SARS-CoV-2 Infection Causes Hyperglycemia in Cats.

Isolated reports of new-onset diabetes in patients with coronavirus disease 2019 (COVID-19) have led researchers to hypothesize that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects human exocrine and endocrine pancreatic cells ex vivo and in vivo. However, existing research lacks experimental evidence indicating that SARS-CoV-2 can infect pancreatic tissue. Here, we found that cats infected with a high dose of SARS-CoV-2 exhibited hyperglycemia. We also detected SARS-CoV-2 RNA in pancreatic tissues of these cats, and immunohistochemical staining revealed the presence of SARS-CoV-2 nucleocapsid protein (NP) in islet cells. SARS-CoV-2 NP and spike proteins were primarily detected in glucagon-positive cells, and most glucagon-positive cells expressed ACE2. Additionally, immune protection experiments conducted on cats showed that blood glucose levels of immunized cats did not increase postchallenge. Our data indicate cat pancreas as a SARS-CoV-2 target and suggest that the infection of glucagon-positive cells could contribute to the metabolic dysregulation observed in SARS-CoV-2-infected cats.

Alterations of adipokines, pancreatic hormones and incretins in acute and convalescent COVID-19 children.

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), accountable for Coronavirus disease 2019 (COVID-19), may cause hyperglycemia and additional systemic complexity in metabolic parameters. It is unsure even if the virus itself causes type 1 or type 2 diabetes mellitus (T1DM or T2DM). Furthermore, it is still unclear whether even recuperating COVID-19 individuals have an increased chance to develop new-onset diabetes. METHODS: We wanted to determine the impact of COVID-19 on the levels of adipokines, pancreatic hormones, incretins and cytokines in acute COVID-19, convalescent COVID-19 and control children through an observational study. We performed a multiplex immune assay analysis and compared the plasma levels of adipocytokines, pancreatic hormones, incretins and cytokines of children presenting with acute COVID-19 infection and convalescent COVID-19. RESULTS: Acute COVID-19 children had significantly elevated levels of adipsin, leptin, insulin, C-peptide, glucagon and ghrelin in comparison to convalescent COVID-19 and controls. Similarly, convalescent COVID-19 children had elevated levels of adipsin, leptin, insulin, C-peptide, glucagon, ghrelin and Glucagon-like peptide-1 (GLP-1) in comparison to control children. On the other hand, acute COVID-19 children had significantly decreased levels of adiponectin and Gastric Inhibitory Peptide (GIP) in comparison to convalescent COVID-19 and controls. Similarly, convalescent COVID-19 children had decreased levels of adiponectin and GIP in comparison to control children. Acute COVID-19 children had significantly elevated levels of cytokines, (Interferon (IFN)) IFNγ, Interleukins (IL)-2, TNFα, IL-1α, IL-1ß, IFNα, IFNß, IL-6, IL-12, IL-17A and Granulocyte-Colony Stimulating Factors (G-CSF) in comparison to convalescent COVID-19 and controls. Convalescent COVID-19 children had elevated levels of IFNγ, IL-2, TNFα, IL-1α, IL-1ß, IFNα, IFNß, IL-6, IL-12, IL-17A and G-CSF in comparison to control children. Additionally, Principal component Analysis (PCA) analysis distinguishes acute COVID-19 from convalescent COVID-19 and controls. The adipokines exhibited a significant correlation with the levels of pro-inflammatory cytokines. CONCLUSION: Children with acute COVID-19 show significant glycometabolic impairment and exaggerated cytokine responses, which is different from convalescent COVID-19 infection and controls.

Hypoglycemia: A closer look at a community pharmacist's impact in optimizing diabetes care.

BACKGROUND: Hypoglycemia is a complication of diabetes and can have considerable clinical impact on mortality, morbidity, and quality of life. Certain patient populations with diabetes are at an increased risk of experiencing hypoglycemia, posing as a safety concern and may have possible negative affect(s) on diabetes if not appropriately managed. With community pharmacies often being an accessible means of health care, there is potential for widespread diabetes education in this setting. OBJECTIVES: Assess impact of pharmacist-initiated education on proper recognition/management of hypoglycemia in patients with type 1 and 2 diabetes. Secondary objectives aim to optimize diabetes care: (1) assessment of patient need for a glucagon kit prescription, (2) evaluation of adherence to highly recommended vaccinations for individuals with diabetes and acceptance of pharmacist vaccination recommendations, and (3) assessment of patient satisfaction with the study intervention. SETTING AND PRACTICE DESCRIPTION: A community pharmacy in the Suffolk County of Massachusetts serving middle- to lower-class and medically underserved patients. Most of the population includes an elderly, Hispanic, and Asian demographic. EVALUATION: Outcomes evaluated through change in hypoglycemia questionnaire scores from preintervention to postintervention, the percentage of patients who received a prescription for glucagon kit post pharmacist intervention, the percentage of patients that received a vaccination because of pharmacist intervention, and Likert scale-based survey for the assessment of patient satisfaction. RESULTS: Participant knowledge of hypoglycemia awareness/treatment improved significantly post pharmacist intervention (P < 0.001). Average gain in questionnaire scores from pre-edcation to posteducation was 6.4 points (maximum score = 9, P < 0.001). Glucagon prescriptions were facilitated/dispensed for 28.5% of eligible participants. Fifty-eight vaccinations were recommended, and 25.8% were administered. Patients' overall satisfaction score averaged 4.7 out of a maximum of 5 (higher scores more favorable). CONCLUSION: An educational service in a community pharmacy setting can provide effective education to recognize signs, symptoms, and proper treatment of hypoglycemia in patients on diabetes therapy that carries a high risk.

SARS-CoV-2 infection induces beta cell transdifferentiation.

Recent clinical data have suggested a correlation between coronavirus disease 2019 (COVID-19) and diabetes. Here, we describe the detection of SARS-CoV-2 viral antigen in pancreatic beta cells in autopsy samples from individuals with COVID-19. Single-cell RNA sequencing and immunostaining from ex vivo infections confirmed that multiple types of pancreatic islet cells were susceptible to SARS-CoV-2, eliciting a cellular stress response and the induction of chemokines. Upon SARS-CoV-2 infection, beta cells showed a lower expression of insulin and a higher expression of alpha and acinar cell markers, including glucagon and trypsin1, respectively, suggesting cellular transdifferentiation. Trajectory analysis indicated that SARS-CoV-2 induced eIF2-pathway-mediated beta cell transdifferentiation, a phenotype that could be reversed with trans-integrated stress response inhibitor (trans-ISRIB). Altogether, this study demonstrates an example of SARS-CoV-2 infection causing cell fate change, which provides further insight into the pathomechanisms of COVID-19.