Diabetes in the COVID-19 pandemic era

SUMMARY OBJECTIVE: To analyze the association between patients with diabetes mellitus and the increased severity and its complications that arise with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: This is a complementary review of literature in which 14 articles published in 2020 were selected. These reviewed articles were written in both Portuguese and English available in the SciELO and PubMed databases. This review also involved searching on websites of international and national organizations in order to gather information published by these bodies about diabetic population and coronavirus disease (COVID-19)-infected individuals. DISCUSSION: The presence of comorbidities in SARS-CoV-2-infected individuals causes an increase in the expression level of angiotensin-converting enzyme 2, facilitating the entry of the virus into the cell. Diabetes causes metabolic and vascular changes, thus weakening the immune system through the inhibition of the innate immune system and the secretion of various inflammatory cytokines. This hyperinflammation can lead to multiple organ failure. The interaction between this comorbidity and COVID-19 can worsen pre-existing diabetes or predispose the onset of diabetes in non-diabetic individuals. CONCLUSIONS: Diabetes mellitus is related to the increased severity and complications of COVID-19. The association between diabetes and COVID-19 creates a devastating double pandemic, as it worsens the prognosis of COVID-19.

Prediction of bone mass changes after successful parathyroidectomy using biochemical markers of bone metabolism in primary hyperparathyroidism: is it clinically useful?

ABSTRACT Objective To measure type 1 serum amino-terminal propeptide procollagen (P1NP) and type 1 cross-linked C-terminal telopeptide collagen (CTX) before parathyroidectomy (PTX) in PHPT patients, correlating these measurements with bone mineral density (BMD) changes. Subjects and methods 31 primary hyperparathyroidism (HPTP) were followed from diagnosis up to 12-18 months after surgery. Serum levels of calcium, parathyroid hormone (PTH) vitamin D, CTX, P1NP, and BMD were measured before and 1 year after surgery. Results One year after PTX, the mean BMD increased by 8.6%, 5.5%, 5.5%, and 2.2% in the lumbar spine, femoral neck (FN), total hip (TH), and distal third of the nondominant radius (R33%), respectively. There was a significant correlation between BMD change 1 year after the PTX and CTX (L1-L4: r = 0.614, p < 0.0003; FN: r = 0.497, p < 0.0051; TH: r = 0.595, p < 0.0005; R33%: r = 0.364, p < 0.043) and P1NP (L1-L4: r = 0,687, p < 0,0001; FN: r = 0,533, p < 0,0024; TH: r = 0,642, p < 0,0001; R33%: r = 0,467, p < 0,0079) preoperative levels. The increase in 25(OH)D levels has no correlation with BMD increase (r = -0.135; p = 0.4816). On linear regression, a minimum preoperative CTX value of 0.331 ng/mL or P1NP of 37.9 ng/mL was associated with a minimum 4% increase in L1-L4 BMD. In TH, minimum preoperative values of 0.684 ng/mL for CTX and 76.0 ng/mL for P1NP were associated with a ≥ 4% increase in BMD. Conclusion PHPT patients presented a significant correlation between preoperative levels of turnover markers and BMD improvement 1 year after PTX.