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1.
Cardiovasc Diabetol ; 20(1): 218, 2021 11 06.
Article in English | MEDLINE | ID: covidwho-1503722

ABSTRACT

Type 2 diabetes is one of the most relevant risk factors for heart failure, the prevalence of which is increasing worldwide. The aim of the review is to highlight the current perspectives of the pathophysiology of heart failure as it pertains to type 2 diabetes. This review summarizes the proposed mechanistic bases, explaining the myocardial damage induced by diabetes-related stressors and other risk factors, i.e., cardiomyopathy in type 2 diabetes. We highlight the complex pathology of individuals with type 2 diabetes, including the relationship with chronic kidney disease, metabolic alterations, and heart failure. We also discuss the current criteria used for heart failure diagnosis and the gold standard screening tools for individuals with type 2 diabetes. Currently approved pharmacological therapies with primary use in type 2 diabetes and heart failure, and the treatment-guiding role of NT-proBNP are also presented. Finally, the influence of the presence of type 2 diabetes as well as heart failure on COVID-19 severity is briefly discussed.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Disease Management , Heart Failure/epidemiology , Mass Screening/methods , Biomarkers/blood , COVID-19/blood , COVID-19/diagnosis , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Glycated Hemoglobin A/metabolism , Heart Failure/blood , Heart Failure/diagnosis , Humans , Mass Screening/trends , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Prognosis
2.
Sci Rep ; 10(1): 21613, 2020 12 10.
Article in English | MEDLINE | ID: covidwho-972258

ABSTRACT

Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, gender and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection.


Subject(s)
COVID-19/mortality , Diabetes Mellitus/mortality , Hypertension/mortality , SARS-CoV-2 , Aged , Aged, 80 and over , COVID-19/ethnology , Comorbidity , Diabetes Mellitus/ethnology , Female , Humans , Hypertension/ethnology , Male , Middle Aged , Obesity/ethnology , Obesity/mortality , Pandemics , Risk Factors , Romania/epidemiology , Romania/ethnology
3.
Cardiovasc Diabetol ; 19(1): 114, 2020 07 20.
Article in English | MEDLINE | ID: covidwho-656673

ABSTRACT

In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.


Subject(s)
Betacoronavirus/pathogenicity , Blood Glucose/drug effects , Coronavirus Infections/therapy , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Intensive Care Units , Pneumonia, Viral/therapy , Antihypertensive Agents/therapeutic use , Biomarkers/blood , Blood Glucose/metabolism , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/virology , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Dyslipidemias/drug therapy , Dyslipidemias/mortality , Host-Pathogen Interactions , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypertension/drug therapy , Hypertension/mortality , Hypoglycemic Agents/adverse effects , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Treatment Outcome
4.
Farmacia ; 3(68): 377-383, 2020.
Article in English | ELSEVIER | ID: covidwho-638983

ABSTRACT

In the context of the COVID-19 continuous spreading, this paper focuses on the increased risk of diabetic patients regarding the metabolic control and the uncertainties related to SARS-CoV-2 infection. Chronic hyperglycaemia negatively affects the immune system, which triggers an increase of morbidity and mortality for viral infections. A key aspect of COVID-19 resides in the involvement of renin-angiotensin-aldosterone (RAAS) system that causes a cascade of reactions mediated by vasoactive peptides with implications in vasoconstriction, vascular permeability, oxidative stress remodelling and tissue injuries. Activation of RAAS at pulmonary level, is responsible for the local damage. Many questions regarding the treatment with ACE inhibitors and angiotensin receptor blockers were raised considering the correlation between RAAS and viral infection in diabetic patients.

5.
Diabetes Metab Res Rev ; 37(2): e3379, 2021 02.
Article in English | MEDLINE | ID: covidwho-615188

ABSTRACT

Hydroxychloroquine has been proposed for the cure of the COVID-19 due to its anti-inflammatory and anti-viral action. People with diabetes are more prone to severe outcome if affected by COVID-19 and the use of Hydroxychloroquine might have some benefit in this setting. However, the use of Hydroxychloroquine in diabetes deserves particular attention for its documented hypoglycemic action.


Subject(s)
Blood Glucose/drug effects , COVID-19/drug therapy , Diabetes Mellitus/drug therapy , Hydroxychloroquine/therapeutic use , Blood Glucose/metabolism , COVID-19/blood , COVID-19/epidemiology , COVID-19/pathology , Diabetes Complications/drug therapy , Diabetes Complications/epidemiology , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Glycemic Control/methods , Humans , Hypoglycemic Agents/therapeutic use , SARS-CoV-2/drug effects , Severity of Illness Index , Signal Transduction/drug effects
6.
Diabetes Care ; 43(7): 1427-1432, 2020 07.
Article in English | MEDLINE | ID: covidwho-360923

ABSTRACT

People with diabetes compared with people without exhibit worse prognosis if affected by coronavirus disease 2019 (COVID-19) induced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), particularly when compromising metabolic control and concomitant cardiovascular disorders are present. This Perspective seeks to explore newly occurring cardio-renal-pulmonary organ damage induced or aggravated by the disease process of COVID-19 and its implications for the cardiovascular risk management of people with diabetes, especially taking into account potential interactions with mechanisms of cellular intrusion of SARS-CoV-2. Severe infection with SARS-CoV-2 can precipitate myocardial infarction, myocarditis, heart failure, and arrhythmias as well as an acute respiratory distress syndrome and renal failure. They may evolve along with multiorgan failure directly due to SARS-CoV-2-infected endothelial cells and resulting endotheliitis. This complex pathology may bear challenges for the use of most diabetes medications in terms of emerging contraindications that need close monitoring of all people with diabetes diagnosed with SARS-CoV-2 infection. Whenever possible, continuous glucose monitoring should be implemented to ensure stable metabolic compensation. Patients in the intensive care unit requiring therapy for glycemic control should be handled solely by intravenous insulin using exact dosing with a perfusion device. Although not only ACE inhibitors and angiotensin 2 receptor blockers but also SGLT2 inhibitors, GLP-1 receptor agonists, pioglitazone, and probably insulin seem to increase the number of ACE2 receptors on the cells utilized by SARS-CoV-2 for penetration, no evidence presently exists that shows this might be harmful in terms of acquiring or worsening COVID-19. In conclusion, COVID-19 and related cardio-renal-pulmonary damage can profoundly affect cardiovascular risk management of people with diabetes.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Pneumonia, Viral/epidemiology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Blood Glucose , Blood Glucose Self-Monitoring , COVID-19 , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Comorbidity , Coronavirus/drug effects , Coronavirus Infections/drug therapy , Diabetes Mellitus/drug therapy , Humans , Pandemics , Risk Factors , SARS-CoV-2
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