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1.
Lancet ; 400(10365): 1803-1820, 2022 11 19.
Article in English | MEDLINE | ID: covidwho-2159959

ABSTRACT

Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Technology might improve outcomes, but its potential is yet to be realised. Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.


Subject(s)
Diabetes Mellitus, Type 2 , Epidemics , Humans , Child , Young Adult , Adult , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Pharmacogenetics , Precision Medicine , Technology
2.
Indian J Public Health ; 66(Supplement): S71-S75, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2144166

ABSTRACT

Background: Persons with type 2 diabetes mellitus (T2DM) are at high-risk for COVID-19 infection and are a priority group for vaccination. Objectives: The objective of this study is to estimate the seroconversion and determine the side effects after COVID-19 vaccination among persons with T2DM in urban, rural, and tribal areas in Kerala. Methods: A cross-sectional study was conducted in urban, rural, and tribal field practice areas of a medical college in Central Kerala, among 396 persons with T2DM. The participants were selected by simple random sampling from the 200-250 diabetic patients visiting each health center. Qualitative and quantitative estimation of antibodies were done by WANTAI Ab enzyme-linked immunosorbent assay kit and Abbott SARS COV-2 IgG Quantitative assay, respectively. Results: The mean age of the respondents was 59.40 ± 12.25 years. A majority (65.5%) had received both doses of vaccine. About half (51.5%) experienced side effects after vaccination. Antibodies (IgG or IgM) were detected in 93.2% (95% confidence interval [CI] 90.2, 95.5) of participants. Those with a duration of diabetes ≥5 years, with a single dose of vaccine, were five times (adjusted odds ratio [aOR] - 5.23,95% CI 1.86, 14.66) and four times (aOR - 4.11, 95% CI 1.66, 10.13) more likely, respectively, to be seronegative. Those who took medication for diabetes were protected against a no antibody (aOR - 0.05, 95% CI 0.02, 0.148) response. The median antibody titer in a subset (150) of participants was 365.2 (90-1587) AU/ml. Past COVID infection was an independent determinant of high IgG titers (aOR - 4.95, 95% CI 1.50, 16.36). Conclusion: Reinforcing the importance of vaccination particularly among those with longer duration of diabetes is imperative.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Humans , Middle Aged , Aged , Diabetes Mellitus, Type 2/epidemiology , India/epidemiology , Seroconversion , Cross-Sectional Studies , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Vaccination , Immunoglobulin G
3.
Drug Saf ; 45(12): 1477-1490, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2129484

ABSTRACT

INTRODUCTION: In Hong Kong, CoronaVac and BNT162b2 have been approved for emergency use owing to the coronavirus disease 2019 (COVID-19) pandemic. Reactions towards the vaccine and the risk of post-vaccination adverse events may be different between recipients with and without type 2 diabetes mellitus (T2DM). OBJECTIVE: The aim of this study was to evaluate the risk of adverse events of special interest (AESI) and acute diabetic complications in the T2DM population after COVID-19 vaccination in Hong Kong. RESEARCH DESIGN AND METHODS: Self-controlled case-series analysis was conducted. Patients with T2DM who received at least one dose of BNT162b2 or CoronaVac between 23 February 2021 and 31 January 2022 from electronic health records in Hong Kong were included. The incidence rates of 29 AESIs and acute diabetic complications (any of severe hypoglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome) requiring hospitalization within 21 days after the first or second dose of vaccination were reported. The risks of these outcomes were evaluated using conditional Poisson regression. RESULTS: Among 141,224 BNT162b2 recipients and 209,739 CoronaVac recipients with T2DM, the incidence per 100,000 doses and incidence per 100,000 person-years of individual AESIs and acute diabetic complications ranged from 0 to 24.4 and 0 to 438.6 in BNT162b2 group, and 0 to 19.5 and 0 to 351.6 in CoronaVac group. We did not observe any significantly increased risk of individual AESIs or acute diabetic complications after first or second doses of BNT162b2 or CoronaVac vaccine. Subgroup analysis based on HbA1c < 7% and ≥ 7% also did not show significantly excess risk after vaccination. CONCLUSIONS: Patients with T2DM do not appear to have higher risks of AESI and acute diabetic complications after BNT162b2 or CoronaVac vaccination. Moreover, given the low incidence of AESIs and acute diabetic complications after vaccination, the absolute risk increment was likely minimal.


Subject(s)
COVID-19 Vaccines , COVID-19 , Diabetes Complications , Diabetes Mellitus, Type 2 , Humans , BNT162 Vaccine , COVID-19/complications , COVID-19/epidemiology , COVID-19 Vaccines/adverse effects , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , RNA, Messenger , Vaccination/adverse effects
5.
Prim Care Diabetes ; 16(6): 753-759, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2113826

ABSTRACT

AIMS: To analyse if antidiabetic treatment was associated with better COVID-19 outcomes in type 2 diabetic patients, measured by hospital admission and mortality rates as severe outcomes. METHODS: Cohort study including COVID-19 patients registered in the Primary Care electronic records, in March-June 2020, comparing exposed to metformin in monotherapy with exposed to any other antidiabetic. DATA SOURCE: SIDIAP (Information System for Research in Primary Care), which captures clinical information of 5,8 million people from Catalonia, Spain. RESULTS: We included 31,006 diabetic patients infected with COVID-19, 43.7% previously exposed to metformin, 45.5% of them in monotherapy. 16.4% were admitted to hospital and 15.1% died. Users of insulin in monotherapy (OR 1.29, 95% CI 1.11-1.50), combined with metformin (OR 1.38, 1.13-1.69) or IDPP4 alone (OR 1.29, 1.03-1.63) had higher risk of severe outcomes than those in metformin monotherapy. Users of any insulin (OR 1.61, 1.32-1.97) or combined with metformin (OR 1.69, 1.30-2.20) had a higher risk of mortality. CONCLUSIONS: Patients receiving metformin monotherapy in our study showed a lower risk of hospitalization and death in comparison to those treated with other frequent antidiabetic agents. We cannot distinguish if better outcomes are related with the antidiabetic therapy or with other factors, such as metabolic control or interventions applied during the hospital admission.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Metformin , Humans , Hypoglycemic Agents/adverse effects , Spain/epidemiology , Pandemics , Cohort Studies , COVID-19/drug therapy , COVID-19/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Metformin/adverse effects , Insulin/adverse effects , Primary Health Care
6.
Prim Care Diabetes ; 16(6): 768-774, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2113810

ABSTRACT

AIM: To examine the differences in the continuity of health care for type 2 diabetic patients before and during COVID pandemic in family medicine depending on whether the physician who provided care finished vocational training in family medicine or not. METHODS: This retrospective longitudinal research lasted from 2018 to 2020 in eight family medicine practices on 648 patients with type 2 diabetes diagnosed before 2018, and without Sars-Cov2 infection in previous medical history in Zagreb, Croatia. Follow-up parameters (HbA1c, LDL, eGFR, blood pressure, BMI, eye fundus and neurological findings, number of check-ups and vaccination against the flu) were noted before (2018, 2019), and in the COVID period (2020) in the care of family medicine specialists (FMPs) and without it (FMPws). RESULTS: No differences were found between the gender and age of patients. A decrease was seen in existing laboratory findings (64-47%, P < 0.001), eye fundus check-ups (39-37%, P = NS), neurologist check-ups (28-25%, P = NS) and FMP check-ups (382-321, P < 0.001) during the COVID period with significant differences between FMPs and FMPws. Significant changes were seen in LDL cholesterol (2.7-2.4 mmol/L, P < 0.001) and eGFR (83-80 ml/min/1.73 m2, P = 0.002), but BMI, blood pressure and HbA1c (>7% had 42% of patients) values did not differ during the COVID period. CONCLUSION: According to the observed parameters, the continuity of care for diabetic patients in Zagreb has worsened during the COVID pandemic but remained significantly better in care of FMPs than in FMPws, without differences in achieving target values of follow-up parameters.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , COVID-19/epidemiology , Glycated Hemoglobin A , Croatia/epidemiology , Retrospective Studies , RNA, Viral , SARS-CoV-2 , Primary Health Care , Continuity of Patient Care
7.
J Diabetes Res ; 2022: 9652940, 2022.
Article in English | MEDLINE | ID: covidwho-2113176

ABSTRACT

Introduction: New onset of diabetes mellitus was noted as the commonest comorbidity in the COVID-19 pandemic, which contributed to a worse prognosis. Existing evidence showed that new-onset diabetes is associated with increased mortality compared to nondiabetic and known diabetic patients in the COVID-19 era. SARS-CoV-2 virus can worsen existing diabetes; at the same time, it can trigger new-onset diabetes that eventually worsens patient outcomes. Thus, this study is aimed at determining the prevalence and factors associated with new onset of diabetes mellitus among COVID-19 patients. Methods: Institution-based retrospective cross-sectional study design was conducted by reviewing 244 patient's records in the Addis Ababa COVID-19 care center. Descriptive statistics and binary logistic regression were used. During bivariate analysis, variables with p ≤ 0.25 were transferred into multivariate analysis. Adjusted odds ratios to determine the strength and presence of the association with a 95% confidence interval and p value ≤ 0.05 were considered, respectively. Results: The mean age of the study participants was 53.2 years with (SD = 13.35). The study findings showed that 31.1% (CI: 25.4-37.4) of COVID-19 patients had new onset of diabetes mellitus; of those, 11.8% had type 1 and 88.2% had type 2 diabetes. Being male (aOR = 2.9; 95% CI: 1.2, 7.1), family history of hypertension (aOR = 3.7; 95% CI: 1.3, 10.5), obesity (aOR = 3.1; 95% CI: 1.01, 8.9), having pulmonary embolism (aOR = 0.2; 95% CI: 0.06, 0.04), and hyperkalemia (aOR = 9.3; 95% CI: 1.8, 47.3) showed statistically significant association with new onset of diabetes mellitus. Conclusion: A significant proportion of COVID-19 patients had been diagnosed with new onset of diabetes mellitus, and new-onset type 2 diabetes mellitus is the most common diabetes mellitus type. Being male, obesity, having a pulmonary embolism, family history of hypertension, and hyperkalemia were independently associated with new onset of diabetes mellitus among COVID-19 patients. Therefore, focused interventions need to be strengthened towards the identified factors.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Hyperkalemia , Hypertension , Pulmonary Embolism , Humans , Male , Middle Aged , Female , COVID-19/complications , COVID-19/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Cross-Sectional Studies , Hyperkalemia/complications , Hyperkalemia/epidemiology , Ethiopia/epidemiology , Retrospective Studies , Pandemics , Risk Factors , SARS-CoV-2 , Hypertension/epidemiology , Hypertension/complications , Obesity/complications , Obesity/epidemiology , Pulmonary Embolism/complications , Pulmonary Embolism/epidemiology
8.
BMC Med ; 20(1): 444, 2022 11 15.
Article in English | MEDLINE | ID: covidwho-2119486

ABSTRACT

BACKGROUND: There is growing evidence that patients recovering after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have a variety of acute sequelae including newly diagnosed diabetes. However, the risk of diabetes in the post-acute phase is unclear. To solve this question, we aimed to determine if there was any association between status post-coronavirus disease (COVID-19) infection and a new diagnosis of diabetes. METHODS: We performed a systematic review and meta-analysis of cohort studies assessing new-onset diabetes after COVID-19. PubMed, Embase, Web of Science, and Cochrane databases were all searched from inception to June 10, 2022. Three evaluators independently extracted individual study data and assessed the risk of bias. Random-effects models estimated the pooled incidence and relative risk (RR) of diabetes compared to non-COVID-19 after COVID-19. RESULTS: Nine studies with nearly 40 million participants were included. Overall, the incidence of diabetes after COVID-19 was 15.53 (7.91-25.64) per 1000 person-years, and the relative risk of diabetes after COVID-19 infection was elevated (RR 1.62 [1.45-1.80]). The relative risk of type 1 diabetes was RR=1.48 (1.26-1.75) and type 2 diabetes was RR=1.70 (1.32-2.19), compared to non-COVID-19 patients. At all ages, there was a statistically significant positive association between infection with COVID-19 and the risk of diabetes: <18 years: RR=1.72 (1.19-2.49), ≥18 years: RR=1.63 (1.26-2.11), and >65 years: RR=1.68 (1.22-2.30). The relative risk of diabetes in different gender groups was about 2 (males: RR=2.08 [1.27-3.40]; females: RR=1.99 [1.47-2.80]). The risk of diabetes increased 1.17-fold (1.02-1.34) after COVID-19 infection compared to patients with general upper respiratory tract infections. Patients with severe COVID-19 were at higher risk (RR=1.67 [1.25-2.23]) of diabetes after COVID-19. The risk (RR=1.95 [1.85-2.06]) of diabetes was highest in the first 3 months after COVID-19. These results remained after taking confounding factors into account. CONCLUSIONS: After COVID-19, patients of all ages and genders had an elevated incidence and relative risk for a new diagnosis of diabetes. Particular attention should be paid during the first 3 months of follow-up after COVID-19 for new-onset diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Respiratory Tract Infections , Humans , Female , Male , Young Adult , Adult , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/epidemiology , Cohort Studies
9.
PLoS One ; 17(11): e0277014, 2022.
Article in English | MEDLINE | ID: covidwho-2119257

ABSTRACT

Screening, prevention, and management of non-communicable diseases (NCDs, including obesity, hypertension, and type 2 diabetes) is the core function of Integrated Measurement for Early Detection (MIDO), a digital strategy developed by the Carlos Slim Foundation in Mexico. An extension of this strategy, MIDO COVID, was developed to address the need for an integrated plan in primary health care during the COVID-19 pandemic. MIDO COVID facilitates planning, surveillance, testing, and clinical management of SARS-CoV-2 infections and the major NCDs and their pre-disease states, to streamline the continuum of care. MIDO COVID screening was applied in 1063 Carso Group workplaces in 190 municipalities of the 32 Mexican states. Staff were trained to screen healthy workers for NCDs using a questionnaire, anthropomorphic measurements, and blood work; healthy individuals returning to work also received a SARS-CoV-2 antibody test. Between June 26 and December 31, 2020, 58,277 asymptomatic individuals underwent screening. The prevalence of obesity, hypertension, and type 2 diabetes was 32.1%, 25.7%, and 9.7% respectively. Only 2.2%, 8.8%, and 4.5% of individuals, respectively, were previously aware of their condition. Pre-obesity was identified in 38.6%, pre-hypertension in 17.4%, and prediabetes in 7.5% of the population. Risk of SARS-CoV-2 infection was highest for individuals with multiple NCDs. Many Mexicans are unaware of their health status and potentially increased risk of COVID-19 and serious complications. As a universal strategy implemented regardless of social factors, MIDO COVID promotes equity in access to health care prevention and early stage detection of NCDs; the information gained may help inform decisionmakers regarding prioritising vulnerable populations for immunisation.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Hypertension , Humans , Public Health , COVID-19/epidemiology , COVID-19/prevention & control , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/prevention & control , Mexico/epidemiology , Pandemics/prevention & control , SARS-CoV-2 , Chronic Disease , Hypertension/epidemiology , Hypertension/prevention & control , Obesity/epidemiology
10.
BMJ Open ; 12(11): e065148, 2022 11 08.
Article in English | MEDLINE | ID: covidwho-2108285

ABSTRACT

OBJECTIVE: During COVID-19 pandemic, complete lockdown of cities was one of the measures implemented by governments worldwide. Lockdown had a significant impact on people's lifestyles and access and utilisation of health services. This study aimed to assess the impact of the lockdown on glycaemic control among patients with type 2 diabetes mellitus (T2DM). DESIGN AND SETTING: This was a retrospective study, electronic medical records at a leading University Hospital in Northern Jordan were used to extract study data. PARTICIPANTS: All outpatients with T2DM. PRIMARY AND SECONDARY OUTCOME MEASURES: Glycated haemoglobin (HbA1c), blood glucose and lipid profile for patients with T2DM, 6 months before and 6 months after the full COVID-19 lockdown. RESULTS: A total of 639 patients (289 (45.2%) males and 350 (54.8%) females) were included in this study. Their age ranged from 18 to 91 years, with a mean (SD) of 59.9 (13.8) years. The overall means of HbA1c (8.41 vs 8.20, <0.001), high-density lipoprotein (1.16 vs 1.12, <0.001), low-density lipoprotein (2.81 vs 2.49, <0.001) and total cholesterol (4.45 vs 4.25, p<0.001) levels were significantly higher in the period before lockdown compared with the period after the lockdown. However, triglyceride and fasting blood glucose levels were not affected significantly after the lockdown. CONCLUSIONS: The glycaemic control and lipid profile had significantly improved after COVID-19 pandemic lockdown. The availability of medication and medical advice delivery systems (monthly medicine deliveries) during the lockdown in Jordan might have positive impact on patients with diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Glycated Hemoglobin A/analysis , Diabetes Mellitus, Type 2/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Blood Glucose , Retrospective Studies , Pandemics , Jordan/epidemiology , Communicable Disease Control , Lipids
11.
WMJ ; 121(3): 177-180, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2092197

ABSTRACT

INTRODUCTION: Recent studies report a significant impact of the COVID-19 pandemic on the incidence, severity, and management of diabetes. OBJECTIVE: To determine the incidence of new onset pediatric diabetes prepandemic versus during the pandemic and to analyze the presentation based on age, severity, HbA1c, body mass index, and COVID testing. METHODS: We conducted a retrospective review of all pediatric patients admitted with newly diagnosed type 1 and type 2 diabetes mellitus admitted to the American Family Children's Hospital (Madison, Wisconsin) from 2018 through 2021. Data included age at diagnosis, body mass index, hemoglobin A1c percent and pH at presentation, presence of autoimmune pancreatic antibodies, and COVID-19 polymerase chain reaction (PCR) results at admission in pre-COVID (January 2018-February 2020) versus during COVID (March 2020-December 2021). Statistical analysis was performed using SAS software with the incidences analyzed using univariate and multivariate Poisson regression analyses. RESULTS: During the pandemic, the incidence of both type 1 and type 2 diabetes mellitus increased significantly (69% and 225%, P < 0.001, respectively), and a higher number of patients had diabetic ketoacidosis. Type 1 diabetes patients with a body mass index greater than the 95th percentile increased from 11.1% to 16.9% (OR 0.62; 95% CI, 0.29-1.29; P = 0.19). Almost all patients were COVID-19 PCR negative at the time of diagnosis. CONCLUSIONS: A dramatic increase in number and severity of newly diagnosed pediatric diabetes cases was seen during the pandemic. The increase was not explained by factors such as changes in referral patterns or insurance coverage. Further work is needed to understand the impact of societal factors and the direct diabetogenic effect of SARS-CoV-2.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Humans , Child , COVID-19/epidemiology , Pandemics , SARS-CoV-2 , COVID-19 Testing , Diabetes Mellitus, Type 2/epidemiology , Retrospective Studies
12.
WMJ ; 121(3): 177-180, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2083392

ABSTRACT

INTRODUCTION: Recent studies report a significant impact of the COVID-19 pandemic on the incidence, severity, and management of diabetes. OBJECTIVE: To determine the incidence of new onset pediatric diabetes prepandemic versus during the pandemic and to analyze the presentation based on age, severity, HbA1c, body mass index, and COVID testing. METHODS: We conducted a retrospective review of all pediatric patients admitted with newly diagnosed type 1 and type 2 diabetes mellitus admitted to the American Family Children's Hospital (Madison, Wisconsin) from 2018 through 2021. Data included age at diagnosis, body mass index, hemoglobin A1c percent and pH at presentation, presence of autoimmune pancreatic antibodies, and COVID-19 polymerase chain reaction (PCR) results at admission in pre-COVID (January 2018-February 2020) versus during COVID (March 2020-December 2021). Statistical analysis was performed using SAS software with the incidences analyzed using univariate and multivariate Poisson regression analyses. RESULTS: During the pandemic, the incidence of both type 1 and type 2 diabetes mellitus increased significantly (69% and 225%, P < 0.001, respectively), and a higher number of patients had diabetic ketoacidosis. Type 1 diabetes patients with a body mass index greater than the 95th percentile increased from 11.1% to 16.9% (OR 0.62; 95% CI, 0.29-1.29; P = 0.19). Almost all patients were COVID-19 PCR negative at the time of diagnosis. CONCLUSIONS: A dramatic increase in number and severity of newly diagnosed pediatric diabetes cases was seen during the pandemic. The increase was not explained by factors such as changes in referral patterns or insurance coverage. Further work is needed to understand the impact of societal factors and the direct diabetogenic effect of SARS-CoV-2.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Humans , Child , COVID-19/epidemiology , Pandemics , SARS-CoV-2 , COVID-19 Testing , Diabetes Mellitus, Type 2/epidemiology , Retrospective Studies
13.
Turk J Med Sci ; 52(4): 1093-1102, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2067783

ABSTRACT

BACKGROUND: There are not many studies conducted to detect and recognize the symptoms during the prediabetes period. In our study, we aimed to determine the symptoms that can be seen in prediabetes and diabetes and their prevalence and to determine the similarities and differences between the two groups. METHODS: Individuals who were diagnosed with prediabetes or diabetes, over the age of 18, literate, and accepted to collaborate were included in our study. The "Diabetes Symptoms Checklist Scale" was used by interviewing 321 participants, 161 prediabetic and 160 diabetic, face-to-face. RESULTS: It has been found that the most common symptom in both the prediabetes and the diabetes group is "fatigue" (88.2% prediabetes, 89.4% diabetes). The symptoms seen in the dimensions of neurology and hyperglycemia are more common in individuals with diabetes than in individuals with prediabetes [neurology score: 1.85 ± 0.84 vs. 1.66 ± 0.64 (p = 0.02), respectively; hyperglycemia score: 2.39 ± 0.94 vs. 2.08 ± 0.83 (p = 0.002), respectively]. It was observed that the symptom burden increased in all subdimensions with the long duration of illness, being a female, not working, having a family history, and not doing exercise, and high fasting blood glucose and high HbA1c values. The level of education, family history, accompanying hyperlipidemia, neurology, and hyperglycemia symptoms are associated with diabetes; and it has been determined that cardiology symptoms are associated with prediabetes. DISCUSSION: Especially; during the follow-up of patients with prediabetes who have a low education level and diabetic family history and concomitant hyperlipidemia, there may be an increase in neurological and hyperglycemic symptoms at the point of development of type 2 diabetes. In this respect, we recommend that these factors, which we found to be predictive of diabetes compared to prediabetes, should be questioned more carefully during patient visits.


Subject(s)
Diabetes Mellitus, Type 2 , Hyperglycemia , Prediabetic State , Humans , Female , Adult , Middle Aged , Prediabetic State/diagnosis , Prediabetic State/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Glycated Hemoglobin A/analysis , Blood Glucose
14.
BMJ Open ; 12(10): e063046, 2022 10 12.
Article in English | MEDLINE | ID: covidwho-2064161

ABSTRACT

PURPOSE: The Scottish Diabetes Research Network (SDRN)-diabetes research platform was established to combine disparate electronic health record data into research-ready linked datasets for diabetes research in Scotland. The resultant cohort, 'The SDRN-National Diabetes Dataset (SDRN-NDS)', has many uses, for example, understanding healthcare burden and socioeconomic trends in disease incidence and prevalence, observational pharmacoepidemiology studies and building prediction tools to support clinical decision making. PARTICIPANTS: We estimate that >99% of those diagnosed with diabetes nationwide are captured into the research platform. Between 2006 and mid-2020, the cohort comprised 472 648 people alive with diabetes at any point in whom there were 4 million person-years of follow-up. Of the cohort, 88.1% had type 2 diabetes, 8.8% type 1 diabetes and 3.1% had other types (eg, secondary diabetes). Data are captured from all key clinical encounters for diabetes-related care, including diabetes clinic, primary care and podiatry and comprise clinical history and measurements with linkage to blood results, microbiology, prescribed and dispensed drug and devices, retinopathy screening, outpatient, day case and inpatient episodes, birth outcomes, cancer registry, renal registry and causes of death. FINDINGS TO DATE: There have been >50 publications using the SDRN-NDS. Examples of recent key findings include analysis of the incidence and relative risks for COVID-19 infection, drug safety of insulin glargine and SGLT2 inhibitors, life expectancy estimates, evaluation of the impact of flash monitors on glycaemic control and diabetic ketoacidosis and time trend analysis showing that diabetic ketoacidosis (DKA) remains a major cause of death under age 50 years. The findings have been used to guide national diabetes strategy and influence national and international guidelines. FUTURE PLANS: The comprehensive SDRN-NDS will continue to be used in future studies of diabetes epidemiology in the Scottish population. It will continue to be updated at least annually, with new data sources linked as they become available.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Diabetic Ketoacidosis , Sodium-Glucose Transporter 2 Inhibitors , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Humans , Insulin Glargine , Middle Aged , Naphthalenesulfonates , Scotland/epidemiology
15.
Prim Care Diabetes ; 16(6): 745-752, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2061753

ABSTRACT

OBJECTIVES: The objective of this study was to evaluate the impact of a telehealth intervention on metabolic outcomes and self-perceptions of the patients regarding their management of diabetes during the COVID-19 pandemic. METHODS: This is a non-blind randomized controlled clinical trial to assess a telehealth intervention. We included adults with diabetes mellitus. The outcomes assessed were the level of HbA1c, lipid profile, blood pressure levels, weight, body mass index and self-perceptions about diabetes management. RESULTS: A total of 150 individuals with diabetes participated in the study and at the end of telehealth intervention there were no changes in the patient's HbA1c levels between intervention and control groups for neither type 1 (8.1% vs. 8.6%; p = 0.11) nor type 2 diabetes (8.6% vs. 9.0%; p = 0.09), respectively. From the rest of the metabolic profile, triglyceride levels from type 1 diabetes group was the only variable that demonstrated improvement with telehealth intervention (66.5% intervention group vs. 86.5% control group; p = 0.05). CONCLUSIONS: After 4 months of telehealth intervention, no statistically significant results were observed in HbA1c nor in secondary outcomes (with the exception of triglycerides for the type 1 diabetes group).


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Telemedicine , Adult , Humans , Glycated Hemoglobin A/analysis , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , COVID-19/epidemiology , Pandemics , Telemedicine/methods , Metabolome
16.
Metabolism ; 137: 155330, 2022 12.
Article in English | MEDLINE | ID: covidwho-2061660

ABSTRACT

BACKGROUND: COVID-19 might be a risk factor for various chronic diseases. However, the association between COVID-19 and the risk of incident diabetes remains unclear. We aimed to meta-analyze evidence on the relative risk of incident diabetes in patients with COVID-19. METHODS: In this systematic review and meta-analysis, the Embase, PubMed, CENTRAL, and Web of Science databases were searched from December 2019 to June 8, 2022. We included cohort studies that provided data on the number, proportion, or relative risk of diabetes after confirming the COVID-19 diagnosis. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias. We used a random-effects meta-analysis to pool the relative risk with corresponding 95 % confidence intervals. Prespecified subgroup and meta-regression analyses were conducted to explore the potential influencing factors. We converted the relative risk to the absolute risk difference to present the evidence. This study was registered in advance (PROSPERO CRD42022337841). MAIN FINDINGS: Ten articles involving 11 retrospective cohorts with a total of 47.1 million participants proved eligible. We found a 64 % greater risk (RR = 1.64, 95%CI: 1.51 to 1.79) of diabetes in patients with COVID-19 compared with non-COVID-19 controls, which could increase the number of diabetes events by 701 (558 more to 865 more) per 10,000 persons. We detected significant subgroup effects for type of diabetes and sex. Type 2 diabetes has a higher relative risk than type 1. Moreover, men may be at a higher risk of overall diabetes than women. Sensitivity analysis confirmed the robustness of the results. No evidence was found for publication bias. CONCLUSIONS: COVID-19 is strongly associated with the risk of incident diabetes, including both type 1 and type 2 diabetes. We should be aware of the risk of developing diabetes after COVID-19 and prepare for the associated health problems, given the large and growing number of people infected with COVID-19. However, the body of evidence still needs to be strengthened.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Male , Humans , Female , Diabetes Mellitus, Type 2/epidemiology , Retrospective Studies , COVID-19 Testing , COVID-19/epidemiology , Risk Factors
17.
S Afr Fam Pract (2004) ; 64(1): e1-e5, 2022 Sep 22.
Article in English | MEDLINE | ID: covidwho-2055673

ABSTRACT

BACKGROUND:  Coronavirus disease 2019 (COVID-19) is associated with an increased prevalence and mortality from diabetic ketoacidosis (DKA) globally. With limited access to specialised care, most patients with DKA in South Africa are managed at district hospital level. This study describes the profile of patients admitted to a district hospital in South Africa with DKA and COVID-19 and examines associated risk factors encountered. METHODS:  This was a case series of all patients presenting to a district hospital with DKA and COVID-19 infection between July 2020 and July 2021. Data extracted included patients' demographic profiles, biochemical results, comorbidities and clinical outcomes. RESULTS:  The median age of the 10 patients admitted during the study period was 39 years old (±12), six of whom were male. The hemoglobin A1c (HbA1c) values on admission ranged from 9.7 to 13.8. Five of the patients had pre-existing type 2 diabetes mellitus (DM). Four of the known DM patients were on metformin only, and one was on biphasic insulin. Three patients had other pre-existing comorbidities, two patients with hypertension and one with human immunodeficiency virus (HIV). Three patients demised, two of whom were hypoxic on admission. CONCLUSION:  Diabetic ketoacidosis appears more commonly in COVID-19 infected patients with type 2 DM and at a young age. Suboptimal glycaemic control was associated with DKA, and hypoxia was a strong predictor for mortality. Treatment inertia was evident in the known DM group, who were on monotherapy despite persistent hyperglycaemia. Greater vigilance is required to detect ketosis in type 2 DM and intensify therapy to improve glycaemic control.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Diabetic Ketoacidosis , Metformin , Adult , Biphasic Insulins/therapeutic use , COVID-19/complications , COVID-19/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/epidemiology , Diabetic Ketoacidosis/therapy , Female , Glycated Hemoglobin A/analysis , Glycated Hemoglobin A/therapeutic use , Hospitals, District , Humans , Male , Metformin/therapeutic use , Retrospective Studies , South Africa/epidemiology
18.
Pediatr Diabetes ; 23(7): 872-902, 2022 11.
Article in English | MEDLINE | ID: covidwho-2052902

ABSTRACT

Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth-onset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Adolescent , Child , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Humans , Incidence , Pandemics , Risk Factors , Young Adult
19.
Psychiatr Danub ; 34(Suppl 8): 262-264, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2046183

ABSTRACT

In this study, with a psychodiagnostic survey, we wanted to evaluate the possible presence of depressive symptoms in patients diagnosed with type 2 diabetes. The sample of 106 type 2 diabetic patients consisted of three groups. Group A of 80 patients interviewed in 2017 at the Olbia clinic, group A-1 (a subgroup of A), of 41 patients with a follow-up after 5 years from the first examination in 2017 and group B of 26 new type 2 diabetic patients examined for the first time in 2022. All subject underwent an interview and and have completed the following validated questionnaires: Questionnaire for Mood Disorders (MDQ), Hamilton Psychiatric Rating Scale for Depression (HAM-D), Montgomery-Asberg Scale for Depression (MADRS), Hamilton Anxiety Scale (HAR -S) and Clinical Global Impression (CGI). The objective of the follow-up was to evaluate the possible emotional impact of the COVID-19 pandemic. The aim of the research is to evaluate the correlation between any depressive symptoms and diabetes.


Subject(s)
Depression , Diabetes Mellitus, Type 2 , COVID-19/epidemiology , COVID-19/psychology , Depression/diagnosis , Depression/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Humans , Pandemics , Psychiatric Status Rating Scales
20.
Diabetes Res Clin Pract ; 191: 110034, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2035941

ABSTRACT

INTRODUCTION: The COVID-19 pandemic disproportionately affected patients who had comorbid diabetes mellitus. COVID-19 patients with diabetes experience significantly higher rates of complications and mortality. COVID-induced diabetes is a novel phenomenon observed in critically ill patients. The aims of this review were to explore the literature about COVID-induced diabetes and the pathophysiological mechanisms that could lead to this novel presentation. METHODS: A literature search was performed using PUBMED, Google Scholar, MEDLINE and Embase for original studies (meta-analyses, cross-sectional studies, case series, case reports) about new-onset diabetes following COVID infection, and the proposed biochemical pathways behind this presentation. It was assumed that the authors of the studies used the current diagnostic criteria for diagnosis of type 1 and type 2 diabetes. RESULTS: COVID-19 causes dysregulation of glucose homeostasis leading to new-onset diabetes and hyperglycaemia. This is also seen in patients with no previous risk factors for diabetes mellitus. The atypical glycaemic parameters and increased rates of DKA suggest that COVID-induced diabetes is a novel form of diabetes. A spectrum of COVID-induced diabetes has also been noted. COVID-induced diabetes is associated with remarkably higher mortality rates and worse outcomes compared to COVID-19 patients with pre-existing diabetes. The novel presentation of COVID-induced diabetes could be due to beta cell damage and insulin resistance caused by SARS-CoV-2. CONCLUSION: COVID-induced diabetes is essential to detect early, owing to its implications on prognosis. Further studies must include follow-up of these patients to better understand the trajectory of COVID-induced diabetes and the best management plan. It is also important to assess the beta cell function and insulin resistance of COVID-induced diabetes patients over time to better understand the underlying biochemical mechanisms.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Insulin Resistance , Blood Glucose , COVID-19/complications , Cross-Sectional Studies , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Humans , Pandemics , SARS-CoV-2
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