Mild Hyperglycaemia in Hospitalised Children with Moderate COVID-19 Infection.

Background and Objectives: COVID-19 infection may influence many physiological processes, including glucose metabolism. Acute hyperglycaemia has been related to a worse prognosis in patients with severe COVID-19 infection. The aim of our study was to find out if moderate COVID-19 infection is associated with hyperglycaemia. Materials and Methods: A total of 235 children were enrolled in the study between October 2021 and October 2022, 112 with confirmed COVID-19 infection and 123 with other RNA viral infection. In all patients, types of symptoms, glycaemia at the time of admission, and basic anthropometric and biochemical parameters were recorded. Results: Average glycaemia was significantly higher in COVID-19 patients compared to other viral infections (5.7 ± 1.12 vs. 5.31 ± 1.4 mmol/L, p = 0.011). This difference was more obvious in subgroups with gastrointestinal manifestations (5.6 ± 1.11 vs. 4.81 ± 1.38 mmol/L, p = 0.0006) and with fever (5.76±1.22 vs. 5.11±1.37 mmol/L, p = 0.002), while no significant difference was found in subgroups with mainly respiratory symptoms. The risk of hyperglycaemia (>5.6 mmol/L) was higher in COVID-19 patients compared to other viral infections (OR = 1.86, 95%CI = 1.10-3.14, p = 0.02). The risk of hyperglycaemia was significantly higher in COVID-19 compared to other viral infections in the subgroups of patients with fever (OR = 3.59, 95% CI 1.755-7.345, p = 0.0005) and with gastrointestinal manifestations (OR = 2.48, 95% CI 1.058-5.791, p = 0.036). Conclusion: According to our results, mild hyperglycaemia was significantly more common in children with moderate COVID-19 infection compared to other RNA virus respiratory and gastrointestinal infections, especially when accompanied by fever or gastrointestinal symptoms.

Practical Guide to Glucocorticoid Induced Hyperglycaemia and Diabetes.

Glucocorticoids, also known as steroids, are a class of anti-inflammatory drugs utilised widely in clinical practice for a variety of conditions. They are associated with a range of side effects including abnormalities of glucose metabolism. Multiple guidelines have been published to illustrate best management of glucocorticoid-induced hyperglycaemia and diabetes in a variety of settings. This article discusses current best clinical practice including diagnosis, investigations and ongoing management of glucocorticoid-induced dysglycaemia in both in- and outpatient settings.

Newly diagnosed diabetes in patients with COVID-19: in a tertiary care center in central India

Background: Diabetes mellitus (DM) is associated with adverse clinical outcomes and high mortality in patients with corona virus disease 2019 (COVID-19). The relationship between diabetes and COVID-19 is known to be bidirectional. Aim: To analyze the rate of new-onset diabetes in COVID-19 patients and asses the clinical outcomes of new-onset diabetes and hyperglycemia among COVID-19 patients Methods: This cross sectional study was enrolled individuals admitted with COVID-19 and newly diagnosed diabetes mellitus. (DM);based on laboratory diagnoses. Results: Analysis showed that 13.7% (84/610) of COVID-19 patients had newly diagnosed DM. Majority of the newly diagnosed diabetic patient was male (58.3%), most of them (33.3%) were 51-60 year age group. Higher incidence of DM was reported in urban population (54.8%). The significant risk factors of diabetes were found family history of diabetes, (53.6%) and obesity (72.6%). Hypertension was the most common (61.7%) comorbidity associated with the DM. Conclusions: Diabetes diagnosed at COVID-19 presentation is associated with lower glucose but higher inflammatory markers and ICU admission, suggesting stress hyperglycemia as a major physiologic mechanism.

Effects of an incentive virtual physical activity sessions for people with type 2 diabetes, during social containment due to COVID-19 pandemic

The lockdown measures due to the COVID-19 pandemic had induced a negative impact on the physical, mental and social health of people with chronic diseases, and more specifically Type 2 Diabetes. The study's aim was to evaluate the impact of an incentive Physical Activity (PA) program during the COVID-19 lockdown period on the mental health of people with Type 2 Diabetes. Via an association of patients, people with Type 2 Diabetes were contacted by e-mail to receive virtual PA sessions (from 30 to 60 minutes), 3 times a week for 7 weeks. Their mental health status was assessed using the Hospital Anxiety and Depression Scale and their PA level was assessed using International Physical Activity Questionnaire's score. Nine people with Type 2 Diabetes (64.2 +or- 11.5 years) completed the study. The participants' mental health status was maintained after the incentive intervention or even improved for some of them, with changes in the anxiety/depression profile for 3 patients. The PA score was also maintained at the end of the program (p = 0.153). In conclusion, this first exploratory work on the effects of an incentive virtual PA program on the mental health of diabetic people highlighted that this type of e-health approach could be relevant to use for, at least, maintaining the state of anxiety/depression of diabetic people during a lockdown period.

A study of the profile and the impact of diabetes, steroid and stress hyperglycaemia on COVID-19 outcomes

Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aim(s): This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Result(s): A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients;261 had mild, 317 moderate, and 422 severe infections;and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion(s): HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Risk factors of mucormycosis in post-COVID-19 patients- a retrospective study

Background: Rhino-orbito-cerebral mucormycosis was seen in increasing severity in the recent second wave of COVID-19 in India. The incidence of mucormycosis is increased significantly in patients with diabetes. The most common cause attributed to the rise of mucormycosis in COVID-19 patients are uncontrolled diabetes. Lymphopenia and increased levels of certain cytokines, such as IL-6, have been closely associated with the disease severity. Aims and Objectives: The aims of this study were to analyze risk factors involved in Mucormycosis in 2nd wave of COVID-19. Materials and Methods: The study was done in the Mucormycosis ward, Department of ENT, Patna Medical College and Hospital, Patna, between May 2021 and July 2021. A total of 100 patients of both gender and all age groups were taken into the study. Results: Out of 100 patients included in the study, 57% (n=57) of patients had history of steroid intake, while 43% (n=43) had no history. About 41% (n=41) of patients needed oxygen support during treatment, while 59% (n=59) had no history of oxygen inhalation. About 88% (n=88) of patients had prior history of diabetes or detected during treatment, while 12% (n=12) had no prior history of diabetes or detected during treatment. About 91% (n=91)of patients had uncontrolled hyperglycemia, while 9% (n=9) had controlled blood sugar level. Conclusion: Uncontrolled hyperglycemia and delta strain are mainly associated major risk factors that lead to such high number of mucormycosis cases in India (post 2nd wave of COVID-19). Steroid role is not that much significant in our study and oxygen inhalation is not associated with mucormycosis.

SARBOHYDRATE METABOLISM DISORDERS AND THEIR OUTCOMES IN THE LONG-TERM PERIOD IN HOSPITALIZED PATIENTS WITH COVID-19.

BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients. AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it. MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose;HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters. RESULT(S): The study included 280 patients with a median age of 61.5+/-14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included - 56 people (20%), a group with steroid-induced hyperglycemia (SIH) - 95 people (34%), a group of stress- induced hyperglycaemia - 20 people (7%), with undiagnosed diabetes - 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%);8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people). CONCLUSION(S): The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course.Copyright © Endocrinology Research Centre, 2022.

Discharge Planning for People with Inpatient Hyperglycaemia: A Review on Pharmacological Management.

Inadequate glycaemic control post-discharge is the root cause of readmission in people with diabetes mellitus (DM) and is often linked to improper discharge planning (DP). A structured DP plays a crucial role in ensuring continuing home care and avoiding readmissions. DP should help patients in self-care and provide appropriate guidance to maintain optimal glycaemic control. There is a scarcity of reports and recommendations on the proper DP for people with DM on insulin therapy. The present review provides important consideration based on experts' opinions from the National Insulin and Incretin summit (NIIS), focusing on the effective treatment strategies at the time of discharge, especially for insulin therapy. A review of literature from PubMed and Embase was conducted. The consensus was derived, and recommendations were made on effective DP for patients with DM. Recommendations arrived at the NIIS for post-discharge treatment for medical and surgical cases, stress-induced hyperglycaemia, elderly, pregnant women, and coronavirus disease 2019 (COVID-19) cases. The committee also recommended a comprehensive checklist to assist the physicians during discharge.

The cross-talk between mucormycosis, steroids and diabetes mellitus amidst the global contagion of COVID-19.

Mucormycosis is an opportunistic fungal disease that targets individuals having an impaired immune system due to a wide array of risk factors including HIV-AIDS, immunosuppressive therapy, diabetes mellitus, etc. The current explosive outbreak of coronavirus disease 2019 (COVID-19) has become the latest threat to such patients who are already susceptible to secondary infections. Physiological outcomes of COVID-19 end up in a cascade of grave alterations to the immunological profile and irreparable harm to their respiratory passage, heart and kidneys. Corticosteroidal treatment facilitates faster recovery and alleviates the adverse pathological effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). But clinical reports lend this approach a darker perspective especially if these patients have pre-existing diabetes mellitus. The mucormycotic fungal genera belonging to the order Mucorales not only survive but thrive under the comorbidity of COVID-19 and diabetes, often staying undetected until they have inflicted irreversible damage. Steroidal usage has been noted to be a common thread in the sudden spurt in secondary fungal infections among COVID-19 cases. Once considered a rare occurrence, mucormycosis has now acquired a notoriously lethal status in mainstream medical hierarchy. We set out to investigate whether corticosteroidal therapy against COVID-19 emboldens the development of mucormycosis. We also assess the conditions brought forth by steroidal usage and uncontrolled progression of diabetes in COVID-19 cases and their effect on the susceptibility towards mucormycosis.

Diabetes and hyperglycaemia among hospitalised patients with COVID-19 in Western Sydney: a retrospective cohort study.

BACKGROUND: Diabetes has been recognised as a major risk factor for COVID-19 mortality and hospital complications in earlier studies. AIMS: To examine the characteristics of hospitalised COVID-19 patients with diabetes and the impact of diabetes and hyperglycaemia on hospital outcomes. METHODS: This was a retrospective cohort study. Admission glucose levels, HbA1c, diabetes status and hospital outcomes were determined for subjects admitted from June to November 2021 by matching a pathology data set, a clinical data set and the hospital administrative database. The outcomes of interest were death, intensive care unit (ICU) admission and length of stay (LOS). RESULTS: There were 1515 individuals admitted with COVID-19 with 49 deaths (3.2%) and 205 (13.5%) ICU admissions. The median length of hospital stay was 3.7 days. Three hundred and ten patients (20%) had diabetes, with 46 (15%) newly diagnosed. Patients with diabetes had a higher mortality than patients who did not have diabetes (8% vs 2%, P < 0.001), were more likely to be admitted to ICU (20% vs 12%, P = 0.001) and have longer median LOS stay (6.6 (interquartile range (IQR) 2.9-12.5) vs 2.9 (IQR 0.5-7.1) days, P < 0.001). In multivariate models, neither diabetes nor admission glucose predicted death. Admission glucose level but not diabetes was an independent predictor of ICU admission and LOS. CONCLUSIONS: There is a high prevalence of diabetes among patients hospitalised with COVID-19, with worse outcomes. In contrast to previous studies, the association of diabetes with mortality was not significant when adjusted for other variables. This is possibly related to the benefits of vaccination and current medical and ICU interventions.

Clinical significance of prediabetes, undiagnosed diabetes and diagnosed diabetes on critical outcomes in COVID-19: Integrative analysis from the Japan COVID-19 task force.

AIM: Diabetes mellitus (DM) is a known risk factor for severe coronavirus disease 2019 (COVID-19), but the clinical impact of undiagnosed diabetes and prediabetes in COVID-19 are unclear particularly in Japan. We clarify the difference in clinical characteristics, including age, sex, body mass index and co-morbidities, laboratory findings and critical outcomes, in a large Japanese COVID-19 cohort without diabetes, with prediabetes, undiagnosed diabetes and diagnosed diabetes, and to identify associated risk factors. MATERIALS AND METHODS: This multicentre, retrospective cohort study used the Japan COVID-19 Task Force database, which included data on 2430 hospitalized COVID-19 patients from over 70 hospitals from February 2020 to October 2021. The prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes were estimated based on HbA1c levels or a clinical diabetes history. Critical outcomes were defined as the use of high-flow oxygen, invasive positive-pressure ventilation or extracorporeal membrane oxygenation, or death during hospitalization. RESULTS: Prediabetes, undiagnosed diabetes and diagnosed diabetes were observed in 40.9%, 10.0% and 23.0%, respectively. Similar to diagnosed diabetes, prediabetes and undiagnosed diabetes were risk factors for critical COVID-19 outcomes (adjusted odds ratio [aOR] [95% CI]: 2.13 [1.31-3.48] and 4.00 [2.19-7.28], respectively). HbA1c was associated with COVID-19 severity in prediabetes patients (aOR [95% CI]: 11.2 [3.49-36.3]), but not other groups. CONCLUSIONS: We documented the clinical characteristics and outcomes of Japanese COVID-19 patients according to HbA1c levels or diabetes co-morbidity. As well as undiagnosed and diagnosed diabetes, physicians should be aware of prediabetes related to COVID-19 severity.

СARBOHYDRATE METABOLISM DISORDERS AND THEIR OUTCOMES IN THE LONG-TERM PERIOD IN HOSPITALIZED PATIENTS WITH COVID-19

BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients. AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it. MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose;HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters. RESULTS: The study included 280 patients with a median age of 61.5±14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included — 56 people (20%), a group with steroid-induced hyperglycemia (SIH) — 95 people (34%), a group of stress- induced hyperglycaemia — 20 people (7%), with undiagnosed diabetes — 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%);8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people). CONCLUSION: The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course. © Endocrinology Research Centre, 2022.

Diabetes Mellitus and COVID-19: Possible Interactions and Mechanisms in Comorbid Patients

Beginning in December 2019 and still ongoing, coronavirus disease 2019 (COVID-19) infections have posed a public health challenge worldwide. There have been reports of diabetes mellitus (DM) as one of the most prevalent comorbidities in patients with COVID-19. Although the interactions and possible mechanisms of this association have not been fully established, the existence of DM is believed to aggravate the adverse effects of COVID-19 infection. Hence, the need for this paper. Findings from other studies have shown different possible mechanisms of how COVID-19 and DM aggravate the severity of each other. Among the hypothetical mechanisms reported between COVID-19 and DM in this paper are: COVID-19 causes complications of DM through the following: (1) Destruction of β-cells in the pancreas by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. (2) Cytokine storm generation which mediates tissue inflammation resulting in organ damage and (3) The use of corticosteroid drugs which have been found to be highly diabetogenic. Similarly, DM facilitates internalizing of SARS-CoV-2 symptoms through increasing expression of angiotensin-converting enzyme 2 (ACE2) and the furin protein, viral load, entrance and replication of SARS-CoV-2, glycosylation, and compromising of the immune response that worsens COVID-19. Having a clear understanding of the biochemical mechanisms of interactions between COVID-19 and DM may be useful for future research of agents targeted as therapeutic remedies for managing patients with diabetes infected with COVID-19 and vice versa. © 2022 JHSMR. Hosted by Prince of Songkla University. All rights reserved.

SARBOHYDRATE METABOLISM DISORDERS AND THEIR OUTCOMES IN THE LONG-TERM PERIOD IN HOSPITALIZED PATIENTS WITH COVID-19

BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients. AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it. MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose;HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters. RESULT(S): The study included 280 patients with a median age of 61.5+/-14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included - 56 people (20%), a group with steroid-induced hyperglycemia (SIH) - 95 people (34%), a group of stress- induced hyperglycaemia - 20 people (7%), with undiagnosed diabetes - 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%);8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people). CONCLUSION(S): The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course. Copyright © Endocrinology Research Centre, 2022.

Coronavirus disease 2019-associated mucormycosis - a syndemic

Coronavirus disease 2019 (COVID-19) and COVID-associated mucormycosis (CAM) came as a syndemic that not only severely increased morbidity and mortality but also posed a serious challenge for the healthcare system of a developing country like India. Although mucormycosis is a rare disease with a worldwide incidence of 0.43 cases per million population/year, these two COVID-19 waves caused a total of more than 14,000 cases in India itself. Mucormycosis is an angio-invasive fungal infection with rapid progression. The three major modalities of treatment involve early surgical debridement, initiation of antifungal therapy and controlling the predisposing risk factor. A complex interplay of factors, including pre-existing disease such as diabetes mellitus, use of immunosuppressants and immunomodulators, risk of hospital-acquired infection and immune dysregulation post-COVID-19, may all predispose to the development of CAM. Future research regarding the efficiency of newer antifungal with lower side effect profiles and evidence-based establishment of risk factors for adopting preventing strategies is the need of the hour. The disease is known to have high mortality despite the best treatment. We review in this article the aetiopathogenesis, various diagnostic modalities and treatment considerations for this disease.

Marked changes in NAMPT expression, CRP and D-dimer levels were associated with type 2 diabetes and those WHO were previously infected with COVID-19

As our understanding grows, it has been demonstrated that the metabolism of many biomolecules and immune responses can be clearly studied. via delving deeply into the relationship between intracellular NAD levels and immune responses. NAD has been shown to play an important role as a substrate for several NAD-dependent signaling enzymes (both degrading and synthesis enzymes) and has been linked to a variety of diseases, including diabetes and COVID 19. In this study, we looked at the expression of the main NAD-synthesizing enzyme (NAMPT), as well as D-Dimer and C-reactive protein levels in serum. This study included one hundred participants: twenty-five patients with type 2 diabetes who recovered from COVID 19, twenty-five type 2 diabetic patients who were not infected with COVID-19, and twenty-five people who recovered from COVID 19 but were not diabetic compared to twenty-five controls. NAMPT levels were determined using quantitative PCR;C-reactive protein levels as well as D-Dimer were determined using competitive fluorescent immunoassay technology. The results revealed a decrease in the expression levels of NAD-homeostasis enzyme (NAMPT), whileC-reactive protein and D-Dimer levels increased, in addition to the change in malondialdehyde (MDA) levels and catalase activity. These findings suggest that low NAD+ levels during infection may be associated with an inflammatory response as well as During infection with COVID 19, diabetes patients had elevated C-reactive protein and D-dimer levels.

Association of hyperglycaemia at-admission & diabetes mellitus with 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection: A retrospective study.

Background & objectives: The association between hyperglycaemia at admission, diabetes mellitus (DM) status and mortality in hospitalized SARS-CoV-2 infected patients is not clear. The purpose of this study was to determine the relationship between DM, at-admission hyperglycaemia and 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection requiring intensive care. Methods: All consecutive moderate-to-severe patients with SARS-CoV-2 infection admitted to the intensive care units (ICUs) over six months were enrolled in this single-centre, retrospective study. The predicators for 28 day mortality were analysed from the independent variables including DM status and hyperglycaemia at-admission. Results: Four hundred and fifty two patients with SARS-CoV-2 were admitted to the ICU, with a mean age of 58.5±13.4 yr, 78.5 per cent being male, HbA1c of 7.2 per cent (6.3-8.8) and 63.7 per cent having DM. Overall, 28 day mortality was 48.9 per cent. In univariate analysis, mortality in diabetes patients was comparable with non-diabetes (47.9 vs. 50.6%, P=0.58), while it was significantly higher in hyperglycaemic group (60.4 vs. 35.8%, P<0.001). In multivariate Cox regression analysis, after adjusting for age, sex and comorbidities, hyperglycaemia at-admission was an independent risk factor of mortality [hazard ratio (HR) 1.45, 95% confidence interval (CI) (1.06-1.99), P<0.05]. Interpretation & conclusions: This study showed that the presence of hyperglycaemia at-admission in critically ill SARS-CoV-2 patients was an independent predictor of 28 day mortality. However, the findings may be susceptible to unmeasured confounding, and more research from prospective studies is required.

Dexamethasone-induced hyperglycaemia in COVID-19: Glycaemic profile in patients without diabetes and factors associated with hyperglycaemia.

AIMS: To evaluate glycaemic profiles of COVID-19 patients without diabetes receiving dexamethasone and determine factors associated with hyperglycaemia. METHODS: All subjects without pre-existing diabetes receiving dexamethasone 6 mg for COVID-19 in a non-critical care setting were identified. Glucose profiles were obtained from capillary blood glucose (BG). Univariate and multivariate analyses were performed to identify factors associated with dexamethasone-induced hyperglycaemia (BG ≥ 10 mmol/L). RESULTS: Of 254 subjects, 129 (50.8%) were male with age 51.1 ± 18.2 years and weight 89.7 ± 26.3 kg. Hyperglycaemia post-dexamethasone occurred in 121 (47.6%). Glucose excursions began within three hours (6.8 ± 1.4 mmol/L pre-dexamethasone vs 8.7 ± 2.4 mmol/L at ≤ 3 h, p < 0.001) and peaked at 7-9 h (10.5 ± 2.3 mmol/L, p < 0.001 vs pre-dexamethasone). BGs post-intravenous were higher than post-oral administration for the initial six hours. Hyperglycaemic subjects were older (57.8 ± 17.5 years vs 45.0 ± 16.6 years, p < 0.001), had higher initial glucose (6.3 ± 1.0 vs 5.9 ± 0.9 mmol/L, p = 0.004), higher HbA1c (5.8 ± 0.3% [40 ± 3.5 mmol/mol] vs 5.5 ± 0.4% [37 ± 4.1 mmol/mol], p < 0.001) higher C-reactive protein (CRP) (100 ± 68 vs 83 ± 58 mg/L, p = 0.026), and lower eGFR (79 ± 17 vs 84 ± 16 mL/min/1.73 m2, p = 0.045). Mortality was greater in the hyperglycaemia group (9/121 [7.4%] vs 2/133 [1.5%], p = 0.02). Age, HbA1c and CRP were independently associated with hyperglycaemia. CONCLUSIONS: Half of subjects without diabetes experienced hyperglycaemia post-dexamethasone for COVID-19, peak occurring after 7-9 h. Age, HbA1c and CRP were associated with hyperglycaemia.