, Tehran, Iran
| | - Seyedeh Pardis Pezeshki
- Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohammad Sadegh Pezeshki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Xie L, Zhang Z, Wang Q, Chen Y, Lu D, Wu W. COVID-19 and Diabetes: A Comprehensive Review of Angiotensin Converting Enzyme 2, Mutual Effects and Pharmacotherapy. Front Endocrinol (Lausanne) 2021; 12:772865. [PMID: 34867819 PMCID: PMC8639866 DOI: 10.3389/fendo.2021.772865] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
The potential relationship between diabetes and COVID-19 has been evaluated. However, new knowledge is rapidly emerging. In this study, we systematically reviewed the relationship between viral cell surface receptors (ACE2, AXL, CD147, DC-SIGN, L-SIGN and DPP4) and SARS-CoV-2 infection risk, and emphasized the implications of ACE2 on SARS-CoV-2 infection and COVID-19 pathogenesis. Besides, we updated on the two-way interactions between diabetes and COVID-19, as well as the treatment options for COVID-19 comorbid patients from the perspective of ACE2. The efficacies of various clinical chemotherapeutic options, including anti-diabetic drugs, renin-angiotensin-aldosterone system inhibitors, lipid-lowering drugs, anticoagulants, and glucocorticoids for COVID-19 positive diabetic patients were discussed. Moreover, we reviewed the significance of two different forms of ACE2 (mACE2 and sACE2) and gender on COVID-19 susceptibility and severity. This review summarizes COVID-19 pathophysiology and the best strategies for clinical management of diabetes patients with COVID-19.
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Affiliation(s)
| | | | | | | | | | - Weihua Wu
- Department of Endocrinology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China
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Maleki E, Baniasad A, Sepehran M, Davoudian N. The first presentation of Wolcott-Rallison syndrome in a four-month-old infant with diabetic ketoacidosis (DKA) precipitating by COVID-19: A case report. Clin Case Rep 2021; 9:e05096. [PMID: 34824850 PMCID: PMC8603413 DOI: 10.1002/ccr3.5096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Monogenic diabetes mellitus (eg, Wolcott-Rallison syndrome) is a rare condition. It associates with neonatal or early-infancy insulin-dependent diabetes. We reported DKA in the four-month infant as the first presentation of monogenic diabetes that has accelerated by COVID-19 infection. Therefore, considering the concurrency of COVID-19 and DKA is crucial.
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Affiliation(s)
- Elham Maleki
- Endocrinology and Metabolism Research CenterInstitute of Basic and Clinical Physiology ScienceKerman University of Medical SciencesKermanIran
| | - Amir Baniasad
- Endocrinology and Metabolism Research CenterInstitute of Basic and Clinical Physiology ScienceKerman University of Medical SciencesKermanIran
| | - Mina Sepehran
- Endocrinology and Metabolism Research CenterInstitute of Basic and Clinical Physiology ScienceKerman University of Medical SciencesKermanIran
| | - Najmeh Davoudian
- Infectious Diseases Research CentreGonabad University of Medical SciencesGonabadIran
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Zipris D. Visceral Adipose Tissue: A New Target Organ in Virus-Induced Type 1 Diabetes. Front Immunol 2021; 12:702506. [PMID: 34421908 PMCID: PMC8371384 DOI: 10.3389/fimmu.2021.702506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Type 1 diabetes (T1D) is a proinflammatory pathology that leads to the specific destruction of insulin producing β-cells and hyperglycaemia. Much of the knowledge about type 1 diabetes (T1D) has focused on mechanisms of disease progression such as adaptive immune cells and the cytokines that control their function, whereas mechanisms linked with the initiation of the disease remain unknown. It has been hypothesized that in addition to genetics, environmental factors play a pivotal role in triggering β-cell autoimmunity. The BioBreeding Diabetes Resistant (BBDR) and LEW1.WR1 rats have been used to decipher the mechanisms that lead to virus-induced T1D. Both animals develop β-cell inflammation and hyperglycemia upon infection with the parvovirus Kilham Rat Virus (KRV). Our earlier in vitro and in vivo studies indicated that KRV-induced innate immune upregulation early in the disease course plays a causal role in triggering β-cell inflammation and destruction. Furthermore, we recently found for the first time that infection with KRV induces inflammation in visceral adipose tissue (VAT) detectable as early as day 1 post-infection prior to insulitis and hyperglycemia. The proinflammatory response in VAT is associated with macrophage recruitment, proinflammatory cytokine and chemokine upregulation, endoplasmic reticulum (ER) and oxidative stress responses, apoptosis, and downregulation of adipokines and molecules that mediate insulin signaling. Downregulation of inflammation suppresses VAT inflammation and T1D development. These observations are strikingly reminiscent of data from obesity and type 2 diabetes (T2D) in which VAT inflammation is believed to play a causal role in disease mechanisms. We propose that VAT inflammation and dysfunction may be linked with the mechanism of T1D progression.
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Affiliation(s)
- Danny Zipris
- Innate Biotechnologies LLC, Denver, CO, United States
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12
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Phillips J, Chen JHC, Ooi E, Prunster J, Lim WH. Global Epidemiology, Health Outcomes, and Treatment Options for Patients With Type 2 Diabetes and Kidney Failure. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:731574. [PMID: 36994340 PMCID: PMC10012134 DOI: 10.3389/fcdhc.2021.731574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/29/2021] [Indexed: 12/15/2022]
Abstract
The burden of type 2 diabetes and related complications has steadily increased over the last few decades and is one of the foremost global public health threats in the 21st century. Diabetes is one of the leading causes of chronic kidney disease and kidney failure and is an important contributor to the cardiovascular morbidity and mortality in this population. In addition, up to one in three patients who have received kidney transplants develop post-transplant diabetes, but the management of this common complication continues to pose a significant challenge for clinicians. In this review, we will describe the global prevalence and temporal trend of kidney failure attributed to diabetes mellitus in both developing and developed countries. We will examine the survival differences between treated kidney failure patients with and without type 2 diabetes, focusing on the survival differences in those on maintenance dialysis or have received kidney transplants. With the increased availability of novel hypoglycemic agents, we will address the potential impacts of these novel agents in patients with diabetes and kidney failure and in those who have developed post-transplant diabetes.
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Affiliation(s)
- Jessica Phillips
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- *Correspondence: Jessica Phillips,
| | - Jenny H. C. Chen
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Depatment of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Esther Ooi
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Janelle Prunster
- Department of Renal Medicine, Cairns Hospital, Cairns, QLD, Australia
| | - Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
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Zhang Y, Zhang Y, Xu Y, Huang Y. The associations between fasting blood glucose levels and mortality of SFTS in patients. BMC Infect Dis 2021; 21:761. [PMID: 34353296 PMCID: PMC8343909 DOI: 10.1186/s12879-021-06463-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To identify the correlation between the level of at-admission fasting blood glucose (FBG) with poor outcomes in hospitalized patients suffering from severe fever with thrombocytopenia syndrome (SFTS). Methods Between April 1 and December 1, 2020, the list of hospitalized patients affected with SFTS infection was provided by the Infectious Disease Department at First Affiliated Hospital of Anhui Medical University, followed by the collection of information I.e., gender, age, diabetic history and the level of FBG on admission. Results In this study, a total of 77 patients were included and were categorized into three groups (< 5.6, 5.6–6.9, and ≥ 7.0 mmol/l) on the basis of their glucose level in the blood. The obtained results revealed that among three groups considerable variations were observed in leukocytes, FBG, D-Dimer, aspartate aminotransferase (AST), tumor necrosis factor-α (TNF-α), fibrin degradation products (FDP), and interleukin (IL)-10 level. Correlation analysis indicated a linear negative correlation between PLT and FBG (r = − 0.28, P = 0.01), however, a linear positive correlation was observed between AST, IL10, D-Dimer, and FDP levels and FBG (P-value < 0.05). Multivariate statistical analysis results shown that there was significant difference between group comparison (F = 17.01, P < 0.001) and interaction between group and time (F = 8.48, P < 0.05); but there was no significant difference between time point comparison (F = 0.04, P = 0.96). With the prolongation of time, the changes of FBG were different between survivor group and non-survivor group. The FBG in survival group shown a downward trend; The non-survivor group shown an upward trend. Conclusions Elevated level of FBG has been correlated with hypercoagulability, inflammation, and lower PLT in SFTS patients. The measurement of FBG level can help in evaluating the inflammatory process, hypercoagulability, and prognosis of patients suffering from SFTS. FBG can predict the prognosis of SFTS. It is necessary to pay attention to the role of FBG in the process of treatment in patients with SFTS.
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Affiliation(s)
- Yin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Rd, Hefei, Anhui Province, China
| | - Yu Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Rd, Hefei, Anhui Province, China
| | - Yuanhong Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Rd, Hefei, Anhui Province, China
| | - Ying Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Rd, Hefei, Anhui Province, China.
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Zafar M, Shahbaz M, Karkhanis M, Abdelbagi M, Makanjuola OA, Pun B, Randhawa RS, Cuison F, Safarova D, Ojofeitimi O, Lawrence K, Farooq M, Eldebri R, Alam S, Barry L, Khanna A, Subba K, Elyasaky A, Nooredinvand HA, Periasamy M, Adekunle BA, Maryam Z, Khuu B, Hegner J, Esteves Morete A, Patel M, Ciroi G, Rehman UU, Hsiao J, Zafar MJ, Zafar N, Lazau BA, Rizvi NUS, Moran S, O'Neill WA, Clarke V, Berliti S, Nakos A, Muhammad T, Kankam O, Whitehead M, Giddings EM, Merritt S, Dashora U. A Retrospective Observational Study: Is Absolute Lymphocyte Count a Prognostic Marker in COVID-19? Cureus 2021; 13:e16554. [PMID: 34327110 PMCID: PMC8301268 DOI: 10.7759/cureus.16554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 01/08/2023] Open
Abstract
Aim Our study aimed to find a correlation between low absolute lymphocyte count and COVID-19-related mortality. Methods This study followed a retrospective observational cohort design to analyze the data of patients who presented with symptoms and signs of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at the Conquest Hospital and Eastbourne District General Hospital in East Sussex, United Kingdom, between February 10, 2020 and May 1, 2020, retrospectively. Survival and mortality for the first 30 days and comorbidities were analyzed for all patients who were tested for COVID-19 irrespective of swab results and had blood lymphocyte levels taken at the time of their visit to the ED and their data were analyzed for statistical significance. Results A total of 1226 patients had SARS-CoV-2 RNA identification swabs taken between February 10, 2020 and May 1, 2020. A cohort of 742 patients of these patients tested for COVID-19 also had blood lymphocyte levels measured. Overall, the lymphocyte count did not differ significantly between patients suspected to have COVID-19 infection with either positive or negative COVID-19 swab results. The lymphocyte count, however, was significantly lower in those who died from COVID-19 (p < 0.001) but when comorbidities were analyzed, we found an association between an increased number of comorbidities and a significantly decreased lymphocyte count. Conclusion Once adjusted for comorbidities, the lymphocyte count had no association with COVID-19 infection and mortality.
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Affiliation(s)
- Mansoor Zafar
- Gastroenterology and General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Muhammad Shahbaz
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Mangala Karkhanis
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Mohamed Abdelbagi
- Emergency Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Opeyemi A Makanjuola
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Bipin Pun
- Cardiology, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Ratan S Randhawa
- Family and Community Medicine, The London and South East Postgraduate Medical and Dental Education, London, GBR
| | - Frederic Cuison
- Gastroenterology, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Dana Safarova
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Oluwamayowa Ojofeitimi
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Kamal Lawrence
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Mariya Farooq
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Reem Eldebri
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Saba Alam
- Family Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Lucinda Barry
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Alisha Khanna
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Karuna Subba
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Amr Elyasaky
- Geriatrics, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Hesam A Nooredinvand
- Gastroenterology and Hepatology, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Manivannan Periasamy
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Bolurin A Adekunle
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Zahra Maryam
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Bao Khuu
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Johannes Hegner
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Andreia Esteves Morete
- Family Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Mirej Patel
- Medicine, University of Debrecen, Debrecen, HUN
| | - Gjulio Ciroi
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Ubaid Ur Rehman
- Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR
| | - Jabeen Hsiao
- Department of Nuclear Medicine, Sunnybrook Health Sciences Centre, Toronto, CAN
| | | | | | - Bianca A Lazau
- Nursing, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Najam-Us-Saher Rizvi
- Dermatology, Aga Khan Health Services, Aga Khan Development Network, Karachi, PAK
| | - Steve Moran
- Microbiology, Eastbourne District General Hospital, Eastbourne, GBR
| | | | - Viktoriya Clarke
- Acute Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Stefano Berliti
- Acute Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Athanasios Nakos
- Respiratory Medicine/Acute Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Tila Muhammad
- Gastroenterology and Hepatology, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Osei Kankam
- Respiratory Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Mark Whitehead
- Gastroenterology, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Ellie M Giddings
- Respiratory Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Simon Merritt
- Respiratory Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Umesh Dashora
- General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
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15
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New-Onset Diabetes with Ketoacidosis Precipitated by COVID-19 in Children: A Report of Two Cases. Case Rep Pediatr 2021; 2021:5545258. [PMID: 34327034 PMCID: PMC8302395 DOI: 10.1155/2021/5545258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims There is growing evidence that the 2019 coronavirus disease (COVID-19) is emerging as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism. Here, we report two rare cases of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. These cases are reported in view of their rarity and originality. The relationship between type 1 diabetes mellitus and COVID-19 is discussed. Results Two children developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and asbestos. There is a documented COVID-19 infection in the parents of the 2 children. An asymptomatic infection was detected in the 2 patients on the basis of a reverse transcription polymerase chain reaction (RT-PCR) test. Thoracic imaging and inflammatory workup were negative in both cases. Both patients responded well to treatment, including rehydration regimens and intravenous insulin. On the 2nd day of their hospitalization, they were transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. After about 4 weeks, their insulin requirements probably decreased due to the diabetes honeymoon. Conclusion COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.
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16
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Magdy Beshbishy A, Oti VB, Hussein DE, Rehan IF, Adeyemi OS, Rivero-Perez N, Zaragoza-Bastida A, Shah MA, Abouelezz K, Hetta HF, Cruz-Martins N, Batiha GES. Factors Behind the Higher COVID-19 Risk in Diabetes: A Critical Review. Front Public Health 2021; 9:591982. [PMID: 34307267 PMCID: PMC8292635 DOI: 10.3389/fpubh.2021.591982] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19) are public health issues worldwide, and their comorbidities trigger the progress to severe disease and even death in such patients. Globally, DM has affected an estimated 9.3% adults, and as of April 18, 2021, the World Health Organization (WHO) has confirmed 141,727,940 COVID-19 confirmed cases. The virus is spread via droplets, aerosols, and direct touch with others. Numerous predictive factors have been linked to COVID-19 severity, including impaired immune response and increased inflammatory response, among others. Angiotensin receptor blockers and angiotensin converting enzyme 2 have also been identified as playing a boosting role in both susceptibility and severity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Specifically, in DM patients, both their control and management during this pandemic is herculean as the restriction periods have markedly hampered the maintenance of means to control glycemia, hypertension, and neuroendocrine and kidney diseases. In addition, as a result of the underlyin cardio-metabolic and immunological disorders, DM patients are at a higher risk of developing the severe form of COVID-19 despite other comorbidities, such as hypertension, also potentially boosting the development of higher COVID-19 severity. However, even in non-DM patients, SARS-CoV-2 may also cause transient hyperglycemia through induction of insulin resistance and/or pancreatic β-cell injury. Therefore, a strict glucose monitoring of DM patients with COVID-19 is mandatory to prevent life-threatening complications.
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Affiliation(s)
- Amany Magdy Beshbishy
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Victor B. Oti
- Department of Microbiology, Nasarawa State University, Keffi, Nigeria
| | - Diaa E. Hussein
- Researcher, Department of Food Hygiene, Agricultural Research Center, Animal Health Research Institute, Port of Alexandria, Egypt
| | - Ibrahim F. Rehan
- Department of Husbandry and Development of Animal Wealth, Faculty of Veterinary Medicine, Menofa University, Shebin Alkom, Egypt
| | - Oluyomi S. Adeyemi
- Medicinal Biochemistry, Infectious Diseases, Nanomedicine & Toxicology Laboratory, Department of Biochemistry, Landmark University, Omu-Aran, Nigeria
| | - Nallely Rivero-Perez
- Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuaria, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Mexico
| | - Adrian Zaragoza-Bastida
- Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuaria, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Mexico
| | - Muhammad Ajmal Shah
- Department of Pharmacognosy, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Khaled Abouelezz
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Helal F. Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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17
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Pandiar D, Kumar NS, Anand R, Kamboj M, Narwal A, Shameena PM. Does COVID 19 generate a milieu for propagation of mucormycosis? Med Hypotheses 2021; 152:110613. [PMID: 34087613 PMCID: PMC8152198 DOI: 10.1016/j.mehy.2021.110613] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023]
Abstract
Corona Virus Disease 2019 (COVID 2019), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a dreadful infectious disease which has emerged as one of the most significant medical emergency affecting everyone directly or indirectly. COVID 2019 is a multisystem disease and causes severe immunosuppression. Initially thought to affect mainly the respiratory system, it strikes all vital organ systems and cause defects in cardio-circulatory, respiratory system and gastrointestinal systems to name a few leading to copious biochemical alterations. Reports show there is thromoembolism, raised ferritin levels, lymphocytopenia, thrombocytopenia, lactic acidosis, acute diabetes like state and cytokine storm. Data regarding levels of neutrophils is equivocal. Further there is increased incidence regarding high incidents of mucormycosis in COVID 2019 positive subjects. In the present paper, we identified and correlated the virus mediated biochemical alterations as the potential ideal environment for propagation of mucorales; and thus concentrate on early diagnosis and treatment of mucormycosis in COVID 2019 cases.
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Affiliation(s)
- Deepak Pandiar
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India; Department of Oral Pathology and Microbiology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - N Siva Kumar
- Department of Oral Pathology and Microbiology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Rahul Anand
- Department of Oral Pathology and Microbiology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India.
| | - Mala Kamboj
- Department of Oral Pathology and Microbiology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Anjali Narwal
- Department of Oral Pathology and Microbiology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - P M Shameena
- Department of Oral Pathology and Microbiology, Government Dental College, Kozhikode, Kerala, India
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18
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COVID-19 and diabetes: A bidirectional relationship. CLÍNICA E INVESTIGACIÓN EN ARTERIOSCLEROSIS (ENGLISH EDITION) 2021. [PMCID: PMC8064838 DOI: 10.1016/j.artere.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Diabetes is one of the most frequent comorbidities in people with COVID-19 with a prevalence that varies between 7 and 30%. Diabetics infected with SARS-CoV-2 have a higher rate of hospital admission, severe pneumonia, and higher mortality compared to non-diabetic subjects. Chronic hyperglycemia can compromise innate and humoral immunity. Furthermore, diabetes is associated with a low-grade chronic inflammatory state that favours the development of an exaggerated inflammatory response and therefore the appearance of acute respiratory distress syndrome. Recent evidence has shown that SARS-CoV-2 is also capable of causing direct damage to the pancreas that could worsen hyperglycemia and even induce the onset of diabetes in previously non-diabetic subjects. Therapeutic strategies should be aimed at facilitating patient access to the healthcare system. Control of blood glucose and comorbidities must be individualised in order to reduce the incidence of complications and decrease the burden on health systems. In this article we will review the pathophysiological mechanisms that explain the bidirectional relationship between COVID-19 and diabetes mellitus, its implication in the prognosis and management of hyperglycemia in this group of patients.
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19
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Abstract
The novel 2019 coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly transmissible and pathogenic coronavirus. Because of the novelty of the COVID-19 pandemic, few data are available on the impact of the SARS-CoV-2 on the different endocrine glands. Previous studies of severe acute respiratory syndrome (SARS) have shown a harmful effect on endocrine function. Notably, the angiotensin-converting enzyme-2 receptor, which is the entry route of coronaviruses to the host cell, is widely expressed in the endocrine organs including testis, endocrine pancreas, thyroid, and adrenal, and pituitary glands. Clinical and biochemical manifestations have been recorded in COVID-19 patients resulting in changes in endocrine activities, which were also recorded during the SARS outbreak in 2003. This review aims to explore the impact of SARS-CoV-2 infection on the function of endocrine glands, based on the latest research in the field.
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Affiliation(s)
- Adel Abdel-Moneim
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Hosni
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
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20
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Zhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). Diabetes Metab Res Rev 2021; 37:e3377. [PMID: 32588943 PMCID: PMC7361201 DOI: 10.1002/dmrr.3377] [Citation(s) in RCA: 274] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of the coronavirus disease 2019 (Covid-19) has become an evolving worldwide health crisis. With the rising prevalence of obesity and diabetes has come an increasing awareness of their impacts on infectious diseases, including increased risk for various infections, post-infection complications and mortality from critical infections. Although epidemiological and clinical characteristics of Covid-19 have been constantly reported, no article has systematically illustrated the role of obesity and diabetes in Covid-19, or how Covid-19 affects obesity and diabetes, or special treatment in these at-risk populations. Here, we present a synthesis of the recent advances in our understanding of the relationships between obesity, diabetes and Covid-19 along with the underlying mechanisms, and provide special treatment guidance for these at-risk populations.
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Affiliation(s)
- Yue Zhou
- Department of EndocrinologyAffiliated Hospital of Medical College Qingdao UniversityQingdaoChina
| | - Jingwei Chi
- Department of EndocrinologyAffiliated Hospital of Medical College Qingdao UniversityQingdaoChina
| | - Wenshan Lv
- Department of EndocrinologyAffiliated Hospital of Medical College Qingdao UniversityQingdaoChina
| | - Yangang Wang
- Department of EndocrinologyAffiliated Hospital of Medical College Qingdao UniversityQingdaoChina
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21
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Lv Z, Lv S. Clinical characteristics and analysis of risk factors for disease progression of COVID-19: A retrospective Cohort Study. Int J Biol Sci 2021; 17:1-7. [PMID: 33390828 PMCID: PMC7757033 DOI: 10.7150/ijbs.50654] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: Since December 2019, an outbreak of coronavirus disease 2019 (COVID 19) has been experienced from Wuhan, China to the world. A retrospective cohort study was conducted to summarize the clinical characteristics of patients with COVID-19 and to explore the risk factors affecting the disease duration in Jiangan Fangcang shelter hospital, Wuhan, China. Methods: Clinical characteristics of 409 patients with COVID-19 were retrospectively analyzed. We describe the clinical characteristics and distribution of discharge time or transfer time for each patient. Then we performed univariate and multivariate Cox regression analysis to identify potential risk factors for progression from non-severe to severe COVID-19 or death. Results: The median disease duration of all patients was 23 days (IQR 19-28). The main symptoms of the patient were fever (95.6%), cough (74.3%), tiredness (21.5%), and so on. Comorbidities mainly included hypertension (30.6%) diabetes (17.6%) and heart disease (12.5%). The univariate Cox regression analysis showed that old age, number of symptoms, the combination of hypertension, heart disease and pulmonary disease were associated with the progression of disease. The multivariate Cox regression analysis showed that old age (HR: 7.294; 95% CI: 1.442-36.888; P = 0.016), the combination of hypertension (HR: 2.230; 95% CI: 1.090-4.562; P = 0.028) and heart disease (HR: 2.650; 95% CI: 1.079-6.510; P = 0.034) were independent risk factors for progression of COVID-19. Conclusions: The age of the patient, the combination of hypertension and heart disease were independent risk factors for the progression of COVID-19. Cautions should be raised for patients with these risk factors.
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Affiliation(s)
- Zhengtong Lv
- Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
| | - Shubin Lv
- Department of Respiratory Medicine, Tianjin Binhai New Area Dagang Hospital, Tianjin, P.R. China
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22
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Nassar M, Nso N, Baraka B, Alfishawy M, Mohamed M, Nyabera A, Sachmechi I. The association between COVID-19 and type 1 diabetes mellitus: A systematic review. Diabetes Metab Syndr 2021; 15:447-454. [PMID: 33592371 PMCID: PMC7872855 DOI: 10.1016/j.dsx.2021.02.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND /Aim: Various reports of the occurrence of type 1 diabetes mellitus (T1DM) in patients with COVID-19 have been published, denoting an association between both diseases. Therefore, we conducted this systematic review to summarize the prevalence of T1DM in COVID-19 patients and to identify the clinical presentations and outcomes in this patient population. MATERIALS AND METHODS Up to 10/27/2020, Medline, Embase, cochrane and google scholar databases were searched for original studies investigating the association between COVID-19 and T1DM. A manual search was conducted to identify missing studies. The quality of included studies was analyzed by the National Institute of Health (NIH) risk of bias tool. Outcomes included length of hospital stay, hospitalization, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), severe hypoglycemia, and death. RESULTS Fifteen studies were included in the qualitative analysis. Included studies reported data of both adult and pediatric patients. The prevalence of T1DM in COVID-19 patients ranged from 0.15% to 28.98%, while the rate of COVID-19 in patients with T1DM ranged from 0% to 16.67%. Dry cough, nausea, vomiting, fever and elevated blood glucose levels were the most commonly reported presentations. The investigated outcomes varied widely among studied populations. CONCLUSIONS The prevalence of T1DM in patients with COVID-19 ranged from 0.15% to 28.98%. The most common presentation of COVID-19 in patients with T1DM included fever, dry cough, nausea and vomiting, elevated blood glucose and diabetic ketoacidosis. The outcomes of COVID-19 in terms of length of hospital stay, hospitalization, ICU admission, DKA rate, and severe hypoglycemia were reported variably in included studies. Due to the heterogeneous study populations and the presence of many limitations, more studies are still warranted to reach a definitive conclusion.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, NY, USA.
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, NY, USA.
| | - Bahaaeldin Baraka
- Oncology Department, Southend University Hospital, Mid and South Essex NHS Foundation Trust, ESSEX, UK.
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo, Egypt.
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, USA.
| | - Akwe Nyabera
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, NY, USA.
| | - Issac Sachmechi
- Division of Endocrinology, Department of Medicine, Mount Sinai Services, Queens Hospital, Center, NY, USA.
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23
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Wang J, Guo S, Zhang Y, Gao K, Zuo J, Tan N, Du K, Ma Y, Hou Y, Li Q, Xu H, Huang J, Huang Q, Na H, Wang J, Wang X, Xiao Y, Zhu J, Chen H, Liu Z, Wang M, Zhang L, Wang W. Clinical features and risk factors for severe inpatients with COVID-19: A retrospective study in China. PLoS One 2020; 15:e0244125. [PMID: 33332437 PMCID: PMC7745975 DOI: 10.1371/journal.pone.0244125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background A worldwide outbreak of coronavirus disease (COVID-19), since 2019, has brought a disaster to people all over the world. Many researchers carried out clinical epidemiological studies on patients with COVID-19 previously, but risk factors for patients with different levels of severity are still unclear. Methods 562 patients with laboratory-confirmed COVID-19 from 12 hospitals in China were included in this retrospective study. Related clinical information, therapies, and imaging data were extracted from electronic medical records and compared between patients with severe and non-severe status. We explored the risk factors associated with different severity of COVID-19 patients by logistic regression methods. Results Based on the guideline we cited, 509 patients were classified as non-severe and 53 were severe. The age range of whom was 5–87 years, with a median age of 47 (IQR 35.0–57.0). And the elderly patients (older than 60 years old) in non-severe group were more likely to suffer from fever and asthma, accompanied by higher level of D-dimer, red blood cell distribution width and low-density lipoprotein. Furthermore, we found that the liver and kidney function of male patients was worse than that of female patients in both severe and non-severe groups with different age levels, while the severe females had faster ESR and lower inflammatory markers. Of major laboratory markers in non-severe cases, baseline albumin and the lymphocyte percentage were higher, while the white blood cell and the neutrophil count were lower. In addition, severe patients were more likely to be accompanied by an increase in cystatin C, mean hemoglobin level and a decrease in oxygen saturation. Besides that, advanced age and indicators such as count of white blood cell, glucose were proved to be the most common risk factors preventing COVID-19 patients from aggravating. Conclusion The potential risk factors found in our study have shown great significance to prevent COVID-19 patients from aggravating and turning to critical cases during treatment. Meanwhile, focusing on gender and age factors in groups with different severity of COVID-19, and paying more attention to specific clinical symptoms and characteristics, could improve efficacy of personalized intervention to treat COVID-19 effectively.
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Affiliation(s)
- Juan Wang
- Department of Education Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Shuzhen Guo
- Department of Scientific Research, Beijing University of Chinese Medicine, Beijing, China
| | - Yili Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Kuo Gao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jiacheng Zuo
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Nannan Tan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Kangjia Du
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Ma
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yong Hou
- The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Quntang Li
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Hongming Xu
- Department of Infectious Disease, Daqing Second Hospital, Daqing, Heilongjiang, China
| | - Jin Huang
- Department of Traditional Chinese Medicine, The People’s Hospital of GuangXi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qiuhua Huang
- Department of Traditional Chinese Medicine, The People’s Hospital of GuangXi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hui Na
- Department of Infectious Disease, Harbin Infectious Disease Hospital, Harbin, Heilongjiang, China
| | - Jingwei Wang
- Department of Infectious Disease, Harbin Infectious Disease Hospital, Harbin, Heilongjiang, China
| | - Xiaoyan Wang
- Department of Infectious Disease, Jinzhong Infectious Disease Hospital, Jinzhong, Shanxi, China
| | - Yanhua Xiao
- Department of Traditional Chinese Medicine, Mudanjiang Kangan Hospital, Mudanjiang, Heilongjiang, China
| | - Junteng Zhu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Hong Chen
- President’s Office, The First Hospital of Qiqihar, Qiqihar, Heilongjiang, China
| | - Zhang Liu
- Department of Traditional Chinese Medicine, The First Hospital of Suihua City, Suihua, Heilongjiang, China
| | - Mingxuan Wang
- Department of Traditional Chinese Medicine, Suining Central Hospital, Suining, Sichuan, China
| | - Linsong Zhang
- Department of Traditional Chinese Medicine, Hospital (T·C·M) Affiliated to Southwest Medical University, Luzhou, Sichuan, China
| | - Wei Wang
- President’s Office, Beijing University of Chinese Medicine, Beijing, China
- * E-mail:
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Samanta J, Gupta R, Singh MP, Patnaik I, Kumar A, Kochhar R. Coronavirus disease 2019 and the pancreas. Pancreatology 2020; 20:1567-1575. [PMID: 33250089 PMCID: PMC7550073 DOI: 10.1016/j.pan.2020.10.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/12/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to a world-wide pandemic since its onset in December of 2019. Although, a primary respiratory pathogen, over the ensuing period, its extra-pulmonary effects have come to the forefront. The virus, having multi-organ tropism, has been shown to affect a host of other organs beyond the lung, including the pancreas. The data on pancreatic involvement by COVID-19, however, have been limited. Moreover, whether the effects on the pancreas are due to the direct effects of the virus or is just an epi-phenomenon is debatable. The prevalence of pancreatic injury and degree of injury are the other issues that need to be addressed. Pancreatic cancer has a dismal prognosis and the management of the same in the COVID era needs to be tailored assessing the risk-benefit ratio for the same. Additionally, pancreatic surgery increases not only the morbidity of the patient, but also the risk of the operator and burden on the health care system. Hence, the decision for such major procedures needs to be rationalized for optimum benefit during this pandemic. Similarly, for the endoscopist, pancreatic endoscopy needs to be carefully regulated to reduce risk to both the patient and the physician and yet deliver optimum patient care. This review gives a concise summary of various aspects of pancreatic involvement and pancreatic disease management during this pandemic.
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Affiliation(s)
| | - Rohit Gupta
- Department of Gastroenterology, AIIMS, Rishikesh, India
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Itish Patnaik
- Department of Gastroenterology, AIIMS, Rishikesh, India
| | - Ashok Kumar
- Department of Gastroenterology, AIIMS, Rishikesh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India.
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25
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Lima-Martínez MM, Carrera Boada C, Madera-Silva MD, Marín W, Contreras M. COVID-19 and diabetes: A bidirectional relationship. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 33:151-157. [PMID: 33303218 PMCID: PMC7598432 DOI: 10.1016/j.arteri.2020.10.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 01/17/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Diabetes is one of the most frequent comorbidities in people with COVID-19 with a prevalence that varies between 7 and 30%. Diabetics infected with SARS-CoV-2 have a higher rate of hospital admission, severe pneumonia, and higher mortality compared to non-diabetic subjects. Chronic hyperglycemia can compromise innate and humoral immunity. Furthermore, diabetes is associated with a low-grade chronic inflammatory state that favors the development of an exaggerated inflammatory response and therefore the appearance of acute respiratory distress syndrome. Recent evidence has shown that SARS-CoV-2 is also capable of causing direct damage to the pancreas that could worsen hyperglycemia and even induce the onset of diabetes in previously non-diabetic subjects. Therapeutic strategies should be aimed at facilitating patient access to the healthcare system. Control of blood glucose and comorbidities must be individualized in order to reduce the incidence of complications and decrease the burden on health systems. In this article we will review the pathophysiological mechanisms that explain the bidirectional relationship between COVID-19 and diabetes mellitus, its implication in the prognosis and management of hyperglycemia in this group of patients.
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Affiliation(s)
- Marcos M Lima-Martínez
- Unidad de Endocrinología, Diabetes, Metabolismo y Nutrición, Anexo Centro Médico Orinoco, Ciudad Bolívar, Bolívar, Venezuela; Departamento de Ciencias Fisiológicas, Universidad de Oriente, Núcleo Bolívar, Ciudad Bolívar, Bolívar, Venezuela.
| | | | | | - Waleskha Marín
- Servicio de Oftalmología, Hospital Universitario de Caracas, Caracas, Venezuela
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26
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Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, Qin R, Wang H, Shen Y, Du K, Zhao L, Fan H, Luo S, Hu D. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev 2020; 36:e3319. [PMID: 32233013 PMCID: PMC7228407 DOI: 10.1002/dmrr.3319] [Citation(s) in RCA: 842] [Impact Index Per Article: 210.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGOUND To figure out whether diabetes is a risk factor influencing the progression and prognosis of 2019 novel coronavirus disease (COVID-19). METHODS A total of 174 consecutive patients confirmed with COVID-19 were studied. Demographic data, medical history, symptoms and signs, laboratory findings, chest computed tomography (CT) as well the treatment measures were collected and analysed. RESULTS We found that COVID-19 patients without other comorbidities but with diabetes (n = 24) were at higher risk of severe pneumonia, release of tissue injury-related enzymes, excessive uncontrolled inflammation responses and hypercoagulable state associated with dysregulation of glucose metabolism. Furthermore, serum levels of inflammation-related biomarkers such as IL-6, C-reactive protein, serum ferritin and coagulation index, D-dimer, were significantly higher (P < .01) in diabetic patients compared with those without, suggesting that patients with diabetes are more susceptible to an inflammatory storm eventually leading to rapid deterioration of COVID-19. CONCLUSIONS Our data support the notion that diabetes should be considered as a risk factor for a rapid progression and bad prognosis of COVID-19. More intensive attention should be paid to patients with diabetes, in case of rapid deterioration.
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Affiliation(s)
- Weina Guo
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Mingyue Li
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yalan Dong
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Haifeng Zhou
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Zili Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Chunxia Tian
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Renjie Qin
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Haijun Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yin Shen
- Department of Neurosurgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Keye Du
- Department of Neurosurgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Lei Zhao
- Department of Infectious Disease, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Heng Fan
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shanshan Luo
- Institute of Hematology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Desheng Hu
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Institute of Hematology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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27
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Liu SP, Zhang Q, Wang W, Zhang M, Liu C, Xiao X, Liu Z, Hu WM, Jin P. Hyperglycemia is a strong predictor of poor prognosis in COVID-19. Diabetes Res Clin Pract 2020; 167:108338. [PMID: 32712122 PMCID: PMC7377976 DOI: 10.1016/j.diabres.2020.108338] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
AIMS The objective of this study is to explore the association between documented diabetes, fasting plasma glucose (FPG), and the clinical outcomes of Coronavirus disease 2019 (COVID-19). METHODS This retrospective study included 255 patients with COVID-19. Of these, 214 were admitted to isolation wards and 41were admitted to intensive care units (ICUs). Demographic, clinical, treatment, and laboratory data were collected and compared between ICU and non-ICU patients. Multivariable logistic regression models were used to explore the risk factors associated with poor clinical outcomes (ICU admission or death). RESULTS There were significant changes in several clinical parameters in ICU patients (leukopenia, lymphopenia, elevated D-dimer, as well as higher levels of FPG, cardiac troponin, serum ferritin, IL-6, and high-sensitivity C-reactive protein)compared with non-ICU patients. The prevalence of known diabetes was substantially higher in ICU than non-ICU patients (31.7% vs. 17.8%, P = 0.0408). Multivariable regression analysis showed that a history of diabetes [odds ratio (OR), 0.099; 95% confidence interval (CI), 0.016-0.627; P = 0.014], high FPG at admission (OR, 1.587; 95% CI, 1.299-1.939, P < 0.001), high IL-6 (OR, 1.01; 95% CI, 1.002-1.018, P = 0.013), and D-dimer higher than 1 mg/L at admission (OR, 4.341; 95% CI, 1.139-16.547, P = 0.032) were independent predictors of poor outcomes. Cox proportional hazards analysis showed that compared with FPG < 7 mmol/L, FPG levels of 7.0-11.1 mmol/L and ≥ 11.1 mmol/L were associated with an increased hazard ratio (HR) for poor outcome (HR, 5.538 [95% CI, 2.269-13.51] and HR, 11.55 [95% CI, 4.45-29.99], respectively). CONCLUSION Hyperglycemia and a history of diabetes on admission predicted poor clinical outcomes in COVID-19.
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Affiliation(s)
- Sheng-Ping Liu
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China
| | - Qin Zhang
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China
| | - Wei Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Min Zhang
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China
| | - Chun Liu
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China
| | - Xuefei Xiao
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China
| | - Zongdao Liu
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China
| | - Wen-Mu Hu
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China
| | - Ping Jin
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, 410007 Changsha, Hunan, China.
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28
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Soliman AT, Al-Amri M, Alleethy K, Alaaraj N, Hamed N, De Sanctis V. Newly-onset type 1 diabetes mellitus precipitated by COVID-19 in an 8-month-old infant. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:ahead of print. [PMID: 32921748 PMCID: PMC7717024 DOI: 10.23750/abm.v91i3.10074] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is rare in infants and toddlers and is usually associated with a relatively high mortality when complicated with diabetic ketoacidosis (DKA). In infants, the classical symptoms of DKA are atypical and therefore many infants with DKA are mistreated for infections. We report a case of DKA precipitated by COVID-19 in an 8-month-old infant with newly diagnosed diabetes mellitus. This case is reported in view of its rarity and originality. The relation between T1DM and COVID19 infection is discussed.
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Affiliation(s)
| | - Mohamed Al-Amri
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Khaled Alleethy
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
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Abstract
Autopsy data from 80 patients who died of the COVID-19 infection were analysed. Using macro- and microscopic studies, specific features of pathological processes in various organs were identified. The obtained experimental data, along with information from literature sources, allowed conclusions to be drawn about the mechanisms of damaging internal organs and body systems, as well as assumptions to be made about individual links in the pathogenesis of COVID-19. The thanatogenesis of the disease and the main causes of death are discussed, including acute cardiopulmonary failure, acute renal failure, pulmonary thromboembolism, shock involving multiple organ failure and sepsis. The critical importance of autopsy is emphasized, which provides valuable information on the morphological substrate for this infection closely associated with possible clinical manifestations.
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30
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Pal R, Banerjee M. COVID-19 and the endocrine system: exploring the unexplored. J Endocrinol Invest 2020; 43:1027-1031. [PMID: 32361826 PMCID: PMC7195612 DOI: 10.1007/s40618-020-01276-8] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Affiliation(s)
- R Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - M Banerjee
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, 700007, India
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31
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Agarwal S, Agarwal SK. Endocrine changes in SARS-CoV-2 patients and lessons from SARS-CoV. Postgrad Med J 2020; 96:412-416. [PMID: 32527756 PMCID: PMC7306278 DOI: 10.1136/postgradmedj-2020-137934] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
Coronavirus infection outbreaks have occurred frequently in the last two decades and have led to significant mortality. Despite the focus on reducing mortality by preventing the spread of the virus, patients have died due to several other complications of the illness. The understanding of pathological mechanisms and their implications is continuously evolving. A number of symptoms occur in these patients due to the involvement of various endocrine glands. These clinical presentations went largely unnoticed during the first outbreak of severe acute respiratory syndrome (SARS) in 2002–2003. A few of these derangements continued during the convalescence phase and sometimes occurred after recovery. Similar pathological and biochemical changes are being reported with the novel coronavirus disease outbreak in 2020. In this review, we focus on these endocrine changes that have been reported in both SARS coronavirus and SARS coronavirus-2. As we battle the pandemic, it becomes imperative to address these underlying endocrine disturbances that are contributing towards or predicting mortality of these patients.
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Affiliation(s)
- Shubham Agarwal
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, Illinois, USA
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32
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Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res Clin Pract 2020; 164:108214. [PMID: 32416121 PMCID: PMC7233217 DOI: 10.1016/j.diabres.2020.108214] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diabetes is a risk factor for the progression and prognosis of coronavirus disease (COVID-19), but the relationship between glycosylated hemoglobin (HbA1c) level, inflammation, and prognosis of COVID-19 patients has not been explored. METHODS This was a retrospective study of COVID-19 patients who underwent an HbA1c test. Their demographic data, medical history, signs and symptoms of COVID-19, laboratory test results, and final outcomes of COVID-19 treatment were collected and analyzed. RESULTS A total of 132 patients were included and divided into three groups based on their blood glucose status. There were significant differences in SaO2, serum ferritin level, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen (Fbg) level, and IL6 level among the three groups. A pairwise comparison of the groups showed that groups B and C were significantly different from group A in terms of CRP, ESR, and Fbg, IL6, and serum ferritin levels (P < 0.05). Correlation analysis showed that there was a linear negative correlation between SaO2 and HbA1c (r = -0.22, P = 0.01), while there was a linear positive correlation between serum ferritin, CRP, Fbg, and ESR levels and HbA1c (P < 0.05). CONCLUSIONS High HbA1c level is associated with inflammation, hypercoagulability, and low SaO2 in COVID-19 patients, and the mortality rate (27.7%) is higher in patients with diabetes. Determining HbA1c level after hospital admission is thus helpful assessing inflammation, hypercoagulability, and prognosis of COVID-19 patients.
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Affiliation(s)
- Zhenzhou Wang
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital, Beijing 100044, China
| | - Zhe Du
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital, Beijing 100044, China
| | - Fengxue Zhu
- Trauma Center, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Peking University People's Hospital, Beijing 100044, China.
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Peric S, Stulnig TM. Diabetes and COVID-19 : Disease-Management-People. Wien Klin Wochenschr 2020; 132:356-361. [PMID: 32435867 PMCID: PMC7238399 DOI: 10.1007/s00508-020-01672-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
The current pandemic of SARS-CoV‑2 coronavirus disease 2019 (COVID-19) is a particular challenge for diabetes patients. Diabetes mellitus predisposes to a particularly severe course of the disease and doubles the COVID-19 mortality risk due to pulmonary and cardiac involvement. In addition, diabetes patients often suffer from comorbidities which further worsen clinical outcomes. Glycemic control during infectious diseases is often suboptimal, and antidiabetic drugs and insulin therapy have to be adapted accordingly. On the other hand, access of diabetes patients to outpatient clinics are limited during the ongoing season urging alternative treatment options, particularly the implementation of novel telemedicine strategies. Hence, the opportunity of the COVID 19 crisis should be taken to make a significant step forward in the care for diabetes patients.
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Affiliation(s)
- Slobodan Peric
- Third Department of Medicine with Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Wolkersbergenstraße 1, 1130, Vienna, Austria
- Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Vienna, Austria
| | - Thomas M Stulnig
- Third Department of Medicine with Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Wolkersbergenstraße 1, 1130, Vienna, Austria.
- Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Hietzing Hospital with Neurological Center Rosenhuegel, Vienna, Austria.
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Shaheen ZR, Stafford JD, Voss MG, Oleson BJ, Stancill JS, Corbett JA. The location of sensing determines the pancreatic β-cell response to the viral mimetic dsRNA. J Biol Chem 2020; 295:2385-2397. [PMID: 31915247 DOI: 10.1074/jbc.ra119.010267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
Viral infection is an environmental trigger that has been suggested to initiate pancreatic β-cell damage, leading to the development of autoimmune diabetes. Viruses potently activate the immune system and can damage β cells by either directly infecting them or stimulating the production of secondary effector molecules (such as proinflammatory cytokines) during bystander activation. However, how and where β cells recognize viruses is unclear, and the antiviral responses that are initiated following virus recognition are incompletely understood. In this study, we show that the β-cell response to dsRNA, a viral replication intermediate known to activate antiviral responses, is determined by the cellular location of sensing (intracellular versus extracellular) and differs from the cellular response to cytokine treatment. Using biochemical and immunological methods, we show that β cells selectively respond to intracellular dsRNA by expressing type I interferons (IFNs) and inducing apoptosis, but that they do not respond to extracellular dsRNA. These responses differ from the activities of cytokines on β cells, which are mediated by inducible nitric oxide synthase expression and β-cell production of nitric oxide. These findings provide evidence that the antiviral activities of type I IFN production and apoptosis are elicited in β cells via the recognition of intracellular viral replication intermediates and that β cells lack the capacity to respond to extracellular viral intermediates known to activate innate immune responses.
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Affiliation(s)
- Zachary R Shaheen
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Joshua D Stafford
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Michael G Voss
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Bryndon J Oleson
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Jennifer S Stancill
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - John A Corbett
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin 53226.
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35
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Lombardi A, Tsomos E, Hammerstad SS, Tomer Y. Interferon alpha: The key trigger of type 1 diabetes. J Autoimmun 2018; 94:7-15. [PMID: 30115527 DOI: 10.1016/j.jaut.2018.08.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023]
Abstract
IFNα is a cytokine essential to a vast array of immunologic processes. Its induction early in the innate immune response provides a priming mechanism that orchestrates numerous subsequent pathways in innate and adaptive immunity. Despite its beneficial effects in viral infections IFNα has been reported to be associated with several autoimmune diseases including autoimmune thyroid disease, systemic lupus erythematosus, rheumatoid arthritis, primary biliary cholangitis, and recently emerged as a major cytokine that triggers Type 1 Diabetes. In this review, we dissect the role of IFNα in T1D, focusing on the potential pathophysiological mechanisms involved. Evidence from human and mouse studies indicates that IFNα plays a key role in enhancing islet expression of HLA-I in patients with T1D, thereby increasing autoantigen presentation and beta cell activation of autoreactive cytotoxic CD8 T-lymphocytes. The binding of IFNα to its receptor induces the secretion of chemokines, attracting monocytes, T lymphocytes, and NK cells to the infected tissue triggering autoimmunity in susceptible individuals. Furthermore, IFNα impairs insulin production through the induction of endoplasmic reticulum stress as well as by impairing mitochondrial function. Due to its central role in the early phases of beta cell death, targeting IFNα and its pathways in genetically predisposed individuals may represent a potential novel therapeutic strategy in the very early stages of T1D.
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Affiliation(s)
- Angela Lombardi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Effie Tsomos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sara S Hammerstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Aker, Oslo, Norway; Department of Pediatrics, Oslo University Hospital, Ulleval, Oslo, Norway
| | - Yaron Tomer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
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36
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Abstract
The gastrointestinal system represents one of the largest interfaces between the human internal microenvironment and the external world. This system harbors trillions of commensal bacteria that reside in symbiosis with the host. Intestinal bacteria play a crucial role in maintaining systemic and intestinal immune and metabolic homeostasis because of their effect on nutrient absorption and immune development and function. Recently, altered gut bacterial composition (dysbiosis) was hypothesized to be involved in mechanisms through which islet autoimmunity is triggered. Evidence from animal models indicates that alterations in the gut bacterial composition precede disease onset, thus implicating a causal role for the gut microbiome in islet destruction. However, it remains unclear whether dysbiosis is directly linked to the mechanisms of human type 1 diabetes (T1D). In this review, we discuss data implicating the gut microbiota in disease progression with an emphasis on our recent studies performed in humans and in rodent models of T1D.
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Affiliation(s)
- James C Needell
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct., Mail Stop B-140, Aurora, CO, 80045, USA
| | - Danny Zipris
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct., Mail Stop B-140, Aurora, CO, 80045, USA.
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37
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Zhang PW, Yang CW, Ji SN, Wang B. Gut microbiota and related diseases. Shijie Huaren Xiaohua Zazhi 2016; 24:2355-2360. [DOI: 10.11569/wcjd.v24.i15.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gut microbiota is the normal flora in the human body, has a great effect on gut digestion and metabolism, and plays an important role in human health and diseases. Advances in research of gut microbiota has led to a better understanding of the relationship between gut microbiota and host immunity and diseases. This article aims to review the association of gut microbiota with the host immunity and related diseases, emphasizing the importance of gut microbiota.
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Kwon BE, Song JH, Song HH, Kang JW, Hwang SN, Rhee KJ, Shim A, Hong EH, Kim YJ, Jeon SM, Chang SY, Kim DE, Cho S, Ko HJ. Antiviral Activity of Oroxylin A against Coxsackievirus B3 Alleviates Virus-Induced Acute Pancreatic Damage in Mice. PLoS One 2016; 11:e0155784. [PMID: 27195463 PMCID: PMC4873122 DOI: 10.1371/journal.pone.0155784] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/04/2016] [Indexed: 01/08/2023] Open
Abstract
The flavonoids mosloflavone, oroxylin A, and norwogonin, which were purified from Scutellaria baicalensis Georgi, significantly protected Vero cells against Coxsackievirus B3 (CVB3)-induced cell death. To investigate the in vivo antiviral activity of oroxylin A, we intraperitoneally inoculated CVB3 into 4-week-old BALB/c mice. Body weights and blood glucose levels of the mice were decreased after CVB3 infection, and these changes were attenuated by the administration of oroxylin A. Importantly, treatment of mice with oroxylin A reduced viral titers in the pancreas and decreased the serum levels of the inflammatory cytokines including interleukin-6 (IL-6) and tumor necrosis factor (TNF)-α. Additionally, the administration of oroxylin A mitigated the histological pancreatic lesions and apoptotic cell death induced by CVB3 infection and increased the levels of phospho-eIF2α in infected pancreata. The results suggest that oroxylin A may represent a potent antiviral agent against CVB3 infection.
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Affiliation(s)
- Bo-Eun Kwon
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon, 200–701, South Korea
| | - Jae-Hyoung Song
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon, 200–701, South Korea
| | - Hyuk-Hwan Song
- Agency for Korea National Food Cluster (AnFC), Iksan, Korea
| | - Ju Won Kang
- Department of Biomedical Laboratory Science, Yonsei University, Wonju, 220–710, Republic of Korea
| | - Sam Noh Hwang
- Department of Biomedical Laboratory Science, Yonsei University, Wonju, 220–710, Republic of Korea
| | - Ki-Jong Rhee
- Department of Biomedical Laboratory Science, Yonsei University, Wonju, 220–710, Republic of Korea
| | - Aeri Shim
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon, 200–701, South Korea
| | - Eun-Hye Hong
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon, 200–701, South Korea
| | - Yeon-Jeong Kim
- College of Pharmacy, Inje University, Gimhae, 621–749, South Korea
| | - Sang-Min Jeon
- College of Pharmacy, Ajou University, Suwon, 443–749, South Korea
| | - Sun-Young Chang
- College of Pharmacy, Ajou University, Suwon, 443–749, South Korea
| | - Dong-Eun Kim
- Anticancer Agent Research Center, Korea Research Institute of Bioscience & Biotechnology, Cheongju, South Korea
| | - Sungchan Cho
- Anticancer Agent Research Center, Korea Research Institute of Bioscience & Biotechnology, Cheongju, South Korea
| | - Hyun-Jeong Ko
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon, 200–701, South Korea
- * E-mail:
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Affiliation(s)
- Gautam Das
- Prince Charles Hospital, Cwm Taf University Health Board; Merthyr Tydfil UK
| | - Hemanth Bolusani
- University Hospital of Wales, Cardiff and Vale University Health Board; Cardiff UK
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Song JH, Kwon BE, Jang H, Kang H, Cho S, Park K, Ko HJ, Kim H. Antiviral Activity of Chrysin Derivatives against Coxsackievirus B3 in vitro and in vivo. Biomol Ther (Seoul) 2015; 23:465-70. [PMID: 26336587 PMCID: PMC4556207 DOI: 10.4062/biomolther.2015.095] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/21/2015] [Accepted: 07/24/2015] [Indexed: 11/30/2022] Open
Abstract
Chrysin is a 5,7-dihydroxyflavone and was recently shown to potently inhibit enterovirus 71 (EV71) by suppressing viral 3C protease (3Cpro) activity. In the current study, we investigated whether chrysin also shows antiviral activity against coxsackievirus B3 (CVB3), which belongs to the same genus (Enterovirus) as EV71, and assessed its ability to prevent the resulting acute pancreatitis and myocarditis. We found that chrysin showed antiviral activity against CVB3 at 10 μM, but exhibited mild cellular cytotoxicity at 50 μM, prompting us to synthesize derivatives of chrysin to increase the antiviral activity and reduce its cytotoxicity. Among four 4-substituted benzyl derivatives derived from C(5) benzyl-protected derivatives 7, 9–11 had significant antiviral activity and showed the most potent activity against CVB3 with low cytotoxicity in Vero cells. Intraperitoneal injection of CVB3 in BALB/c mice with 1×106 TCID50 (50% tissue culture infective dose) of CVB3 induced acute pancreatitis with ablation of acinar cells and increased serum CXCL1 levels, whereas the daily administration of 9 for 5 days significantly alleviated the pancreatic inflammation and reduced the elevation in serum CXCL1 levels. Collectively, we assessed the anti-CVB3 activities of chrysin and its derivatives, and found that among 4-substituted benzyl derivatives, 9 exhibited the highest activity against CVB3 in vivo, and protected mice from CVB3-induced pancreatic damage, simultaneously lowering serum CXCL1 levels.
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Affiliation(s)
- Jae-Hyoung Song
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon 200-701
| | - Bo-Eun Kwon
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon 200-701
| | - Hongjun Jang
- College of Pharmacy, Ajou University, Suwon 443-749
| | - Hyunju Kang
- Targeted Medicine Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongwon 363-883
| | - Sungchan Cho
- Targeted Medicine Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongwon 363-883
| | - Kwisung Park
- Department of Microbiology, Chungcheongnam-Do Institute of Health and Environmental Research, Daejeon 300-801, Republic of Korea
| | - Hyun-Jeong Ko
- Laboratory of Microbiology and Immunology, College of Pharmacy, Kangwon National University, Chuncheon 200-701
| | - Hyoungsu Kim
- College of Pharmacy, Ajou University, Suwon 443-749
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Levenstein S, Rosenstock S, Jacobsen RK, Jorgensen T. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol 2015; 13:498-506.e1. [PMID: 25111233 DOI: 10.1016/j.cgh.2014.07.052] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is controversy over whether psychological stress contributes to development of peptic ulcers. We collected data on features of life stress and ulcer risk factors from a defined population in Denmark and compared these with findings of confirmed ulcers during the next 11-12 years. METHODS We collected blood samples and psychological, social, behavioral, and medical data in 1982-1983 from a population-based sample of 3379 Danish adults without a history of ulcer participating in the World Health Organization's MONICA study. A 0- to 10-point stress index scale was used to measure stress on the basis of concrete life stressors and perceived distress. Surviving eligible participants were reinterviewed in 1987-1988 (n = 2809) and 1993-1994 (n = 2410). Ulcer was diagnosed only for patients with a distinct breach in the mucosa. All diagnoses were confirmed by review of radiologic and endoscopic reports. Additional cases of ulcer were detected in a search of all 3379 subjects in the Danish National Patient Register. RESULTS Seventy-six subjects were diagnosed with ulcer. On the basis of the stress index scale, ulcer incidence was significantly higher among subjects in the highest tertile of stress scores (3.5%) than the lowest tertile (1.6%) (adjusted odds ratio, 2.2; 95% confidence interval [CI], 1.2-3.9; P < .01). The per-point odds ratio for the stress index (1.19; 95% CI, 1.09-1.31; P < .001) was unaffected after adjusting for the presence of immunoglobulin G antibodies against Helicobacter pylori in stored sera, alcohol consumption, or sleep duration but lower after adjusting for socioeconomic status (1.17; 95% CI, 1.07-1.29; P < .001) and still lower after further adjustments for smoking, use of nonsteroidal anti-inflammatory drugs, and lack of exercise (1.11; 95% CI, 1.01-1.23; P = .04). The risk for ulcer related to stress was similar among subjects who were H pylori seropositive, those who were H pylori seronegative, and those exposed to neither H pylori nor nonsteroidal anti-inflammatory drugs. On multivariable analysis, stress, socioeconomic status, smoking, H pylori infection, and use of nonsteroidal anti-inflammatory drugs were independent predictors of ulcer. CONCLUSIONS In a prospective study of a population-based Danish cohort, psychological stress increased the incidence of peptic ulcer, in part by influencing health risk behaviors. Stress had similar effects on ulcers associated with H pylori infection and those unrelated to either H pylori or use of nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
| | - Steffen Rosenstock
- Gastroenterology Department, Surgical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
| | - Torben Jorgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
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Precechtelova J, Borsanyiova M, Sarmirova S, Bopegamage S. Type I diabetes mellitus: genetic factors and presumptive enteroviral etiology or protection. J Pathog 2014; 2014:738512. [PMID: 25574400 PMCID: PMC4276674 DOI: 10.1155/2014/738512] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/14/2014] [Accepted: 11/09/2014] [Indexed: 02/06/2023] Open
Abstract
We review type 1 diabetes and host genetic components, as well as epigenetics and viruses associated with type 1 diabetes, with added emphasis on the enteroviruses, which are often associated with triggering the disease. Genus Enterovirus is classified into twelve species of which seven (Enterovirus A, Enterovirus B, Enterovirus C, and Enterovirus D and Rhinovirus A, Rhinovirus B, and Rhinovirus C) are human pathogens. These viruses are transmitted mainly by the fecal-oral route; they may also spread via the nasopharyngeal route. Enterovirus infections are highly prevalent, but these infections are usually subclinical or cause a mild flu-like illness. However, infections caused by enteroviruses can sometimes be serious, with manifestations of meningoencephalitis, paralysis, myocarditis, and in neonates a fulminant sepsis-like syndrome. These viruses are often implicated in chronic (inflammatory) diseases as chronic myocarditis, chronic pancreatitis, and type 1 diabetes. In this review we discuss the currently suggested mechanisms involved in the viral induction of type 1 diabetes. We recapitulate current basic knowledge and definitions.
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Affiliation(s)
- Jana Precechtelova
- Enterovirus Laboratory, Faculty of Medicine, Slovak Medical University, Limbova 12, 83303 Bratislava, Slovakia
| | - Maria Borsanyiova
- Enterovirus Laboratory, Faculty of Medicine, Slovak Medical University, Limbova 12, 83303 Bratislava, Slovakia
| | - Sona Sarmirova
- Enterovirus Laboratory, Faculty of Medicine, Slovak Medical University, Limbova 12, 83303 Bratislava, Slovakia
| | - Shubhada Bopegamage
- Enterovirus Laboratory, Faculty of Medicine, Slovak Medical University, Limbova 12, 83303 Bratislava, Slovakia
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Surya S, Salam AD, Tomy DV, Carla B, Kumar RA, Sunil C. Diabetes mellitus and medicinal plants-a review. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60585-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hara N, Alkanani AK, Ir D, Robertson CE, Wagner BD, Frank DN, Zipris D. The role of the intestinal microbiota in type 1 diabetes. Clin Immunol 2012; 146:112-9. [PMID: 23314185 DOI: 10.1016/j.clim.2012.12.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 11/30/2012] [Accepted: 12/01/2012] [Indexed: 02/07/2023]
Abstract
The digestive tract hosts trillions of bacteria that interact with the immune system and can influence the balance between pro-inflammatory and regulatory immune responses. Recent studies suggest that alterations in the composition of the intestinal microbiota may be linked with the development of type 1 diabetes (T1D). Data from the biobreeding diabetes prone (BBDP) and the LEW1.WR1 models of T1D support the hypothesis that intestinal bacteria may be involved in early disease mechanisms. The data indicate that cross-talk between the gut microbiota and the innate immune system may be involved in islet destruction. Whether a causal link between intestinal microbiota and T1D exists, the identity of the bacteria and the mechanism whereby they promote the disease remain to be examined. A better understanding of the interplay between microbes and innate immune pathways in early disease stages holds promise for the design of immune interventions and disease prevention in genetically susceptible individuals.
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Affiliation(s)
- Naoko Hara
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO 80045, USA
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Abstract
BACKGROUND Rat models of diabetes have emerged as a powerful experimental tool for addressing the role of microbial pathogens in the mechanism of autoimmune diabetes. We have used the biobreeding diabetes resistant and LEW1.WR1 rat models to identify the role of virus-induced innate immunity in the mechanism of type 1 diabetes. METHODS Groups of rats 21-25 days of age were left untreated, injected i.p. with 1×10(7) PFU of Kilham rat virus (KRV) only, or with 1-3 µg/g body-weight-purified toll-like receptor agonists on three consecutive days and infected with 1×10(7) PFU of KRV on the following day. Spleens and pancreatic lymph nodes were recovered 5 days after infection and used for gene array analysis. To test the role of inflammation in diabetes, rats injected with KRV only or Poly(I:C) plus KRV were also administered with 2 or 0.2 µg/g body weight of dexamethasone and followed for diabetes for 40 days. RESULTS KRV induced the expression of a vast array of proinflammatory genes in pancreatic lymph nodes on day 5 following infection. Brief dexamethasone therapy downmodulated inflammation and completely blocked diabetes. CONCLUSIONS Our data suggest a strong association between early virus-induced proinflammatory responses and islet destruction and raise the possibility that targeting innate immune pathways in the early stages of diabetes may be a useful strategy for disease prevention.
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Affiliation(s)
- Danny Zipris
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO 80045, USA.
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Kaposztas Z, Gyurus E, Kahan BD. New-onset diabetes after renal transplantation: diagnosis, incidence, risk factors, impact on outcomes, and novel implications. Transplant Proc 2011; 43:1375-94. [PMID: 21693204 DOI: 10.1016/j.transproceed.2011.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE New-onset diabetes after transplantation (NODAT) is a multifactorial, complex metabolic disorder associated with impaired long-term graft function, reduced recipient survival, and increased risks of cardiovascular disease and infectious complications. The impact of NODAT is generally underestimated partly due to the inconsistent criteria that have been previously used for its diagnosis and to the generally short observation periods. The aim of this article was to review the recent literature on NODAT and to highlight the novel implications. FINDINGS The 2010 American Diabetes Association guidelines provide useful, simplified criteria to unify the diagnosis including application of hemoglobin A1C levels. We sought to establish the impact of various modifiable and nonmodifiable risk factors. A vast number of papers have examined the effects of immunosuppressive medications on the development of NODAT: Neither calcineurin inhibitor nor sirolimus (SRL) or steroids seems to be innocent of contributing to it. Immunosuppressants account for 74% of the occurrence of NODAT. Among modifiable risk factors, obesity is independent and significant, with great prevalence in the population. In additional to lifestyle modifications, the role of bariatric surgery (BS) either before or after transplantation is highlighted herein as a strategy to reduce disease in the view of the results among overweight, nontransplanted patients. SUMMARY Because of the strong association between high glucose values in the early posttransplant period and the development of NODAT, the condition must be recognized early after (or even before) transplantation by intensive screening. Patients at risk for NODAT must modify appropriate risk factors and particularly undergo pretransplant planning and/or posttransplant adjustment individualizing immunosuppressive therapy to mitigate the risk of this serious complication.
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Affiliation(s)
- Z Kaposztas
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, Wales
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Varani S, Landini MP. Cytomegalovirus-induced immunopathology and its clinical consequences. HERPESVIRIDAE 2011; 2:6. [PMID: 21473750 PMCID: PMC3082217 DOI: 10.1186/2042-4280-2-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/07/2011] [Indexed: 12/23/2022]
Abstract
Human cytomegalovirus (CMV) is a ubiquitous DNA virus that causes severe disease in patients with immature or impaired immune systems. During active infection, CMV modulates host immunity, and CMV-infected patients often develop signs of immune dysfunction, such as immunosuppression and autoimmune phenomena. Furthermore, active viral infection has been observed in several autoimmune diseases, and case reports have linked primary CMV infection and the onset of autoimmune disorders. In addition, CMV infection promotes allograft rejection and graft-versus-host disease in solid organ and bone marrow transplant recipients, respectively, further implicating CMV in the genesis and maintenance of immunopathological phenomena. The mechanisms by which CMV could induce inhibition of host defense, inflammation, and autoimmunity are discussed, as is the treatment of virus-induced immunopathology with antivirals.
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Affiliation(s)
- Stefania Varani
- Section of Microbiology, Department of Hematology and Oncology, University of Bologna, Bologna, Italy.
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Demirci MS, Toz H, Yilmaz F, Ertilav M, Asci G, Ozkahya M, Zeytinoglu A, Nart D, Ok E. Risk factors and consequences of post-transplant diabetes mellitus. Clin Transplant 2011; 24:E170-7. [PMID: 20384711 DOI: 10.1111/j.1399-0012.2010.01247.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study is to investigate the clinical course as well as risk factors and prognosis of post-transplant diabetes mellitus (PTDM). METHODS Five hundred fifty-five kidney transplant recipients were retrospectively evaluated. PTDM was defined as fasting blood glucose ≥140 mg/dL on at least two consecutive measurements or requirement of oral antidiabetic drug or insulin. Patients with PTDM were divided into subgroups according to time of onset (early; <90 d vs. late, ≥90 d) and duration of diabetes (transient, <90 d vs. sustained ≥90 d). RESULTS The frequency of PTDM was 18.3%. In multivariate analysis age (p < 0.001), hepatitis C virus (HCV) infection (p < 0.05) and tacrolimus use (p < 0.001) were independent risk factors. Among 220 HCV+ patients, liver biopsy was performed in 158, the histological grade (3.3 ± 2.8 vs. 4.4 ± 3.1) and stage (0.9 ± 1.1 vs. 1.4 ± 1.2) were significantly more severe in patients with PTDM than in non-diabetics. Incidence of PTDM in patients with severe fibrosis was 46.7%; 19.2% in nil or mild fibrosis (p < 0.05). Patient and graft survival were significantly worse, and cardiovascular events and life-threatening infection episodes were more frequent in PTDM. Half of the patients had early PTDM, while 30.3% of patients with PTDM showed transient nature. Five- and 10-yr death censored graft survival rates were worse in transient subgroup compared with sustained patients with diabetes (log rank 0.025) whereas there was no difference in outcome between early and late subgroups. CONCLUSIONS Age, tacrolimus, and HCV are independent risk factors for PTDM. PTDM has a negative impact on both patient and graft survival, irrespective of the time of onset and duration of diabetes.
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Van Laecke S, Desideri F, Geerts A, Van Vlierberghe H, Berrevoet F, Rogiers X, Troisi R, de Hemptinne B, Vanholder R, Colle I. Hypomagnesemia and the risk of new-onset diabetes after liver transplantation. Liver Transpl 2010; 16:1278-87. [PMID: 21031543 DOI: 10.1002/lt.22146] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
New-onset diabetes after transplantation (NODAT) is a frequent complication after liver transplantation and has a negative impact on both patient and graft survival. In analogy with the previous finding of an association between posttransplant hypomagnesemia and NODAT in renal transplant recipients, the relation between both pretransplant and posttransplant hypomagnesemia and NODAT was studied in liver transplant recipients (LTRs). One hundred sixty-nine adult LTRs (>18 years old) without diabetes who underwent transplantation between 2004 and 2009 were studied (mean age = 52.11 ± 12.6 years, proportion of LTRs who were male = 67.5%, body mass index = 25.5 ± 4.4 kg/m², proportion receiving tacrolimus = 90.0%). NODAT was defined according to the American Diabetes Association criteria. The association of NODAT with both pretransplant and posttransplant serum magnesium (Mg) was examined. Overall, 52 of 169 patients (30.8%) developed NODAT, and 57.7% of these (30 patients) were treated with antidiabetic drugs. Both pretransplant Mg levels and Mg levels in the first month after transplantation were lower in patients developing NODAT (P = 0.008 and P = 0.001, respectively). A multivariate regression model (adjusted for weight, pretransplant glucose levels, hyperglycemia in the first week after transplantation, gender, hepatitis C, and corticosteroid dosing) demonstrated both pretransplant Mg levels (hazard ratio = 0.844 per 0.1 mg/dL increase, 95% confidence interval = 0.764-0.932, P = 0.001) and posttransplant Mg levels (hazard ratio = 0.659, 95% confidence interval = 0.518-0.838, P = 0.001) to be independent predictors of NODAT together with age, biopsy-proven acute rejection, and cytomegalovirus (CMV) infection in the first year after transplantation. In conclusion, pretransplant hypomagnesemia and early posttransplant hypomagnesemia are independent predictors of new-onset diabetes after liver transplantation. Other risk factors are age, biopsy-proven acute rejection, and CMV infection.
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Affiliation(s)
- Steven Van Laecke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
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