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Baker M, Lauterwasser S, Valenti C, Kallenberger M, Stolte H. Evaluation of a hybrid protocol using continuous glucose monitoring and point-of-care testing in non-critically ill patients in a community hospital. Am J Health Syst Pharm 2024; 81:e261-e267. [PMID: 38146957 DOI: 10.1093/ajhp/zxad332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE Inpatient glycemic management typically involves use of point-of-care (POC) glucose measurements to inform insulin dosing decisions. This study evaluated a hybrid monitoring protocol using real-time continuous glucose monitoring (rtCGM) supplemented with POC testing at a community hospital. METHODS Adult inpatients receiving POC glucose testing were monitored using rtCGM in a telemetry unit. The hybrid monitoring protocol required a once-daily POC test but otherwise primarily relied on rtCGM values for insulin dosing decisions. Outcomes assessment included surveillance error grid (SEG) and Clarke Error Grid (CEG) analysis results, the mean absolute relative difference (MARD) for available rtCGM-POC value pairs before and after study protocol application, the number of POC tests avoided, and the number of hypoglycemic events involving a blood glucose value of <70 mg/dL identified by rtCGM and POC values. RESULTS Data were collected from 30 inpatients (the mean age was 69.4 years, 77% were female, 80% had type 2 diabetes, and 37% were at-home insulin users). With the protocol applied, a total of 202 rtCGM-POC pairs produced a MARD of 12.5%. SEG analysis showed 2 pairs in the "moderate" risk category, with all other pairs in the "none" or "slight" risk categories. CEG analysis showed 99% of paired values to be in the clinically acceptable range. Six hypoglycemic events in 5 patients were resolved without incident. Three hundred three POC tests were avoided, a 60% reduction for the study duration. CONCLUSION Use of a hybrid monitoring protocol of rtCGM and POC testing in a community hospital demonstrated sustained rtCGM accuracy and was found to reduce the frequency of POC testing to manage inpatient glycemia.
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Affiliation(s)
- Matt Baker
- North Kansas City Hospital, North Kansas City, MO, USA
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Wu Z, Wang J, Ullah R, Chen M, Huang K, Dong G, Fu J. Covid 19 and diabetes in children: advances and strategies. Diabetol Metab Syndr 2024; 16:28. [PMID: 38287388 PMCID: PMC10823738 DOI: 10.1186/s13098-024-01267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, there has been a notable increase in the incidence of new-onset diabetes and diabetic ketoacidosis (DKA). Simultaneously, children diagnosed with type 1 diabetes (T1D) have encountered difficulties in maintaining optimal blood glucose levels. The mechanisms underpinning these correlations still remain a puzzle. We reviewed the studies that examined changes in incidence during the pandemic. These studies utilized various metrics for comparison, which encompassed the timing of data collection, diagnostic criteria, as well as the numbers and incidence rates of diabetes and DKA. We found the incidence of diabetes and DKA was higher during the pandemic. As to mechanisms, the invivo and invitro study revealed the factors such as direct viral damage, metabolic dysfunction, and immune responses all attribute to the process of T1D after suffering from COVID-19. Furthermore, we provide some useful strategies to prevent and treat children suffering from diabetes and COVID-19. CONCLUSIONS Strong correlations have been observed between new-onset diabetes and COVID-19. Insights gleaned from clinical descriptions and basic research can offer valuable experience and recommendations for the treatment and prevention of diabetes during future pandemics.
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Affiliation(s)
- Zhaoyuan Wu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jinling Wang
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Rahim Ullah
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Minghao Chen
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guanping Dong
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junfen Fu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Agarwal A, Bansal D, Nallasamy K, Jayashree M, William V. Pediatric Diabetes and Diabetic Ketoacidosis After COVID-19: Challenges Faced and Lessons Learnt. Pediatric Health Med Ther 2023; 14:281-288. [PMID: 37691882 PMCID: PMC10488656 DOI: 10.2147/phmt.s384104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic affected the management and follow-up of several chronic ailments, including pediatric type 1 diabetes mellitus (T1DM). Restricted access to healthcare and fear of contracting the virus during medical facility visits resulted in poor compliance, irregular follow-up visits, treatment, and delayed diagnosis of complications in pediatric diabetes such as diabetic ketoacidosis (DKA). As such, the incidence of complicated DKA in resource-limited settings is high due to delayed presentation, poor compliance with therapy, and associated comorbidities such as malnutrition and sepsis. The pandemic had only added to the woes. The increased surge in DKA, in the face of limited resources, prompted clinicians to find alternative solutions to manage these children effectively. In this narrative review, we discuss the key challenges faced globally while caring for children with T1DM and DKA during the COVID-19 pandemic, and the lessons learned thereof.
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Affiliation(s)
- Ashish Agarwal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepankar Bansal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Vijai William
- Division of Pediatric Critical Care, Department of Critical Care, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Grubišić B, Švitek L, Ormanac K, Sabo D, Mihaljević I, Bilić-Ćurčić I, Omanović Kolarić T. Molecular Mechanisms Responsible for Diabetogenic Effects of COVID-19 Infection-Induction of Autoimmune Dysregulation and Metabolic Disturbances. Int J Mol Sci 2023; 24:11576. [PMID: 37511334 PMCID: PMC10380525 DOI: 10.3390/ijms241411576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic has revealed a significant association between SARS-CoV-2 infection and diabetes, whereby individuals with diabetes are more susceptible to severe disease and higher mortality rates. Interestingly, recent findings suggest a reciprocal relationship between COVID-19 and diabetes, wherein COVID-19 may contribute to developing new-onset diabetes and worsen existing metabolic abnormalities. This narrative review aims to shed light on the intricate molecular mechanisms underlying the diabetogenic effects of COVID-19. Specifically, the review explores the potential role of various factors, including direct damage to β-cells, insulin resistance triggered by systemic inflammation, and disturbances in hormonal regulation, aiming to enhance our understanding of the COVID-19 impact on the development and progression of diabetes. By analysing these mechanisms, the aim is to enhance our understanding of the impact of COVID-19 on the development and progression of diabetes. The binding of SARS-CoV-2 to angiotensin-converting enzyme 2 (ACE2) receptors, which are present in key metabolic organs and tissues, may interfere with glucometabolic pathways, leading to hyperglycaemia, and potentially contribute to the development of new disease mechanisms. The virus's impact on β-cells through direct invasion or systemic inflammation may induce insulin resistance and disrupt glucose homeostasis. Furthermore, glucocorticoids, commonly used to treat COVID-19, may exacerbate hyperglycaemia and insulin resistance, potentially contributing to new-onset diabetes. The long-term effects of COVID-19 on glucose metabolism are still unknown, necessitating further research into the possibility of developing a novel type of diabetes. This article provides a comprehensive overview of the current understanding of the interaction between COVID-19 and diabetes, highlighting potential areas for future research and therapeutic interventions.
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Affiliation(s)
- Barbara Grubišić
- Department of Infectious Diseases, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Luka Švitek
- Department of Infectious Diseases, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Klara Ormanac
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Dea Sabo
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Ivica Mihaljević
- Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Department for Nuclear Medicine and Oncology, Faculty of Medicine, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Academy of Medical Sciences of Croatia, 15 Kaptol Street, HR-10000 Zagreb, Croatia
| | - Ines Bilić-Ćurčić
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Department of Endocrinology and Metabolism Disorders, Internal Medicine Clinic, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Tea Omanović Kolarić
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, University of Osijek, 21 Crkvena Street, HR-31000 Osijek, Croatia
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Karavanaki K, Rodolaki K, Soldatou A, Karanasios S, Kakleas K. Covid-19 infection in children and adolescents and its association with type 1 diabetes mellitus (T1d) presentation and management. Endocrine 2023; 80:237-252. [PMID: 36462147 PMCID: PMC9734866 DOI: 10.1007/s12020-022-03266-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022]
Abstract
Children seem to be affected by the new SARS-CoV-2 virus less severely than adults, with better prognosis and low mortality. Serious complications of COVID-19 infection in children include multisystem inflammatory response syndrome in COVID-19 infection (MIS-C), myo-or pericarditis and, less frequently, long COVID syndrome. On the other hand, adults with type 1 (T1D) or type 2 diabetes (T2D) are among the most vulnerable groups affected by COVID-19, with increased morbidity and mortality. Moreover, an association of SARS-CoV-2 with diabetes has been observed, possibly affecting the frequency and severity of the first clinical presentation of T1D or T2D, as well as the development of acute diabetes after COVID-19 infection. The present review summarizes the current data on the incidence of T1D among children and adolescents during the COVID-19 pandemic, as well as its severity. Moreover, it reports on the types of newly diagnosed diabetes after COVID infection and the possible pathogenetic mechanisms. Additionally, this study presents current data on the effect of SARS-CoV-2 on diabetes control in patients with known T1D and on the severity of clinical presentation of COVID infection in these patients. Finally, this review discusses the necessity of immunization against COVID 19 in children and adolescents with T1D.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Kalliopi Rodolaki
- First Department of Pediatrics, National and Kapodistrian University of Athens,"Aghia Sophia" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Kostas Kakleas
- First Department of Pediatrics, National and Kapodistrian University of Athens,"Aghia Sophia" Children's Hospital, Athens, Greece.
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Chen AX, Radhakutty A, Zimmermann A, Stranks SN, Thompson CH, Burt MG. Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia. Diabetes Res Clin Pract 2023; 197:110557. [PMID: 36736733 DOI: 10.1016/j.diabres.2023.110557] [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: 08/31/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
AIMS The optimal treatment of prednisolone-associated hyperglycaemia is unclear, but guidelines recommend using a body weight-based daily insulin dose. This study evaluated how clinical variables were associated with insulin requirements in hospitalised patients with prednisolone-associated hyperglycaemia. METHODS In this prospective study, fifty adult inpatients who were taking prednisolone ≥20 mg/day and experienced hyperglycaemia were prescribed a 24-h intravenous insulin infusion. The daily insulin dose required to attain a mean glucose of 8 mmol/L was calculated. The associations between daily insulin dose and clinical variables were assessed. RESULTS The participants age was 69 ± 10 years, daily prednisolone dose was 34 ± 10 mg, HbA1c was 7.7 ± 2.0 % (61 ± 10 mmol/mol), 77 % had known type 2 diabetes and 30 % were female. In univariate analysis, weight was associated with daily insulin dose (r2 = 0.11, p = 0.024). A multivariate model comprising sex, HbA1c, a prior diagnosis of diabetes, diabetes treatment and weight explained nearly-two thirds of the variability in daily insulin dose (r2 = 0.65, p < 0.001). CONCLUSIONS In patients with prednisolone-associated hyperglycaemia, calculating insulin doses based on sex, HbA1c, diabetes status and regular diabetes treatment and weight may improve glycaemic control compared to weight-based dosing.
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Affiliation(s)
- Angela X Chen
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
| | - Anjana Radhakutty
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia.
| | - Anthony Zimmermann
- Department of Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia; Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, Australia.
| | - Stephen N Stranks
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
| | - Campbell H Thompson
- Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, Australia; Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia.
| | - Morton G Burt
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
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Abstract
Almost immediately after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus emerged, it was evident that people with chronic diseases, including diabetes, were disproportionately affected, with an increased risk of hospitalisation and mortality. Over the ensuing 2 years, the indirect effects of the pandemic on healthcare delivery in the short term have become prominent, along with the lingering effects of the virus in those directly infected. In the wake of the pandemic and without any evidence from high quality studies, a number of national and international consensus recommendations were published, which were subsequently rapidly updated based on observational studies. There have been unprecedented disruptions from both direct and indirect impacts of coronavirus disease-2019 (COVID-19) in people with diabetes. In this review, we summarise the impact of acute COVID-19 in people with diabetes, discuss how the presentation and epidemiology during the pandemic, including presentation of diabetic ketoacidosis and new-onset diabetes, has changed, and we consider the wider impact of the pandemic on patients and healthcare service delivery, including some of the areas of uncertainty. Finally, we make recommendations on prioritising patients as we move into the recovery phase and also how we protect people with diabetes for the future, as COVID-19 is likely to become endemic.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.
| | - Jonathan Valabhji
- Division of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Shivani Misra
- Division of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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8
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Chertok Shacham E, Maman N, Ishay A. Blood glucose control with different treatment regimens in type 2 diabetes patients hospitalized with COVID-19 infection: A retrospective study. Medicine (Baltimore) 2023; 102:e32650. [PMID: 36701712 PMCID: PMC9857348 DOI: 10.1097/md.0000000000032650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Coronavirus disease (COVID-19) is closely associated with hyperglycemia and a worse prognosis in patients with a previous diagnosis of type 2 diabetes mellitus. A few studies investigated the effects of diabetes treatment regimens in these patients during hospitalization. Here, we evaluate the impact of insulin and non-insulin therapy on glucose control in patients with type 2 diabetes admitted with COVID-19. This is a retrospective study including 359 COVID-19 patients with type 2 diabetes. Patients were divided into 2 groups according to diabetes treatment during hospitalization. The first group included patients treated with insulin only, and the second group patients treated with other antidiabetic agents with or without insulin. Average blood glucose was higher in the insulin-only treatment group (201 ± 66 mg/dL vs 180 ± 71 mg/dL, P = .004), even after excluding mechanically ventilated patients (192 ± 69 vs 169 ± 59 mg/dL, P = .003). In patients with moderate severity of COVID-19, average blood glucose was also significantly higher in the insulin-only treated group (197 ± 76 vs 168 ± 51 mg/dL, P = .001). Most patients (80%) in the combination treatment group received metformin. Moderately affected COVID-19 patients with type 2 diabetes could safely be treated with antihyperglycemic medications with or without insulin.
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Affiliation(s)
- Elena Chertok Shacham
- Endocrinology Unit, Haemek Medical Center, Afula, Israel
- * Correspondence: Elena Chertok Shacham, Haemek Medical Center, Endocrinology Unit, Rabin Ave 21, Afula 18134, Israel (e-mail: )
| | - Nimra Maman
- Statistic Department, Haemek Medical Center, Afula, Israel
| | - Avraham Ishay
- Endocrinology Unit, Haemek Medical Center, Afula, Israel
- Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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Dexamethasone use and insulin requirements in coronovirus-19 (COVID-19) infection stratified by Hemoglobin A1c. DIABETES EPIDEMIOLOGY AND MANAGEMENT 2023; 10:100123. [PMID: 36514311 PMCID: PMC9733297 DOI: 10.1016/j.deman.2022.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Aims The study aimed to identify weight-based insulin requirements for dexamethasone-induced hyperglycemia in COVID-19 infection stratified by hemoglobin A1c (HbA1c). Methods This retrospective study assessed hospitalized patients ≥ 18 years admitted with COVID-19 and receiving ≥ 1 dose of dexamethasone 6 mG. Daily blood glucose (BG) and insulin doses were collected and organized by HbA1c. Results Among 45 patients with available HbA1c, 100% [HbA1c ≥ 7%] and 72% [HbA1c < 7%] developed hyperglycemia (BG ≥180 mG/dL). Median daily insulin (Interquartile Range) (units/kG/day) was 0.03 (0, 0.32) [HbA1c 6–6.9%], 0.1 (0.06, 0.36) [HbA1c 7–7.9%], 0.66 (0.39, 0.69) [HbA1c 8–8.9%], and 0.72 (0.63, 0.78) [HbA1c ≥ 9%]. On day 10 of dexamethasone, when majority of patients were at goal BG, patients required 0.07 (0.01, 0.31) [HbA1c 6–6.9%], 0.59 (0.11, 0.75) [HbA1c 7–7.9%], 1.15 (0.95, 1.35) [HbA1c 8–8.9%], and 1.14 units/kG/day [HbA1c ≥ 9%]. Of 24 patients completing 10 days of dexamethasone, 25% experienced hypoglycemia (BG < 70 mG/dL) upon discontinuation. Conclusion Patients with higher HbA1c experienced greater dexamethasone-induced hyperglycemia and required higher insulin doses. Inpatient insulin dosing algorithms should take into consideration baseline HbA1c to avoid delays in achieving normoglycemia.
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Kania M, Mazur K, Terlecki M, Matejko B, Hohendorff J, Chaykivska Z, Fiema M, Kopka M, Kostrzycka M, Wilk M, Klupa T, Witek P, Katra B, Klocek M, Rajzer M, Malecki MT. Characteristics, Mortality, and Clinical Outcomes of Hospitalized Patients with COVID-19 and Diabetes: A Reference Single-Center Cohort Study from Poland. Int J Endocrinol 2023; 2023:8700302. [PMID: 36844106 PMCID: PMC9949948 DOI: 10.1155/2023/8700302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Diabetes is a risk factor for a severe course of COVID-19. We evaluated the characteristics and risk factors associated with undesirable outcomes in diabetic patients (DPs) hospitalized due to COVID-19. MATERIALS AND METHODS The data analysis of patients admitted between March 6, 2020, and May 31, 2021, to the University Hospital in Krakow (Poland), a reference center for COVID-19, was performed. The data were gathered from their medical records. RESULTS A total number of 5191 patients were included, of which 2348 (45.2%) were women. The patients were at the median age of 64 (IQR: 51-74) years, and 1364 (26.3%) were DPs. DPs, compared to nondiabetics, were older (median age: 70 years, IQR: 62-77 vs. 62, IQR: 47-72, and p < 0.001) and had a similar gender distribution. The DP group had a higher mortality rate (26.2% vs. 15.7%, p < 0.001) and longer hospital stays (median: 15 days, IQR: 10-24 vs. 13, IQR: 9-20, and p < 0.001). DPs were admitted to the ICU more frequently (15.7% vs. 11.0%, p < 0.001) and required mechanical ventilation more often (15.5% vs. 11.3%, p < 0.001). In a multivariate logistic regression, factors associated with a higher risk of death were age >65 years, glycaemia >10 mmol/L, CRP and D-dimer level, prehospital insulin and loop diuretic use, presence of heart failure, and chronic kidney disease. Factors contributing to lower mortality were in-hospital use of statin, thiazide diuretic, and calcium channel blocker. CONCLUSION In this large COVID-19 cohort, DPs constituted more than a quarter of hospitalized patients. The risk of death and other outcomes compared to nondiabetics was higher in this group. We identified a number of clinical, laboratory, and therapeutic variables associated with the risk of hospital death in DPs.
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Affiliation(s)
- Michał Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | - Michał Terlecki
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | | | | | | | - Magdalena Wilk
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Barbara Katra
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Marek Klocek
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Rajzer
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
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11
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S267-S278. [PMID: 36507644 PMCID: PMC9810470 DOI: 10.2337/dc23-s016] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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12
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Uchihara M, Kodani N, Bouchi R, Saito S, Miyazato Y, Sugimoto H, Umamoto K, Kobayashi M, Ihana-Sugiyama N, Ohsugi M, Tanabe A, Ueki K, Takasaki J, Hojo M, Kajio H. Glycemic control using intermittently scanned continuous glucose monitoring in patients with diabetes requiring methylprednisolone therapy for severe COVID-19. Glob Health Med 2022; 4:336-340. [PMID: 36589220 PMCID: PMC9773227 DOI: 10.35772/ghm.2022.01053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
In patients with severe coronavirus disease 2019 (COVID-19) with diabetes, glycemic control is essential for a better outcome, however, we face difficulty controlling hyperglycemia induced by high-dose glucocorticoids. We report five cases of severe COVID-19 patients with diabetes, whose glycemic control was managed using an intermittently scanned continuous glucose monitoring (isCGM) system during methylprednisolone therapy. Patients using isCGM showed significantly lower average blood glucose levels and significantly higher total daily insulin dose during the methylprednisolone therapy, compared to patients under regular blood glucose monitoring. The use of isCGM enables remote glucose monitoring, and this can reduce the risks of healthcare workers who have frequent contact with the patients. Thus, we suggest that using isCGM should be considered in hospitalized patients with diabetes under the COVID-19 pandemic to achieve better glycemic control and to minimize the possible risks of healthcare workers.
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Affiliation(s)
- Masaki Uchihara
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Kodani
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan;,Address correspondence to:Noriko Kodani, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
| | - Ryotaro Bouchi
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan;,Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Miyazato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hirofumi Sugimoto
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kotaro Umamoto
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Michi Kobayashi
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Ihana-Sugiyama
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan;,Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuru Ohsugi
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan;,Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kohjiro Ueki
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan;,Department of Molecular Diabetic Medicine, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jin Takasaki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan;,Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
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13
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Abiri B, Ahmadi AR, Hejazi M, Amini S. Obesity, Diabetes Mellitus, and Metabolic Syndrome: Review in the Era of COVID-19. Clin Nutr Res 2022; 11:331-346. [PMID: 36381471 PMCID: PMC9633974 DOI: 10.7762/cnr.2022.11.4.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 01/24/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now at pandemic levels leading to considerable morbidity and mortality throughout the globe. Patients with obesity, diabetes, and metabolic syndrome (MetS) are mainly susceptible and more probably to get severe side effects when affected by this virus. The pathophysiologic mechanisms for these notions have not been completely known. The pro-inflammatory milieu observed in patients with metabolic disruption could lead to COVID-19-mediated host immune dysregulation, such as immune dysfunction, severe inflammation, microvascular dysfunction, and thrombosis. The present review expresses the current knowledge regarding the influence of obesity, diabetes mellitus, and MetS on COVID-19 infection and severity, and their pathophysiological mechanisms.
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Affiliation(s)
- Behnaz Abiri
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 19839-63113, Iran
| | - Amirhossein Ramezani Ahmadi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Mahdi Hejazi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran 14166-34793, Iran
| | - Shirin Amini
- Department of Nutrition, Shoushtar Faculty of Medical Sciences, Shoushtar 64517-73865, Iran
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14
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Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19. Infect Dis Rep 2022; 14:675-685. [PMID: 36136823 PMCID: PMC9498653 DOI: 10.3390/idr14050073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 01/08/2023] Open
Abstract
Evidence is conflicting about the diabetes characteristics associated with worse outcome among hospitalized COVID-19 patients. We aimed to assess the role of stress hyperglycemia ratio (SHR) as a prognostic marker among them. In our retrospective cohort study, patients were stratified according to SHR, admission glucose, and glycated hemoglobin tertiles. The primary outcome was a composite endpoint of invasive mechanical ventilation, intensive care unit admission, and in-hospital mortality. The study included 395 patients with a mean age of 59 years, and 50.1% were males. Patients in the third tertile of SHR developed more primary events, and the difference was significant compared to the first tertile (p = 0.038) and close to significance compared to the second tertile (p = 0.054). There was no significant difference in the outcomes across admission glucose and glycated hemoglobin tertiles. A higher SHR tertile was an independent risk factor for the primary outcome (OR, 1.364; 95% CI: 1.014–1.836; p = 0.040) after adjustment for other covariables. In hospitalized COVID-19 diabetic patients, SHR third tertile was significantly associated with worse outcome and death. SHR can be a better prognostic marker compared to admission glucose and glycated hemoglobin. A higher SHR was an independent risk factor for worse outcome and in-hospital mortality.
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15
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Herzig D, Suhner S, Roos J, Schürch D, Cecchini L, Nakas CT, Weiss S, Kadner A, Kocher GJ, Guensch DP, Wilinska ME, Raabe A, Siebenrock KA, Beldi G, Gloor B, Hovorka R, Vogt AP, Bally L. Perioperative Fully Closed-Loop Insulin Delivery in Patients Undergoing Elective Surgery: An Open-Label, Randomized Controlled Trial. Diabetes Care 2022; 45:2076-2083. [PMID: 35880252 DOI: 10.2337/dc22-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Perioperative management of glucose levels remains challenging. We aimed to assess whether fully closed-loop subcutaneous insulin delivery would improve glycemic control compared with standard insulin therapy in insulin-requiring patients undergoing elective surgery. RESEARCH DESIGN AND METHODS We performed a single-center, open-label, randomized controlled trial. Patients with diabetes (other than type 1) undergoing elective surgery were recruited from various surgical units and randomly assigned using a minimization schedule (stratified by HbA1c and daily insulin dose) to fully closed-loop insulin delivery with fast-acting insulin aspart (closed-loop group) or standard insulin therapy according to local clinical practice (control group). Study treatment was administered from hospital admission to discharge (for a maximum of 20 days). The primary end point was the proportion of time with sensor glucose in the target range (5.6-10.0 mmol/L). RESULTS Forty-five patients were enrolled and assigned to the closed-loop (n = 23) or the control (n = 22) group. One patient (closed-loop group) withdrew from the study before surgery and was not analyzed. Participants underwent abdominal (57%), vascular (23%), orthopedic (9%), neuro (9%), or thoracic (2%) surgery. The mean proportion of time that sensor glucose was in the target range was 76.7 ± 10.1% in the closed-loop and 54.7 ± 20.8% in the control group (mean difference 22.0 percentage points [95% CI 11.9; 32.0%]; P < 0.001). No episodes of severe hypoglycemia (<3.0 mmol/L) or hyperglycemia with ketonemia or any study-related adverse events occurred in either group. CONCLUSIONS In the context of mixed elective surgery, the use of fully closed-loop subcutaneous insulin delivery improves glucose control without a higher risk of hypoglycemia.
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Affiliation(s)
- David Herzig
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Bern, Switzerland
| | - Simon Suhner
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Bern, Switzerland
| | - Jonathan Roos
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Bern, Switzerland
| | - Daniel Schürch
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Bern, Switzerland
| | - Luca Cecchini
- Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland
| | - Christos T Nakas
- Laboratory of Biometry, School of Agriculture, University of Thessaly, Nea Ionia-Volos, Magnesia, Greece.,University Institute of Clinical Chemistry, University Hospital of Bern, Bern, Switzerland
| | - Salome Weiss
- Department of Cardiovascular Surgery, University Hospital of Bern, Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, University Hospital of Bern, Bern, Switzerland
| | - Gregor J Kocher
- Department of General Thoracic Surgery, University Hospital of Bern, Bern, Switzerland
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland
| | - Malgorzata E Wilinska
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Andreas Raabe
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
| | - Beat Gloor
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
| | - Roman Hovorka
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Andreas P Vogt
- Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Bern, Switzerland
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16
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Rey-Reñones C, Martinez-Torres S, Martín-Luján FM, Pericas C, Redondo A, Vilaplana-Carnerero C, Dominguez A, Grau M. Type 2 Diabetes Mellitus and COVID-19: A Narrative Review. Biomedicines 2022; 10:biomedicines10092089. [PMID: 36140191 PMCID: PMC9495673 DOI: 10.3390/biomedicines10092089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 01/08/2023] Open
Abstract
Type-2 diabetes mellitus (T2DM) is a chronic metabolic disorder. The incidence and prevalence of patients with T2DM are increasing worldwide, even reaching epidemic values in most high- and middle-income countries. T2DM could be a risk factor of developing complications in other diseases. Indeed, some studies suggest a bidirectional interaction between T2DM and COVID-19. A growing body of evidence shows that COVID-19 prognosis in individuals with T2DM is worse compared with those without. Moreover, various studies have reported the emergence of newly diagnosed patients with T2DM after SARS-CoV-2 infection. The most common treatments for T2DM may influence SARS-CoV-2 and their implication in infection is briefly discussed in this review. A better understanding of the link between TD2M and COVID-19 could proactively identify risk factors and, as a result, develop strategies to improve the prognosis for these patients.
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Affiliation(s)
- Cristina Rey-Reñones
- Research Support Unit-Camp de Tarragona, Catalan Institute of Health (ICS), 43005 Tarragona, Spain
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), USR Camp de Tarragona, 43202 Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Sara Martinez-Torres
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), USR Camp de Tarragona, 43202 Reus, Spain
| | - Francisco M. Martín-Luján
- Research Support Unit-Camp de Tarragona, Catalan Institute of Health (ICS), 43005 Tarragona, Spain
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), USR Camp de Tarragona, 43202 Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Carles Pericas
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Ana Redondo
- Hospital Universitario Bellvitge, Catalan Institute of Health (ICS), 08907 Barcelona, Spain
| | - Carles Vilaplana-Carnerero
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), 08007 Barcelona, Spain
| | - Angela Dominguez
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - María Grau
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Serra Húnter Fellow, Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Correspondence:
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17
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Gómez-Huelgas R, Gómez-Peralta F. Perceptions about the Management of Patients with DM2 and COVID-19 in the Hospital Care Setting. J Clin Med 2022; 11:jcm11154507. [PMID: 35956122 PMCID: PMC9369585 DOI: 10.3390/jcm11154507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/20/2022] [Accepted: 07/30/2022] [Indexed: 02/08/2023] Open
Abstract
Background: COVID-19 entails a higher rate of complications in subjects with type 2 diabetes mellitus (T2DM). Likewise, COVID-19 infection can cause alterations in glucose metabolism that may lead to worse control. The aim of the study was to analyse the perceptions of a large group of Spanish physicians about the relationship between COVID-19 and T2DM, as well as the management, monitoring, and treatment of both diseases. Methods: A cross-sectional multicenter national project was conducted based on a survey which included opinion, attitude, and behavior (OAB) questions. Physicians specialised in internal medicine or endocrinology, whose usual clinical practices included the management of T2DM, responded to the survey between March and April 2021. Results: A total of 112 participants responded to the survey, from which 64.3% believed that COVID-19 entailed a higher risk of glycaemic decompensation irrespective of the presence of previously known T2DM. Obesity was considered a risk factor for poor control of T2DM by 57.7% and for a worse course of COVID-19 by 61.0%. Treatment intensification in not-on-target patients was considered by 57.1% in the presence of COVID-19 and by 73.2% in the absence of COVID-19. No participants considered the suspension of dipeptidyl peptidase 4 inhibitors (DPP-4i) in ambulatory patients, 85.7% declared that this therapeutic approach in hospitalized patients should be kept, and 88.4% supported the option of maintaining DPP-4i when corticosteroids were prescribed. Conclusion: The physicians involved in the management of T2DM and COVID-19 are aware of the bidirectional relationship between both conditions. However, the monitoring and therapeutic management of patients with T2DM who are infected by SARS-CoV-2 needs improvement through the following of the current recommendations and available evidence.
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Affiliation(s)
- Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain
- Correspondence:
| | - Fernando Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General, Calle Luis Erik Clavería Neurólogo S/N, 40002 Segovia, Spain;
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18
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Brooks D, Schulman-Rosenbaum R, Griff M, Lester J, Low Wang CC. Glucocorticoid-Induced Hyperglycemia Including Dexamethasone-Associated Hyperglycemia in COVID-19 Infection: A Systematic Review. Endocr Pract 2022; 28:1166-1177. [PMID: 35940469 PMCID: PMC9354392 DOI: 10.1016/j.eprac.2022.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/08/2023]
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19
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Yu J, Lee SH, Kim MK. Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus. Endocrinol Metab (Seoul) 2022; 37:26-37. [PMID: 35255599 PMCID: PMC8901964 DOI: 10.3803/enm.2022.105] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/06/2022] [Indexed: 11/12/2022] Open
Abstract
Guidelines for the management of patients with diabetes have become an important part of clinical practice that improve the quality of care and help establish evidence-based medicine in this field. With rapidly accumulating evidence on various aspects of diabetes care, including landmark clinical trials of treatment agents and newer technologies, timely updates of the guidelines capture the most current state of the field and present a consensus. As a leading academic society, the Korean Diabetes Association publishes practice guidelines biennially and the American Diabetes Association does so annually. In this review, we summarize the key changes suggested in the most recent guidelines. Some of the important updates include treatment algorithms emphasizing comorbid conditions such as atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease in the selection of anti-diabetic agents; wider application of continuous glucose monitoring (CGM), insulin pump technologies and indices derived from CGM such as time in range; more active screening of subjects at high-risk of diabetes; and more detailed individualization in diabetes care. Although there are both similarities and differences among guidelines and some uncertainty remains, these updates provide a good approach for many clinical practitioners who are battling with diabetes.
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Affiliation(s)
- Jin Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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20
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GHOTBI TAHEREH, SALAMI JAVAD, KALTEH EHSANALLAH, GHELICHI-GHOJOGH MOUSA. Self-management of patients with chronic diseases during COVID19: a narrative review. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 62:E814-E821. [PMID: 35603256 PMCID: PMC9104668 DOI: 10.15167/2421-4248/jpmh2021.62.4.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION COVID-19 pandemic has affected the self-management of patients with chronic disease all over the world. The present study COVID-19 is a review to investigate the chronic patient self-management challenges during the corona epidemic, and providing solutions to solve this problem. METHODS The relevant literature on chronic patient self-management is investigated (from March 2019 to Jan 2021). Databases including Google Scholar, PubMed, Science Direct, Springer were used to search articles from the Latin articles. Also, keywords in this study included self-management, chronic disease, COVID-19. Finally, 26 relevant articles were used in this study. RESULTS Studies assessed the effective role of self-management in control and prevention of complications of chronic diseases and the challenges related to self-management programs during COVID-19, in addition the role of the health team in patients' self-management during the corona epidemics. CONCLUSION the main challenges for chronic patients during the COVID-19 include decreased healthcare service and regular follow-ups because of physical restrictions; economic problems, change in lifestyle, and lack of rapid compliance with the changes. In this regard, the health team should provide the best healthcare services using the available resources to reduce suffer and pain of the patients.
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Affiliation(s)
| | - JAVAD SALAMI
- Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Javad Salami, Shiraz University of Medical Sciences, Shiraz, Iran - Tel.: (98) 715 2726308 - Fax: (98) 715 2726308 - E-mail:
| | - EHSAN ALLAH KALTEH
- MSc of Epidemiology, Golestan University of Medical Sciences, Gorgan, Iran
| | - MOUSA GHELICHI-GHOJOGH
- PhD Candidate in Epidemiology, Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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21
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Uchihara M, Bouchi R, Kodani N, Saito S, Miyazato Y, Umamoto K, Sugimoto H, Kobayashi M, Hikida S, Akiyama Y, Ihana‐Sugiyama N, Osugi M, Tanabe A, Ueki K, Takasaki J, Hojo M, Kajio H. Impact of newly diagnosed diabetes on COVID‐19 severity and hyperglycemia. J Diabetes Investig 2022; 13:1086-1093. [PMID: 35075818 PMCID: PMC9153833 DOI: 10.1111/jdi.13754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 01/08/2023] Open
Abstract
Aims/Introduction Materials and Methods Results Conclusions
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Affiliation(s)
- Masaki Uchihara
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Ryotaro Bouchi
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
- Diabetes and Metabolism Information Center Research Institute National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Noriko Kodani
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Sho Saito
- Disease Control and Prevention Center National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Yusuke Miyazato
- Disease Control and Prevention Center National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Kotaro Umamoto
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Hirofumi Sugimoto
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Michi Kobayashi
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Sayaka Hikida
- Disease Control and Prevention Center National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Yutaro Akiyama
- Disease Control and Prevention Center National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Noriko Ihana‐Sugiyama
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
- Diabetes and Metabolism Information Center Research Institute National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Mitsuru Osugi
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
- Diabetes and Metabolism Information Center Research Institute National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Kojiro Ueki
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
- Department of Molecular Diabetic Medicine Diabetes Research Center Research Institute National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Jin Takasaki
- Disease Control and Prevention Center National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
- Department of Respiratory Medicine National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology and Metabolism National Center for Global Health and Medicine Toyama 1‐21‐1, Shinjuku‐ku Tokyo 162‐8655 Japan
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22
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de Sá-Ferreira CO, da Costa CHM, Guimarães JCW, Sampaio NS, Silva LDML, de Mascarenhas LP, Rodrigues NG, Dos Santos TL, Campos S, Young EC. Diabetic ketoacidosis and COVID-19: what have we learned so far? Am J Physiol Endocrinol Metab 2022; 322:E44-E53. [PMID: 34779657 PMCID: PMC8721947 DOI: 10.1152/ajpendo.00244.2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In December 2019, a pandemic emerged due to a new coronavirus that imposed various uncertainties and discoveries. It has been reported that diabetes is a risk factor for worst outcomes of COVID-19 and also that SARS-CoV-2 infection was correlated with the occurrence of diabetic ketoacidosis (DKA) in patients. The aim of this work is to discuss this correlation emphasizing the main case reports from 2020 while exploring the management of DKA during the course of COVID-19. Web of Science, PubMed, and Scopus databases were searched using two sets of Medical Subject Heading (MeSH) search terms or Title/Abstract words: Coronavirus Infections (Coronavirus Infections, Middle East Respiratory Syndrome, COVID-19) and Diabetic Ketoacidosis (Diabetic Ketoacidosis, Diabetic Acidosis, Diabetic Ketosis). There is a clear correlation between COVID-19 and DKA. The SARS-Cov-2 infection may precipitate both a hyperglycemic state and ketoacidosis occurrence in patients with diabetes and nondiabetic patients, which may lead to fatal outcomes. DKA in patients with COVID-19 may increase risk and worse outcomes. Hence, the SARS-Cov-2 infection presents a new perspective toward the management of glycemia and acidosis in patients with diabetes and nondiabetic patients, highlighting the need for rapid interventions to minimize the complications from COVID-19 while reducing its spreading.
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Affiliation(s)
| | | | | | - Nathasha Souza Sampaio
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | | | | | - Nicollas Garcia Rodrigues
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Talita Labonia Dos Santos
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Solange Campos
- Gaffrée e Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Esther Cytrynbaum Young
- School of Medicine and Surgery, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
- Gaffrée e Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
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Kazakou P, Lambadiari V, Ikonomidis I, Kountouri A, Panagopoulos G, Athanasopoulos S, Korompoki E, Kalomenidis I, Dimopoulos MA, Mitrakou A. Diabetes and COVID-19; A Bidirectional Interplay. Front Endocrinol (Lausanne) 2022; 13:780663. [PMID: 35250853 PMCID: PMC8891603 DOI: 10.3389/fendo.2022.780663] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/11/2022] [Indexed: 01/08/2023] Open
Abstract
There seems to be a bidirectional interplay between Diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19). On the one hand, people with diabetes are at higher risk of fatal or critical care unit-treated COVID-19 as well as COVID-19 related health complications compared to individuals without diabetes. On the other hand, clinical data so far suggest that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in metabolic dysregulation and in impaired glucose homeostasis. In addition, emerging data on new onset DM in previously infected with SARS-CoV-2 patients, reinforce the hypothesis of a direct effect of SARS-CoV-2 on glucose metabolism. Attempting to find the culprit, we currently know that the pancreas and the endothelium have been found to express Angiotensin-converting enzyme 2 (ACE2) receptors, the main binding site of the virus. To move from bench to bedside, understanding the effects of COVID-19 on metabolism and glucose homeostasis is crucial to prevent and manage complications related to COVID-19 and support recovering patients. In this article we review the potential underlying pathophysiological mechanisms between COVID-19 and glucose dysregulation as well as the effects of antidiabetic treatment in patients with diabetes and COVID-19.
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Affiliation(s)
- Paraskevi Kazakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ignatios Ikonomidis
- Laboratory of Preventive Cardiology, Second Cardiology Department, Attikon University Hospital National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Panagopoulos
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Athanasopoulos
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kalomenidis
- 1 Department of Intensive Care, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Meletios A. Dimopoulos
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Asimina Mitrakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Asimina Mitrakou,
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Miller L, Berber E, Sumbria D, Rouse BT. Controlling the Burden of COVID-19 by Manipulating Host Metabolism. Viral Immunol 2022; 35:24-32. [PMID: 34905407 PMCID: PMC8863913 DOI: 10.1089/vim.2021.0150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the coronavirus-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to cause global health problems, but its impact would be minimized if the many effective vaccines that have been developed were available and in widespread use by all societies. This ideal situation is not occurring so other means of controlling COVID-19 are needed. In this short review, we make the case that manipulating host metabolic pathways could be a therapeutic approach worth exploring. The rationale for such an approach comes from the fact that viruses cause metabolic changes in cells they infect, effective host defense mechanisms against viruses requires the activity of one or more metabolic pathways, and that hosts with metabolic defects such as diabetes are more susceptible to severe consequences after COVID-19. We describe the types of approaches that could be used to redirect various aspects of host metabolism and the success that some of these maneuvers have had at controlling other virus infections. Manipulating metabolic activities to control the outcome of COVID-19 has to date received minimal attention. Manipulating host metabolism will never replace vaccines to control COVID-19 but could be used as an adjunct therapy to the extent of ongoing infection.
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Affiliation(s)
- Logan Miller
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Engin Berber
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Deepak Sumbria
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Barry T. Rouse
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
- Address correspondence to: Dr. Barry T. Rouse, Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996-4539, USA
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Wang W, Chai Z, Cooper ME, Zimmet PZ, Guo H, Ding J, Yang F, Chen X, Lin X, Zhang K, Zhong Q, Li Z, Zhang P, Wu Z, Guan X, Zhang L, He K. High Fasting Blood Glucose Level With Unknown Prior History of Diabetes Is Associated With High Risk of Severe Adverse COVID-19 Outcome. Front Endocrinol (Lausanne) 2021; 12:791476. [PMID: 34956098 PMCID: PMC8692378 DOI: 10.3389/fendo.2021.791476] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background We aimed to understand how glycaemic levels among COVID-19 patients impact their disease progression and clinical complications. Methods We enrolled 2,366 COVID-19 patients from Huoshenshan hospital in Wuhan. We stratified the COVID-19 patients into four subgroups by current fasting blood glucose (FBG) levels and their awareness of prior diabetic status, including patients with FBG<6.1mmol/L with no history of diabetes (group 1), patients with FBG<6.1mmol/L with a history of diabetes diagnosed (group 2), patients with FBG≥6.1mmol/L with no history of diabetes (group 3) and patients with FBG≥6.1mmol/L with a history of diabetes diagnosed (group 4). A multivariate cause-specific Cox proportional hazard model was used to assess the associations between FBG levels or prior diabetic status and clinical adversities in COVID-19 patients. Results COVID-19 patients with higher FBG and unknown diabetes in the past (group 3) are more likely to progress to the severe or critical stage than patients in other groups (severe: 38.46% vs 23.46%-30.70%; critical 7.69% vs 0.61%-3.96%). These patients also have the highest abnormal level of inflammatory parameters, complications, and clinical adversities among all four groups (all p<0.05). On day 21 of hospitalisation, group 3 had a significantly higher risk of ICU admission [14.1% (9.6%-18.6%)] than group 4 [7.0% (3.7%-10.3%)], group 2 [4.0% (0.2%-7.8%)] and group 1 [2.1% (1.4%-2.8%)], (P<0.001). Compared with group 1 who had low FBG, group 3 demonstrated 5 times higher risk of ICU admission events during hospitalisation (HR=5.38, 3.46-8.35, P<0.001), while group 4, where the patients had high FBG and prior diabetes diagnosed, also showed a significantly higher risk (HR=1.99, 1.12-3.52, P=0.019), but to a much lesser extent than in group 3. Conclusion Our study shows that COVID-19 patients with current high FBG levels but unaware of pre-existing diabetes, or possibly new onset diabetes as a result of COVID-19 infection, have a higher risk of more severe adverse outcomes than those aware of prior diagnosis of diabetes and those with low current FBG levels.
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Affiliation(s)
- Wenjun Wang
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Translational Medical Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Artificial Intelligence Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Big Data Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhonglin Chai
- Department of Diabetes, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Mark E. Cooper
- Department of Diabetes, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Paul Z. Zimmet
- Department of Diabetes, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Hua Guo
- Department of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Junyu Ding
- Department of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Feifei Yang
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Translational Medical Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Artificial Intelligence Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Big Data Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Xu Chen
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Translational Medical Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Artificial Intelligence Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Big Data Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Xixiang Lin
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Translational Medical Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Artificial Intelligence Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Big Data Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Kai Zhang
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Qin Zhong
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Translational Medical Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Artificial Intelligence Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Big Data Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zongren Li
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Translational Medical Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Artificial Intelligence Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Big Data Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Peifang Zhang
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Zhenzhou Wu
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Xizhou Guan
- Department of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Lei Zhang
- Department of Diabetes, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Kunlun He
- Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Translational Medical Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Artificial Intelligence Research Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Medical Big Data Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
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27
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Rezaei N, Montazeri F, Malekpour MR, Ghanbari A, Azadnajafabad S, Mohammadi E, Rezaei N, Naderimagham S, Ghasemi E, Abbasi-Kangevari M, Ghamari SH, Nasserinejad M, Kaveh F, Norouzinejad A, Gouya MM, Raeisi A, Farzadfar F, Larijani B. COVID-19 in patients with diabetes: factors associated with worse outcomes. J Diabetes Metab Disord 2021; 20:1605-1614. [PMID: 34729367 PMCID: PMC8553287 DOI: 10.1007/s40200-021-00910-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/24/2021] [Indexed: 01/08/2023]
Abstract
Purpose Diabetes is one of the major comorbidities associated with COVID-19. We aimed to determine the clinical and epidemiological factors associated with the mortality of COVID-19 in diabetic patients in Iran, and also the impact of prescribed antiviral and antibiotics on patients' status. Methods In this study, we used the national registry of hospitalized patients with Severe Acute Respiratory Syndrome (SARS) Symptoms with diabetes from February 18, 2020, to December 22, 2020. Demographic, clinical features, treatments, concurrent comorbidities, and their associations with mortality and severity outcomes were assessed using logistic regression. Results 78,554 diabetic in-patients with SARS symptoms were included from 31 provinces of whom 37,338 were PCR positive for COVID-19. Older age and male gender are associated with COVID-19 mortality in diabetic patients. CVD is the most frequent comorbidity (42%). CVD, kidney disease, liver disease, and COPD are associated comorbidities which increased the risk of mortality. The mortality rate is higher in diabetic patients comparing to patients with no comorbidities, particularly in younger age groups. The frequency of antiviral, and antibiotics in COVID-19 positive patients was 34%, and 31%, respectively. Antibiotic treatment has no association with mortality in COVID-19 patients. Conclusions Diabetic patients indicate higher mortality comparing to patients without any underlying comorbidities. Restrict strategies on increasing effective health care utilization must be considered in diabetic patients, especially in those with parallel underlying comorbidities. Regarding the antibiotic resistance issue and the noticeable use of antibiotics in diabetic patients, it is recommended to prioritize an antibiotic guideline prescription in COVID-19 patients for better stewardship by countries.
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Affiliation(s)
- Negar Rezaei
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Present Address: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Montazeri
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Present Address: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi-Kangevari
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nasserinejad
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Farzad Kaveh
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Abbas Norouzinejad
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Mehdi Gouya
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Alireza Raeisi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farshad Farzadfar
- Present Address: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Present Address: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Present Address: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, 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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29
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Abstract
Diabetes mellitus (DM) is one of the most common comorbid conditions in persons with COVID-19 and a risk factor for poor prognosis. The reasons why COVID-19 is more severe in persons with DM are currently unknown although the scarce data available on patients with DM hospitalized because of COVID-19 show that glycemic control is inadequate. The fact that patients with COVID-19 are usually cared for by health professionals with limited experience in the management of diabetes and the need to prevent exposure to the virus may also be obstacles to glycemic control in patients with COVID-19. Effective clinical care should consider various aspects, including screening for the disease in at-risk persons, education, and monitoring of control and complications. We examine the effect of COVID-19 on DM in terms of glycemic control and the restrictions arising from the pandemic and assess management of diabetes and drug therapy in various scenarios, taking into account factors such as physical exercise, diet, blood glucose monitoring, and pharmacological treatment. Specific attention is given to patients who have been admitted to hospital and critically ill patients. Finally, we consider the role of telemedicine in the management of DM patients with COVID-19 during the pandemic and in the future.
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30
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The Pathophysiology and Management of Diabetic Ketoacidosis in COVID-19 Patients: A Literature Review. J Crit Care Med (Targu Mures) 2021; 8:6-13. [PMID: 35274050 PMCID: PMC8852291 DOI: 10.2478/jccm-2021-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Diabetic individuals are considered a vulnerable population during the COVID-19 Pandemic, and several studies noted worse outcomes, including death, among those who get infected. Diabetic emergencies, such as ketoacidosis (DKA), are common and potentially life-threatening conditions in uncontrolled patients. While the pathophysiological background of the relationship between COVID-19 and DKA is not fully understood, early reports available so far indicate that patients with pre-existing diabetes who get infected with the SARS-CoV 2 virus are at higher risk of DKA. It was also suggested that DKA is a poor prognostic sign for infected patients, these being at higher risk of developing worse forms of COVID-19 disease and having high mortality. Therefore, healthcare personnel dealing with such patients face a considerable challenge, as the correct and safe emergency management of such cases is far from established. This article aimed to conduct a study that reviews the current published data available about patients with DKA and COVID-19.
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31
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Nassar M, Daoud A, Nso N, Medina L, Ghernautan V, Bhangoo H, Nyein A, Mohamed M, Alqassieh A, Soliman K, Alfishawy M, Sachmechi I, Misra A. Diabetes Mellitus and COVID-19: Review Article. Diabetes Metab Syndr 2021; 15:102268. [PMID: 34562865 PMCID: PMC8416292 DOI: 10.1016/j.dsx.2021.102268] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS We aim to cover most of the current evidence on the mutual effect of diabetes & COVID-19 infection on each other and the management of the COVID-19 patients with diabetes. METHODS We utilized databases to review the current evidence related to diabetes mellitus and COVID-19. RESULTS We discussed the most recent evidence of diabetes milieus and COVID-19 regarding risk factors, management, complications, and telemedicine. CONCLUSION Diabetes mellitus is associated with a significant risk of complications, extended hospital stays, and mortality in COVID-19 infected patients.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Ahmed Daoud
- Internal Medicine Department, Faculty of Medicine Cairo University, Cairo, Egypt.
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Luis Medina
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Victoria Ghernautan
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Harangad Bhangoo
- Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens, New York, USA.
| | - Andrew Nyein
- New York Institute of Technology College of Osteopathic Medicine, NYC, USA.
| | - Mahmoud Mohamed
- Medicine department, North Mississippi Medical Center, Tupelo, MS, USA.
| | - Ahmed Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Karim Soliman
- Division of Nephrology, Department of Medicine and Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Egypt.
| | - Issac Sachmechi
- Chair of Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals/Queens USA.
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, Chairman, National Diabetes, Obesity, And Cholesterol Foundation (N-DOC), President, Diabetes Foundation (India) (DFI), USA.
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Hebbard C, Lee B, Katare R, Garikipati VNS. Diabetes, Heart Failure, and COVID-19: An Update. Front Physiol 2021; 12:706185. [PMID: 34721055 PMCID: PMC8554151 DOI: 10.3389/fphys.2021.706185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the WHO in March 2020. As of August 2021, more than 220 countries have been affected, accounting for 211,844,613 confirmed cases and 4,432,802 deaths worldwide. A new delta variant wave is sweeping through the globe. While previous reports consistently have demonstrated worse prognoses for patients with existing cardiovascular disease than for those without, new studies are showing a possible link between SARS-CoV-2 infection and an increased incidence of new-onset heart disease and diabetes, regardless of disease severity. If this trend is true, with hundreds of millions infected, the disease burden could portend a potentially troubling increase in heart disease and diabetes in the future. Focusing on heart failure in this review, we discuss the current data at the intersection of COVID, heart failure, and diabetes, from clinical findings to potential mechanisms of how SARS-CoV-2 infection could increase the incidence of those pathologies. Additionally, we posit questions for future research areas regarding the significance for patient care.
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Affiliation(s)
- Carleigh Hebbard
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Brooke Lee
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rajesh Katare
- Department of Physiology–HeartOtago, University of Otago, Dunedin, New Zealand
| | - Venkata Naga Srikanth Garikipati
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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33
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Czupryniak L, Dicker D, Lehmann R, Prázný M, Schernthaner G. The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence? Cardiovasc Diabetol 2021; 20:198. [PMID: 34598700 PMCID: PMC8485772 DOI: 10.1186/s12933-021-01389-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available—but currently limited—evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care.
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Dror Dicker
- Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Centre, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roger Lehmann
- Department of Endocrinology, Diabetes and Nutrition, University Hospital Zürich, Zürich, Switzerland
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Guntram Schernthaner
- Department of Medicine I, Rudolfstiftung Hospital Vienna, 1030, Vienna, Austria. .,Medical University of Vienna, Vienna, Austria.
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Kazakou P, Paschou SA, Psaltopoulou T, Gavriatopoulou M, Korompoki E, Stefanaki K, Kanouta F, Kassi GN, Dimopoulos MA, Mitrakou A. Early and late endocrine complications of COVID-19. Endocr Connect 2021; 10:R229-R239. [PMID: 34424853 PMCID: PMC8494407 DOI: 10.1530/ec-21-0184] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023]
Abstract
Endocrine system plays a vital role in controlling human homeostasis. Understanding the possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19-infected patients as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express angiotensin-converting enzyme 2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with low triiodothyronine, low thyroid stimulating hormone, or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited, and therefore, long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.
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Affiliation(s)
- Paraskevi Kazakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Stefanaki
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Kanouta
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Asimina Mitrakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Correspondence should be addressed to A Mitrakou:
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35
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Kazakou P, Paschou SA, Psaltopoulou T, Gavriatopoulou M, Korompoki E, Stefanaki K, Kanouta F, Kassi GN, Dimopoulos MA, Mitrakou A. Early and late endocrine complications of COVID-19. Endocr Connect 2021. [PMID: 34424853 DOI: 10.1530/ec-21-0184.pmid:34424853;pmcid:pmc8494407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Endocrine system plays a vital role in controlling human homeostasis. Understanding the possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19-infected patients as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express angiotensin-converting enzyme 2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with low triiodothyronine, low thyroid stimulating hormone, or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited, and therefore, long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.
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Affiliation(s)
- Paraskevi Kazakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Stefanaki
- Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Kanouta
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Unit of Hematology and Oncology, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Asimina Mitrakou
- Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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36
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Patel L, Ayad S, Rayad MN, Gergis K, Ejikeme C, Talpur A, Abdelazeem B, Eckman A. A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19. Cureus 2021; 13:e16923. [PMID: 34513494 PMCID: PMC8418556 DOI: 10.7759/cureus.16923] [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] [Accepted: 07/31/2021] [Indexed: 12/27/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is a significant complication of poorly controlled diabetes. In diabetics, it typically occurs due to insulin deficiency resulting in lipolysis and subsequent ketone body formation and acidosis. The emergence of the COVID-19 infection has been associated with several complications, with the most prominent being pulmonary and cardiovascular-related. However, in some cases, patients with COVID-19 infection present with diabetic ketoacidosis. The pathophysiology of DKA in COVID-19 infection is different and currently not completely understood. The manifestation of DKA in COVID-19 patients is associated with increased severity of mortality and length of stay in these patients. Here, we describe a patient with no past medical history who presented with COVID-19 symptoms and was found to be in DKA. This case report highlights the possible underlying pathophysiology associated with this complication.
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Affiliation(s)
- Latika Patel
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sarah Ayad
- Internal Medicine, Rutgers-New Jersey Medical School/ Trinitas Regional Medical Center, Elizabeth, USA
| | | | | | - Chidinma Ejikeme
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Afrah Talpur
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.,Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Basel Abdelazeem
- Internal Medicine, McLaren Flint/Michigan State University, Flint, USA
| | - Ari Eckman
- Internal Medicine and Endocrinology, Rutgers-New Jersey Medical School/ Trinitas Regional Medical Center, Elizabeth, USA
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37
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Berber E, Sumbria D, Çanakoğlu N. Meta-analysis and comprehensive study of coronavirus outbreaks: SARS, MERS and COVID-19. J Infect Public Health 2021; 14:1051-1064. [PMID: 34174535 PMCID: PMC8214867 DOI: 10.1016/j.jiph.2021.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Zoonotic coronaviruses have caused several endemic and pandemic situations around the world. SARS caused the first epidemic alert at the beginning of this century, followed by MERS. COVID-19 appeared to be highly contagious, with human-to-human transmission by aerosol droplets, and reached nearly all countries around the world. A plethora of studies were performed, with reports being published within a short period of time by scientists and medical physicians. It has been difficult to find the relevant data to create an overview of the situation according to studies from accumulated findings and reports. In the present study we aimed to perform a comprehensive study in the context of the case fatality ratios (CFRs) of three major human Coronavirus outbreaks which occurred during the first twenty years of 21st century. METHODS In this study, we performed meta-analyses on SARS, MERS and COVID-19 outbreak events from publicly available records. Study analyses were performed with the help of highly reputable scientific databases such as PubMed, WOS and Scopus to evaluate and present current knowledge on zoonotic coronavirus outbreaks, starting from 2000 to the end of 2020. RESULTS A total of 250,194 research studies and records were identified with specific keywords and synonyms for the three viruses in order to cover all publications. In the end, 41 records were selected and included after applying several exclusion and inclusion criteria on identified datasets. SARS was found to have a nearly 11% case fatality ratio (CFR), which means the estimated number of deaths as a proportion of confirmed positive cases; Taiwan was the country most affected by the SARS outbreak based on the CFR analysis. MERS had CFRs of 35.8 and 26 in Saudi Arabia during the 2012 and 2015 outbreaks, respectively. COVID-19 resulted in a 2.2 CFR globally, and the USA reported the highest mortality ratio in the world in the end of first year of COVID-19 pandemic. CONCLUSION Some members of the Coronaviridae family can cause highly contagious and devastating infections among humans. Within the last two decades, the whole world has witnessed several deadly emerging infectious diseases, which are most commonly zoonotic in nature. We conclude that pre-existing immunity during the early stages of a pandemic might be important, but case control and management strategies should be improved to decrease CFRs. Finally, we have addressed several concerns in relation to outbreak events in this study.
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Affiliation(s)
- Engin Berber
- University of Tennessee, Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, Knoxville, TN, USA; Erciyes University, College of Veterinary Medicine, Department of Virology, Kayseri, Turkey.
| | - Deepak Sumbria
- University of Tennessee, Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, Knoxville, TN, USA; Dr. Yashwant Singh Parmar University of Horticulture and Forestry, Department of Silviculture and Agroforestry, College of Forestry, Solan, Himachal Pradesh, India
| | - Nurettin Çanakoğlu
- Muğla Sıtkı Koçman University, Milas Faculty of Veterinary Science, Department of Virology, Muğla, Turkey
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38
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Pranata R, Henrina J, Raffaello WM, Lawrensia S, Huang I. Diabetes and COVID-19: The past, the present, and the future. Metabolism 2021; 121:154814. [PMID: 34119537 PMCID: PMC8192264 DOI: 10.1016/j.metabol.2021.154814] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
Diabetes, one of the most prevalent chronic diseases in the world, is strongly associated with a poor prognosis in COVID-19. Scrupulous blood sugar management is crucial, since the worse outcomes are closely associated with higher blood sugar levels in COVID-19 infection. Although recent observational studies showed that insulin was associated with mortality, it should not deter insulin use in hospitalized patients requiring tight glucose control. Back and forth dilemma in the past with regards to continue/discontinue certain medications used in diabetes have been mostly resolved. The initial fears of consequences related to continuing certain medications have been largely dispelled. COVID-19 also necessitates the transformation in diabetes care through the integration of technologies. Recent advances in health-related technologies, notably telemedicine and remote continuous glucose monitoring, have become essential in the management of diabetes during the pandemic. Today, these technologies have changed the landscape of medicine and become more important than ever. Being a high-risk population, patients with type 1 or type 2 diabetes, should be prioritized for vaccination. In the future, as the pandemic fades, the prevalence of non-communicable diseases is expected to rise due to lifestyle changes and medical issues/dilemma encountered during the pandemic.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | | | | | | | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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39
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Mehta PB, Kohn MA, Koliwad SK, Rushakoff RJ. Lack of association between either outpatient or inpatient glycemic control and COVID-19 illness severity or mortality in patients with diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002203. [PMID: 34059527 PMCID: PMC8169218 DOI: 10.1136/bmjdrc-2021-002203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/09/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION To evaluate whether outpatient insulin treatment, hemoglobin A1c (HbA1c), glucose on admission, or glycemic control during hospitalization is associated with SARS-CoV-2 (COVID-19) illness severity or mortality in hospitalized patients with diabetes mellitus (DM) in a geographical region with low COVID-19 prevalence. RESEARCH DESIGN AND METHODS A single-center retrospective study of patients hospitalized with COVID-19 from January 1 through August 31, 2020 to evaluate whether outpatient insulin use, HbA1c, glucose on admission, or average glucose during admission was associated with intensive care unit (ICU) admission, mechanical ventilation (ventilator) requirement, or mortality. RESULTS Among 111 patients with DM, 48 (43.2%) were on outpatient insulin and the average HbA1c was 8.1% (65 mmol/mol). The average glucose on admission was 187.0±102.94 mg/dL and the average glucose during hospitalization was 173.4±39.8 mg/dL. Use of outpatient insulin, level of HbA1c, glucose on admission, or average glucose during hospitalization was not associated with ICU admission, ventilator requirement, or mortality among patients with COVID-19 and DM. CONCLUSIONS Our findings in a region with relatively low COVID-19 prevalence suggest that neither outpatient glycemic control, glucose on admission, or inpatient glycemic control is predictive of illness severity or mortality in patients with DM hospitalized with COVID-19.
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Affiliation(s)
- Paras B Mehta
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael A Kohn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Suneil K Koliwad
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Robert J Rushakoff
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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40
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Seggelke SA, Ingram CC, Crawley S, Low Wang CC. Insulin Resistance in a Hospitalized COVID-19 Patient: A Case Review. Clin Diabetes 2021; 39:228-232. [PMID: 33986579 PMCID: PMC8061538 DOI: 10.2337/cd20-0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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41
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Singh B, Patel P, Kaur P, Majachani N, Maroules M. COVID-19 and Diabetic Ketoacidosis: Report of Eight Cases. Cureus 2021; 13:e14223. [PMID: 33948412 PMCID: PMC8087114 DOI: 10.7759/cureus.14223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim To describe the clinical characteristics and outcome of hospitalized COVID-19 patients with diabetic ketoacidosis (DKA). Methods We report eight cases of diabetic ketoacidosis in COVID-19 who presented to our institution in New Jersey, USA. COVID-19 was diagnosed by nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR). The patients' electronic medical records were reviewed. Data on patients' age, sex, ethnicity, laboratory values, glycosylated hemoglobin level, oral antihyperglycemic agents (OHAs), insulin, and clinical outcomes were collected. Results The median age of the patient was 42.5 years, and seven were males and one was female. Out of eight patients, five had type 2 diabetes mellitus (DM), two had undiagnosed DM, and one had type 1 DM. Median value of initial glucose on presentation was 454 mg/dL. Median value of HbA1c on presentation was 11.4% and of anion gap was 26.5 mEq/L. Four patients had large ketonemia, one patient had moderate ketonemia, and three patients had small ketonemia. All the patients were started on standard treatment protocol for DKA with intravenous fluids and IV insulin infusion. Acute kidney injury (AKI) was seen in four patients, and one patient required renal replacement therapy. Out of eight patients, three required mechanical ventilation, and the same three patients died. Conclusion Our case series shows that COVID-19 infection can precipitate DKA in patients with known diabetes mellitus patients or as a first manifestation in undiagnosed DM patients; COVID-19 with DKA is associated with substantial mortality. Further studies are needed to characterize poor risk factors associated with mortality in these patients.
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Affiliation(s)
- Balraj Singh
- Hematology/Oncology, Saint Joseph's University Medical Center, Paterson, USA
| | - Prem Patel
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Parminder Kaur
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Nicole Majachani
- Internal Medicine, Saint Joseph's University Medical Center, Paterson, USA
| | - Michael Maroules
- Hematology and Oncology, Saint Joseph's University Medical Center, Paterson, USA
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42
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Garg S, Norman GJ. Impact of COVID-19 on Health Economics and Technology of Diabetes Care: Use Cases of Real-Time Continuous Glucose Monitoring to Transform Health Care During a Global Pandemic. Diabetes Technol Ther 2021; 23:S15-S20. [PMID: 33449822 PMCID: PMC7957369 DOI: 10.1089/dia.2020.0656] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has exposed vulnerabilities and placed tremendous financial pressure on nearly all aspects of the U.S. health care system. Diabetes care is an example of the confluence of the pandemic and heightened importance of technology in changing care delivery. It has been estimated the added total direct U.S. medical cost burden due to COVID-19 to range between $160B (20% of the population infected) and $650B (80% of the population infected) over the course of the pandemic. The corresponding range for the population with diabetes is between $16B and $65B, representing between 5% and 20% of overall diabetes expenditure in the United States. We examine the evidence to support allocating part of this added spend to infrastructure capabilities to accelerate remote monitoring and management of diabetes. Methods and Results: We reviewed recent topical literature and COVID-19-related analyses in the public health, health technology, and health economics fields in addition to databases and surveys from government sources and the private sector. We summarized findings on use cases for real-time continuous glucose monitoring in the community, for telehealth, and in the hospital setting to highlight the successes and challenges of accelerating the adoption of a digital technology out of necessity during the pandemic and beyond. Conclusions: One critical and lasting consequence of the pandemic will be the accelerated adoption of digital technology in health care delivery. We conclude by discussing ways in which the changes wrought by COVID-19 from a health care, policy, and economics perspective can add value and are likely to endure postpandemic.
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Affiliation(s)
- Sandip Garg
- Western Digital Corp., San Jose, California, USA
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43
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Berber E, Sumbria D, Rouse BT. Could targeting immunometabolism be a way to control the burden of COVID-19 infection? Microbes Infect 2021; 23:104780. [PMID: 33482357 PMCID: PMC7816601 DOI: 10.1016/j.micinf.2021.104780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
This review portrays the metabolic consequences of Covid-19 infection at different stages of the clinical syndrome. It also describes how events can change when patients with metabolic problems are infected and the effects that diet and nutrition might play to influence the outcome of infection. We also discuss the types of maneuvers that could be used to reshape metabolic events and question if this approach could be a practical therapy used alone or in combination with other approaches to reduce the burden of Covid-19 infection.
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Affiliation(s)
- Engin Berber
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA; Department of Virology, Faculty of Veterinary Medicine, Erciyes University, Kayseri, TR, Turkey
| | - Deepak Sumbria
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Barry T Rouse
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.
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44
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Zhang JY, Shang T, Ahn D, Chen K, Coté G, Espinoza J, Mendez CE, Spanakis EK, Thompson B, Wallia A, Wisk LE, Kerr D, Klonoff DC. How to Best Protect People With Diabetes From the Impact of SARS-CoV-2: Report of the International COVID-19 and Diabetes Summit. J Diabetes Sci Technol 2021; 15:478-514. [PMID: 33476193 PMCID: PMC7925443 DOI: 10.1177/1932296820978399] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has rapidly involved the entire world and exposed the pressing need for collaboration between public health and other stakeholders from the clinical, scientific, regulatory, pharmaceutical, and medical device and technology communities. To discuss how to best protect people with diabetes from serious outcomes from COVID-19, Diabetes Technology Society, in collaboration with Sansum Diabetes Research Institute, hosted the "International COVID-19 and Diabetes Virtual Summit" on August 26-27, 2020. This unique, unprecedented real-time conference brought together physicians, scientists, government officials, regulatory experts, industry representatives, and people with diabetes from six continents to review and analyze relationships between COVID-19 and diabetes. Over 800 attendees logged in. The summit consisted of five sessions: (I) Keynotes, (II) Preparedness, (III) Response, (IV) Recovery, and (V) Surveillance; eight parts: (A) Background, (B) Resilience, (C) Outpatient Care, (D) Inpatient Care, (E) Resources, (F) High-Risk Groups, (G) Regulation, and (H) The Future; and 24 sections: (1) Historic Pandemics and Impact on Society, (2) Pathophysiology/Risk Factors for COVID-19, (3) Social Determinants of COVID-19, (4) Preparing for the Future, (5) Medications and Vaccines, (6) Psychology of Patients and Caregivers, (7) Outpatient Treatment of Diabetes Mellitus and Non-Pharmacologic Intervention, (8) Technology and Telehealth for Diabetes Outpatients, (9) Technology for Inpatients, (10) Management of Diabetes Inpatients with COVID-19, (11) Ethics, (12) Accuracy of Diagnostic Tests, (13) Children, (14) Pregnancy, (15) Economics of Care for COVID-19, (16) Role of Industry, (17) Protection of Healthcare Workers, (18) People with Diabetes, (19) International Responses to COVID-19, (20) Government Policy, (21) Regulation of Tests and Treatments, (22) Digital Health Technology, (23) Big Data Statistics, and 24) Patient Surveillance and Privacy. The two keynote speeches were entitled (1) COVID-19 and Diabetes-Meeting the Challenge and (2) Knowledge Gaps and Research Opportunities for Diabetes and COVID-19. While there was an emphasis on diabetes and its interactions with COVID-19, the panelists also discussed the COVID-19 pandemic in general. The meeting generated many novel ideas for collaboration between experts in medicine, science, government, and industry to develop new technologies and disease treatment paradigms to fight this global pandemic.
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Affiliation(s)
| | - Trisha Shang
- Diabetes Technology Society, Burlingame,
CA, USA
| | - David Ahn
- Mary & Dick Allen Diabetes Center,
Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Kong Chen
- National Institutes of Health, National
Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Gerard Coté
- Texas A&M Engineering Experiment
Station Center for Remote Health Technologies and Systems, Department of Biomedical
Engineering, Texas A&M University, College Station, TX, USA
| | - Juan Espinoza
- Children’s Hospital Los Angeles,
University of Southern California, Los Angeles, CA, USA
| | | | - Elias K. Spanakis
- School of Medicine, University of
Maryland, Baltimore, MD, USA
- Division of Endocrinology, Baltimore
Veterans Affairs Medical Center, Baltimore, MD, USA
| | | | - Amisha Wallia
- Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
| | - Lauren E. Wisk
- David Geffen School of Medicine,
University of California, Los Angeles, CA, USA
| | - David Kerr
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
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Pasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE. Management of diabetes and hyperglycaemia in the hospital. Lancet Diabetes Endocrinol 2021; 9:174-188. [PMID: 33515493 PMCID: PMC10423081 DOI: 10.1016/s2213-8587(20)30381-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.
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Affiliation(s)
- Francisco J Pasquel
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - M Cecilia Lansang
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Guillermo E Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Ambulatory Patients with Cardiometabolic Disease and Without Evidence of COVID-19 During the Pandemic. The CorCOVID LATAM Study. Glob Heart 2021; 16:15. [PMID: 33833939 PMCID: PMC7894376 DOI: 10.5334/gh.932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background SARS-CoV-2 pandemic has modified the cardiovascular care of ambulatory patients. The aim of this survey was to study changes in lifestyle habits, treatment adherence, and mental health status in patients with cardiometabolic disease, but no clinical evidence of COVID-19. Methods A cross-sectional survey was conducted in ambulatory patients with cardiometabolic disease using paper/digital surveys. Variables investigated included socioeconomic status, physical activity, diet, tobacco use, alcohol intake, treatment discontinuation, and psychological symptoms. Results A total of 4,216 patients (50.9% males, mean age 60.3 ± 15.3 years old) from 13 Spanish-speaking Latin American countries were enrolled. Among the study population, 46.4% of patients did not have contact with a healthcare provider, 31.5% reported access barriers to treatments and 17% discontinued some medication. Multivariate analysis showed that non-adherence to treatment was more prevalent in the secondary prevention group: peripheral vascular disease (OR 1.55, CI 1.08-2.24; p = 0.018), heart failure (OR 1.36, CI 1.05-1.75; p = 0.017), and coronary artery disease (OR 1.29 CI 1.04-1.60; p = 0.018). No physical activity was reported by 38% of patients. Only 15% of patients met minimum recommendations of physical activity (more than 150 minutes/week) and vegetable and fruit intake. Low/very low income (45.5%) was associated with a lower level of physical activity (p < 0.0001), less fruit and vegetables intake (p < 0.0001), more tobacco use (p < 0.001) and perception of depression (p < 0.001). Low educational level was also associated with the perception of depression (OR 1.46, CI 1.26-1.70; p < 0.01). Conclusions Patients with cardiometabolic disease but without clinical evidence of COVID-19 showed significant medication non-adherence, especially in secondary prevention patients. Deterioration in lifestyle habits and appearance of depressive symptoms during the pandemic were frequent and related to socioeconomic status.
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Abstract
The dual pandemics of coronavirus disease-19 (COVID-19) and diabetes among patients are associated with 2- to 3-times higher intensive care admissions and higher mortality rates. Whether sheltering at home, quarantined with a positive COVID-19 test, or hospitalized, the person living with diabetes needs special considerations for successful management. Having diabetes and being COVID-19-positive increases the risk of poor outcomes and death. Providers need to give anticipatory pharmacologic guidance to patients with diabetes during COVID-19 lockdown. Patients with diabetes need to be more observant than others and to use self-protective actions. This review (1) discusses the clinical observations of COVID-19, diabetes and underlying mechanisms, (2) describes special considerations in caring for patients with diabetes in a COVID-19 environment, and (3) reviews clinical implications for the health care provider. This review highlights current evidenced-based knowledge. Additional research regarding clinical management is warranted.
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Regelmann MO, Conroy R, Gourgari E, Gupta A, Guttmann-Bauman I, Heksch R, Kamboj MK, Krishnan S, Lahoti A, Matlock K. Pediatric Endocrinology in the Time of COVID-19: Considerations for the Rapid Implementation of Telemedicine and Management of Pediatric Endocrine Conditions. Horm Res Paediatr 2021; 93:343-350. [PMID: 33486483 PMCID: PMC7900478 DOI: 10.1159/000513060] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pediatric endocrine practices had to rapidly transition to telemedicine care at the onset of the novel coronavirus disease 2019 (COVID-19) pandemic. For many, it was an abrupt introduction to providing virtual healthcare, with concerns related to quality of patient care, patient privacy, productivity, and compensation, as workflows had to change. SUMMARY The review summarizes the common adaptations for telemedicine during the pandemic with respect to the practice of pediatric endocrinology and discusses the benefits and potential barriers to telemedicine. Key Messages: With adjustments to practice, telemedicine has allowed providers to deliver care to their patients during the COVID-19 pandemic. The broader implementation of telemedicine in pediatric endocrinology practice has the potential for expanding patient access. Research assessing the impact of telemedicine on patient care outcomes in those with pediatric endocrinology conditions will be necessary to justify its continued use beyond the COVID-19 pandemic.
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Affiliation(s)
- Molly O. Regelmann
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital at Montefiore, Albert Einstein School of Medicine, Bronx, New York, USA,*Molly O. Regelmann, Division of Pediatric Endocrinology, Children's Hospital at Montefiore, 3415 Bainbridge Ave., Bronx NY 10467 (USA),
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital, Springfield, Massachusetts, USA
| | - Evgenia Gourgari
- Division of Pediatric Endocrinology, Georgetown University, Washington, District of Columbia, USA
| | - Anshu Gupta
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ines Guttmann-Bauman
- Division of Pediatric Endocrinology, Department of Pediatrics, OHSU (Oregon Health and Science University), Portland, Oregon, USA
| | - Ryan Heksch
- Center for Diabetes and Endocrinology, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, USA
| | - Manmohan K. Kamboj
- Division of Pediatric Endocrinology, Nationwide Children's Hospital at The Ohio State University, Columbus, Ohio, USA
| | - Sowmya Krishnan
- Division of Pediatric Diabetes and Endocrinology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Amit Lahoti
- Division of Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kristal Matlock
- Division of Pediatric Endocrinology, Medical University of South Carolina, Charleston, South Carolina, USA
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Yeh T, Yeung M, Mendelsohn Curanaj FA. Managing Patients with Insulin Pumps and Continuous Glucose Monitors in the Hospital: to Wear or Not to Wear. Curr Diab Rep 2021; 21:7. [PMID: 33449214 PMCID: PMC7810103 DOI: 10.1007/s11892-021-01375-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW As the prevalence of diabetes mellitus in the USA continues to rise, so does the popularity of diabetes management devices such as continuous glucose monitors (CGMs) and insulin pumps. The use of this technology has been shown to improve outpatient glycemic outcomes and quality of life and oftentimes may be continued in the hospital setting. Our aim is to review the current guidelines and available evidence on the continuation of insulin pumps and CGMs in the inpatient setting. RECENT FINDINGS Patients with diabetes are at higher risk for hospitalizations and complications due to hyper- or hypoglycemia, metabolic co-morbidities, or as seen recently, more severe illness from infections such as SARS-CoV-2. The maintenance of euglycemia is important to decrease both morbidity and mortality in the hospital setting. There is consensus among experts and medical societies that inpatient use of diabetes technology in carefully selected patients with proper institutional protocols is safe and can improve inpatient glycemic outcomes and reduce hypoglycemia. During the COVID-19 pandemic, CGMs played a vital role in managing hyperglycemia in some hospitalized patients. Insulin pumps and CGMs have the potential to transform glycemic management in hospitalized patients. In order for institutions to safely and effectively incorporate these technologies on their inpatient units, hospital-based providers will need to be able to understand how to manage and utilize these devices in their practice in conjunction with diabetes experts.
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Affiliation(s)
- Tiffany Yeh
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine / New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
| | - Michele Yeung
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine / New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Felicia A Mendelsohn Curanaj
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine / New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
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Wallia A, Prince G, Touma E, El Muayed M, Seley JJ. Caring for Hospitalized Patients with Diabetes Mellitus, Hyperglycemia, and COVID-19: Bridging the Remaining Knowledge Gaps. Curr Diab Rep 2020; 20:77. [PMID: 33244614 PMCID: PMC7690847 DOI: 10.1007/s11892-020-01366-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This review discusses the interplay between coronavirus disease 2019 (COVID-19, caused by SARS-CoV-2 infection), diabetes mellitus, and hyperglycemia in the hospital setting. There are data emerging about diabetes and hyperglycemia, their prevalence, and potential risks in the setting of SARS-CoV-2 infection and COVID-19. RECENT FINDINGS It is known that viral infections exert effects on beta cell function and insulin resistance. Therefore, much can be learned about SARS-CoV-2/COVID-19 from examining these known relationships. Such pathophysiological underpinnings may unlock greater understanding as we navigate atypical cases of hyperglycemia, severe insulin resistance, and diabetic ketoacidosis amidst COVID-19. Glycemic outcomes likely have beneficial effects on morbidity and mortality, but this needs to be studied. Changes in diabetes-related protocols and new technology can be deployed in the inpatient setting to potentially improve healthcare worker and patient safety; however, one must weigh the risks and benefits of implementation during a pandemic. Ultimately, knowledge and research must be shared at record speed to combat this global crisis.
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Affiliation(s)
- Amisha Wallia
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute of Public Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Grace Prince
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emilie Touma
- Institute of Public Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Malek El Muayed
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Jeffrie Seley
- Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY, USA
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