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1.
J Thromb Thrombolysis ; 53(2): 363-371, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1638608

ABSTRACT

Diabetes mellitus (DM) is associated with a greater risk of COVID-19 and an increased mortality when the disease is contracted. Metformin use in patients with DM is associated with less COVID-19-related mortality, but the underlying mechanism behind this association remains unclear. Our aim was to explore the effects of metformin on markers of inflammation, oxidative stress, and hypercoagulability, and on clinical outcomes. Patients with DM on metformin (n = 34) and metformin naïve (n = 41), and patients without DM (n = 73) were enrolled within 48 h of hospital admission for COVID-19. Patients on metformin compared to naïve patients had a lower white blood cell count (p = 0.02), d-dimer (p = 0.04), urinary 11-dehydro thromboxane B2 (p = 0.01) and urinary liver-type fatty acid binding protein (p = 0.03) levels and had lower sequential organ failure assessment score (p = 0.002), and intubation rate (p = 0.03), fewer hospitalized days (p = 0.13), lower in-hospital mortality (p = 0.12) and lower mortality plus nonfatal thrombotic event occurrences (p = 0.10). Patients on metformin had similar clinical outcomes compared to patients without DM. In a multiple regression analysis, metformin use was associated with less days in hospital and lower intubation rate. In conclusion, metformin treatment in COVID-19 patients with DM was associated with lower markers of inflammation, renal ischemia, and thrombosis, and fewer hospitalized days and intubation requirement. Further focused studies are required to support these findings.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypoglycemic Agents , Metformin , Thrombosis , COVID-19/drug therapy , COVID-19/mortality , Diabetes Mellitus/drug therapy , Hospitalization , Humans , Hypoglycemic Agents/therapeutic use , Inflammation/complications , Inflammation/drug therapy , Metformin/therapeutic use , Oxidative Stress/drug effects , Retrospective Studies , Thrombosis/drug therapy
2.
Diabetes Metab Syndr ; 16(2): 102407, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1634135

ABSTRACT

BACKGROUND AND AIMS: Glycemic control in critical illness has been linked to outcomes. We sought to investigate if COVID pneumonia was causing disrupted glycemic control compared to historically similar diseases. METHODS: At Intermountain Healthcare, a 23-hospital healthcare system in the intermountain west, we performed a multicenter, retrospective cohort observational study. We compared 13,268 hospitalized patients with COVID pneumonia to 6673 patients with non -COVID-pneumonia. RESULTS: Patients with COVID-19 were younger had fewer comorbidities, had lower mortality and greater length of hospital stay. Our regression models demonstrated that daily insulin dose, indexed for weight, was associated with COVID-19, age, diabetic status, HgbA1c, admission SOFA, ICU length of stay and receipt of corticosteroids. There was significant interaction between a diagnosis of diabetes and having COVID-19. Time in range for our IV insulin protocol was not correlated with having COVID after adjustment. It was correlated with ICU length of stay, diabetic control (HgbA1C) and prior history of diabetes. Among patients with subcutaneous (SQ) insulin only percent of glucose checks in range was correlated with diabetic status, having Covid-19, HgbA1c, total steroids given and Elixhauser comorbidity score even when controlled for other factors. CONCLUSIONS: Hospitalized patients with COVID-19 pneumonia who receive insulin for glycemic control require both more SQ and IV insulin than the non-COVID-19 pneumonia counterparts. Patients with COVID-19 who received SQ insulin only had a lower percent of glucose checks in range.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Glycemic Control/statistics & numerical data , Hyperglycemia/epidemiology , Pneumonia/epidemiology , SARS-CoV-2 , Aged , COVID-19/blood , Cohort Studies , Comorbidity , Diabetes Mellitus/blood , Diabetes Mellitus/drug therapy , Female , Glycated Hemoglobin A/analysis , Glycemic Control/methods , Hospitalization , Humans , Hyperglycemia/drug therapy , Insulin/administration & dosage , Length of Stay , Male , Middle Aged , Pneumonia/blood , Retrospective Studies
3.
Front Endocrinol (Lausanne) ; 12: 772865, 2021.
Article in English | MEDLINE | ID: covidwho-1556281

ABSTRACT

The potential relationship between diabetes and COVID-19 has been evaluated. However, new knowledge is rapidly emerging. In this study, we systematically reviewed the relationship between viral cell surface receptors (ACE2, AXL, CD147, DC-SIGN, L-SIGN and DPP4) and SARS-CoV-2 infection risk, and emphasized the implications of ACE2 on SARS-CoV-2 infection and COVID-19 pathogenesis. Besides, we updated on the two-way interactions between diabetes and COVID-19, as well as the treatment options for COVID-19 comorbid patients from the perspective of ACE2. The efficacies of various clinical chemotherapeutic options, including anti-diabetic drugs, renin-angiotensin-aldosterone system inhibitors, lipid-lowering drugs, anticoagulants, and glucocorticoids for COVID-19 positive diabetic patients were discussed. Moreover, we reviewed the significance of two different forms of ACE2 (mACE2 and sACE2) and gender on COVID-19 susceptibility and severity. This review summarizes COVID-19 pathophysiology and the best strategies for clinical management of diabetes patients with COVID-19.


Subject(s)
Angiotensin-Converting Enzyme 2/blood , COVID-19/complications , COVID-19/drug therapy , Diabetes Complications/drug therapy , Diabetes Mellitus/drug therapy , Aged , Animals , Cardiovascular Diseases/complications , Cardiovascular Diseases/drug therapy , Comorbidity , Female , Humans , Hyperglycemia/metabolism , Hypertension , Inflammation , Insulin Resistance , Insulin-Secreting Cells/metabolism , Male , Middle Aged , Obesity/complications , Obesity/drug therapy , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/drug therapy , Risk , Risk Factors , SARS-CoV-2
4.
Biomed Pharmacother ; 144: 112230, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1517059

ABSTRACT

The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 has become a serious challenge for medicine and science. Analysis of the molecular mechanisms associated with the clinical manifestations and severity of COVID-19 has identified several key points of immune dysregulation observed in SARS-CoV-2 infection. For diabetic patients, factors including higher binding affinity and virus penetration, decreased virus clearance and decreased T cell function, increased susceptibility to hyperinflammation, and cytokine storm may make these patients susceptible to a more severe course of COVID-19 disease. Metabolic changes induced by diabetes, especially hyperglycemia, can directly affect the immunometabolism of lymphocytes in part by affecting the activity of the mTOR protein kinase signaling pathway. High mTOR activity can enhance the progression of diabetes due to the activation of effector proinflammatory subpopulations of lymphocytes and, conversely, low activity promotes the differentiation of T-regulatory cells. Interestingly, metformin, an extensively used antidiabetic drug, inhibits mTOR by affecting the activity of AMPK. Therefore, activation of AMPK and/or inhibition of the mTOR-mediated signaling pathway may be an important new target for drug therapy in COVID-19 cases mostly by reducing the level of pro-inflammatory signaling and cytokine storm. These suggestions have been partially confirmed by several retrospective analyzes of patients with diabetes mellitus hospitalized for severe COVID-19.


Subject(s)
COVID-19/drug therapy , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Immunity, Cellular/drug effects , Metformin/therapeutic use , Severity of Illness Index , COVID-19/epidemiology , COVID-19/immunology , COVID-19/metabolism , Diabetes Mellitus/epidemiology , Diabetes Mellitus/immunology , Diabetes Mellitus/metabolism , Humans , Hypoglycemic Agents/pharmacology , Immunity, Cellular/physiology , Lymphocytes/drug effects , Lymphocytes/immunology , Lymphocytes/metabolism , Metformin/pharmacology , Mortality/trends , T-Lymphocytes, Regulatory/drug effects , T-Lymphocytes, Regulatory/immunology , T-Lymphocytes, Regulatory/metabolism , TOR Serine-Threonine Kinases/antagonists & inhibitors , TOR Serine-Threonine Kinases/immunology , TOR Serine-Threonine Kinases/metabolism
6.
J Diabetes Sci Technol ; 15(5): 1192-1194, 2021 09.
Article in English | MEDLINE | ID: covidwho-1496092
8.
Biomolecules ; 11(11)2021 10 27.
Article in English | MEDLINE | ID: covidwho-1488477

ABSTRACT

The COVID-19 pandemic has escalated the occurrence of hypoxia including thrombotic stroke worldwide, for which nitric oxide (NO) therapy seems very promising and translatable. Therefore, various modes/routes of NO-delivery are now being tested in different clinical trials for safer, faster, and more effective interventions against ischemic insults. Intravenous (IV) infusion of S-Nitrosoglutathione (GSNO), the major endogenous molecular pool of NO, has been reported to protect against mechanical cerebral ischemia-reperfusion (IR); however, it has been never tested in any kind of "clinically" relevant thromboembolic stroke models with or without comorbidities and in combination with the thrombolytic reperfusion therapy. Moreover, "IV-effects" of higher dose of GSNO following IR-injury have been contradicted to augment stroke injury. Herein, we tested the hypothesis that nebulization of low-dose GSNO will not alter blood pressure (BP) and will mitigate stroke injury in diabetic mice via enhanced cerebral blood flow (CBF) and brain tissue oxygenation (PbtO2). GSNO-nebulization (200 µg/kgbwt) did not alter BP, but augmented the restoration of CBF, improved behavioral outcomes and reduced stroke injury. Moreover, GSNO-nebulization increased early reoxygenation of brain tissue/PbtO2 as measured at 6.5 h post-stroke following thrombolytic reperfusion, and enervated unwanted effects of late thrombolysis in diabetic stroke. We conclude that the GSNO-nebulization is safe and effective for enhancing collateral microvascular perfusion in the early hours following stroke. Hence, nebulized-GSNO therapy has the potential to be developed and translated into an affordable field therapy against ischemic events including strokes, particularly in developing countries with limited healthcare infrastructure.


Subject(s)
Diabetes Complications/drug therapy , Diabetes Mellitus/drug therapy , Hemorrhage/prevention & control , S-Nitrosoglutathione/administration & dosage , Stroke/complications , Thrombolytic Therapy/adverse effects , Animals , Behavior, Animal , Blood Pressure , Blood-Brain Barrier , COVID-19/epidemiology , Hemorrhage/complications , Hypoxia , Infusions, Intravenous , Laser-Doppler Flowmetry , Male , Mice , Mice, Inbred C57BL , Microcirculation , Nebulizers and Vaporizers , Neuroprotective Agents/pharmacology , Perfusion , Reperfusion Injury/drug therapy , Risk , Stress, Mechanical
9.
J Trace Elem Med Biol ; 69: 126887, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1487875

ABSTRACT

An increasing evidence suggests that vanadium compounds are novel potential drugs in the treatment of diabetes, atherosclerosis, and cancer. Vanadium has also demonstrated activities against RNA viruses and is a promising candidate for treating acute respiratory diseases. The antidiabetic, antihypertensive, lipid-lowering, cardioprotective, antineoplastic, antiviral, and other potential effects of vanadium are summarized here. Given the beneficial antihyperglycemic and antiinflammatory effects as well as the potential mechanistic link between the COVID-19 and diabetes, vanadium compounds could be considered as a complement to the prescribed treatment of COVID-19. Thus, further clinical trials are warranted to confirm these favorable effects of vanadium treatment in COVID-19 patients, which appear not to be studied yet.


Subject(s)
Antiviral Agents/pharmacology , COVID-19 , Vanadium/pharmacology , Anti-Inflammatory Agents/pharmacology , COVID-19/drug therapy , Diabetes Mellitus/drug therapy , Humans , Hypoglycemic Agents/pharmacology , SARS-CoV-2 , Vanadium Compounds/pharmacology
10.
Mycoses ; 65(1): 65-70, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1480204

ABSTRACT

BACKGROUND: COVID-19-associated mucormycosis (CAM) has emerged as a challenging complication as the current pandemic has increased the population requiring treatment with corticosteroids. CAM has caused a massive outbreak in India, reported to be causing cases in Iran, Egypt and The Netherlands. OBJECTIVES: To describe CAM cases occurring in a single centre in Western Mexico. METHODS: Our group carried out a retrospective study from May 2020 to May 2021 to identify CAM cases in patients with previous COVID-19 diagnosis. RESULTS: Six CAM cases occurred in a single centre in Western Mexico during the study period, most of them with diabetes (n = 5/6) and all received corticosteroid therapy even when only three had severe COVID-19. After analysing local COVID-19 burden, it was estimated that in this region, CAM was 300 times more frequent among COVID individuals than the estimates for general population. CONCLUSION: Similar to large reports in India and other countries, CAM cases reported in this study were diagnosed in individuals with diabetes, hyperglycaemic status and with history of previous use of corticosteroids. Identifying these individuals at risk can help the early identification of CAM. In addition, strict glycaemic control and avoidance of unnecessary corticosteroid in non-severe COVID-19 cases could help in preventing this complicated fungal infection.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Antifungal Agents/therapeutic use , COVID-19/complications , COVID-19/drug therapy , COVID-19 Testing , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Humans , Mexico/epidemiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Retrospective Studies , Steroids
11.
Immunogenetics ; 74(2): 197-206, 2022 04.
Article in English | MEDLINE | ID: covidwho-1446132

ABSTRACT

The catastrophic phase of Covid-19 turns the table over with the spread of its disastrous transmission network throughout the world. Covid-19 associated with mucormycosis fungal infection accompanied by opportunistic comorbidities have emerged the myriad of complications and manifestations. We searched the electronic databases of Google Scholar, PubMed, Springer, and Elsevier until June 05, 2021, using keywords. We retrieved the details of confirmed and suspected mucormycosis patients associated with Covid-19. We analyzed the case reports, treatment given for Covid-19, steroids used, associated comorbidities, mucormycosis site involved, and patients survived or dead. Overall, 102 patients of mucormycosis associated with Covid-19 have been reported from India. Mucormycosis was predominant in males (69.6%) rather than females (19.6%), and most of the patients were active Covid-19 cases (70.5%). Steroids were mostly used (68.6%) for the treatment of Covid-19 followed by remdesivir (10.7%). Patients were suffering from diabetes mellitus (88.2%) and severe diabetic ketoacidosis (11.7%). Mucormycosis affects the sino-nasal (72.5%), orbit (24.5%), central nervous system (18.6%), and maxillary necrosis (13.7%) of the patients. The Mortality rate was recorded as 23.5%, and recovery rate was 2.9%. Diabetes mellitus cases are highest in India as compared to other countries, and prevalent use of steroids with the background of Covid-19 becomes an opportunistic environment for mucormycosis fungal infection to survive.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , COVID-19/epidemiology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Female , Fungi , Humans , India/epidemiology , Male , Mucormycosis/complications , Mucormycosis/drug therapy , Mucormycosis/epidemiology , SARS-CoV-2
12.
J Fr Ophtalmol ; 44(9): 1313-1318, 2021 Nov.
Article in French | MEDLINE | ID: covidwho-1428156

ABSTRACT

PURPOSE: To assess functional and anatomical consequences of the delay in intravitreal injections for diabetic macular edema (DME) patients during the corona virus pandemic lockdown in Morocco as well as to evaluate factors associated with disease progression. PATIENTS AND METHODS: This cross-sectional study included DME patients who did not complete their scheduled intravitreal bevacizumab injections during the Lockdown period (March 20, 2020 to May 20, 2020). Data recorded included age, duration of diabetes, number of previous intravitreal injections, best-corrected visual acuity, and central macular thickness before and after the lockdown. RESULTS: One hundred and fifty four eyes of 104 patients were analyzed. 57.8% were male. The mean age was 59.4±9.04 years. The mean duration of delay of intravitreal injections was 57.3±6.7 days. The mean number of intravitreal bevacizumab injections received before the lockdown was 2.29±2.1. Worsening of visual acuity was noted in 44.8% of patients and was associated with a lower number of intravitreal injections performed prior to the lockdown (P=0.001) and with glycemic imbalance (P=0.04). An increase in central macular thickness was noted in 26.6% of patients and was associated with a lower number of intravitreal injections (P=0.038). CONCLUSION: The delay in intravitreal injections during the lockdown had negative effects on visual acuity and central macular thickness in eyes with DME. Prolonged delay in intravitreal anti-VEGF injections in diabetic patients should be avoided.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Retinopathy , Macular Edema , Aged , Angiogenesis Inhibitors/therapeutic use , Bevacizumab/therapeutic use , Communicable Disease Control , Cross-Sectional Studies , Diabetes Mellitus/drug therapy , Diabetic Retinopathy/complications , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/drug therapy , Humans , Intravitreal Injections , Macular Edema/diagnosis , Macular Edema/drug therapy , Macular Edema/epidemiology , Male , Middle Aged , Pandemics , Prognosis , Retrospective Studies , SARS-CoV-2 , Tomography, Optical Coherence , Treatment Outcome
13.
PLoS One ; 16(9): e0256682, 2021.
Article in English | MEDLINE | ID: covidwho-1416872

ABSTRACT

BACKGROUND: Glucocorticoid (GC)-exacerbated hyperglycemia is prevalent in hospitalized patients with diabetes mellitus (DM) but evidence-based insulin guidelines in inpatient settings are lacking. METHODS AND FINDINGS: Retrospective cohort study with capillary blood glucose (CBG) readings and insulin use, dosed with 50% basal (glargine)-50% bolus (lispro) insulin, analyzed in hospitalized patients with insulin-treated DM given GC and matched controls without GC (n = 131 pairs). GC group (median daily prednisone-equivalent dose: 53.36 mg (IQR 30.00, 80.04)) had greatest CBG differences compared to controls at dinner (254±69 vs. 184±63 mg/dL, P<0.001) and bedtime (260±72 vs. 182±55 mg/dL, P<0.001). In GC group, dinner CBG was 30% higher than lunch (254±69 vs. 199±77 mg/dL, P<0.001) when similar lispro to controls given at lunch. Bedtime CBG not different from dinner when 20% more lispro given at dinner (0.12 units/kg (IQR 0.08, 0.17) vs. 0.10 units/kg (0.06, 0.14), P<0.01). Despite receiving more lispro, bedtime hypoglycemic events were lower in GC group (0.0% vs. 5.9%, P = 0.03). CONCLUSIONS: Since equal bolus doses inadequately treat large dinner and bedtime GC-exacerbated glycemic excursions, initiating higher bolus insulin at lunch and dinner with additional enhanced GC-specific insulin supplemental scale may be needed as initial insulin doses in setting of high-dose GC.


Subject(s)
Blood Glucose/analysis , Diabetes Mellitus , Glucocorticoids/adverse effects , Hyperglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Insulin , Aged , Chicago/epidemiology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Drug Administration Schedule , Female , Humans , Insulin/administration & dosage , Insulin/blood , Male , Middle Aged , Retrospective Studies
14.
J Diabetes Sci Technol ; 15(4): 916-960, 2021 07.
Article in English | MEDLINE | ID: covidwho-1403193

ABSTRACT

Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 12 to November 14, 2020. This meeting brought together speakers to cover various perspectives about the field of diabetes technology. The meeting topics included artificial intelligence, digital health, telemedicine, glucose monitoring, regulatory trends, metrics for expressing glycemia, pharmaceuticals, automated insulin delivery systems, novel insulins, metrics for diabetes monitoring, and discriminatory aspects of diabetes technology. A live demonstration was presented.


Subject(s)
Diabetes Mellitus, Type 1 , Diabetes Mellitus , Artificial Intelligence , Blood Glucose , Blood Glucose Self-Monitoring , Diabetes Mellitus/drug therapy , Humans , Technology
15.
Acta Biomed ; 92(4): e2021271, 2021 09 02.
Article in English | MEDLINE | ID: covidwho-1395637

ABSTRACT

As the world continues to struggle with the pandemic of COVID-19 (coronavirus disease 2019), several cases of mucormycosis have been reported in these patients with a high mortality rate. We conducted a review of literature and found 19 articles with 20 patients who developed mucormycosis during their COVID-19 infection.14 (70%) were males, and 6(30%) were females. While their mean age was 52.2 ± 17.3, affected men were older than females. Ten (50%) patients also had diabetes. Common clinical findings included ophthalmologic complaints, fever, shortness of breath, and facial pain. Amphotericin B was the most common antifungal used and 40% of cases needed surgical management of the infection. Steroid use was reported in around 12 cases (60%). Unfortunately, the mortality rate was 65% in this group of patients. Several changes in care should be brought for a consistent prevention, early diagnosis, and strong management of mucormycosis in COVID-19 patients.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , Adult , Aged , Antifungal Agents/therapeutic use , Diabetes Mellitus/drug therapy , Female , Humans , Male , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Mucormycosis/therapy , SARS-CoV-2
16.
Diabetes Metab Syndr ; 15(6): 102268, 2021.
Article in English | MEDLINE | ID: covidwho-1385429

ABSTRACT

BACKGROUND AND AIMS: We aim to cover most of the current evidence on the mutual effect of diabetes & COVID-19 infection on each other and the management of the COVID-19 patients with diabetes. METHODS: We utilized databases to review the current evidence related to diabetes mellitus and COVID-19. RESULTS: We discussed the most recent evidence of diabetes milieus and COVID-19 regarding risk factors, management, complications, and telemedicine. CONCLUSION: Diabetes mellitus is associated with a significant risk of complications, extended hospital stays, and mortality in COVID-19 infected patients.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hypoglycemic Agents/therapeutic use , SARS-CoV-2/isolation & purification , Telemedicine , Blood Glucose/analysis , COVID-19/mortality , COVID-19/transmission , COVID-19/virology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/mortality , Diabetes Mellitus/virology , Humans , Risk Factors
18.
Endocr Res ; 47(1): 32-38, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1364665

ABSTRACT

PURPOSE: The purpose of this study is to review observational studies on the effect of insulin use and mortality in patients with COVID-19 and diabetes. METHODS: A systematic literature search was performed using the PubMed, Medline, EMBASE, and Cochrane Library databases. The meta-analysis was performed using a random effects model, and I2 was applied to evaluate heterogeneity. Sensitivity and subgroup analyses were also performed. RESULTS: Overall, 1,338 patients over six studies were ultimately included. Insulin use was related to a higher risk of death in diabetic patients with COVID-19 compared to those who did not use insulin (odds ratio: 2.59, 95% confidence interval: 1.66-4.05; P < .0001; I2: 57%). CONCLUSIONS: This meta-analysis revealed a correlation between insulin usage and increased mortality in diabetic patients with COVID-19. These results showed that insulin requirement in patients with COVID-19 and diabetes might indicate a poor prognosis.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetes Mellitus/drug therapy , Humans , Insulin , Observational Studies as Topic , SARS-CoV-2
19.
J Med Virol ; 93(9): 5390-5395, 2021 09.
Article in English | MEDLINE | ID: covidwho-1363677

ABSTRACT

Hypercoagulability and thrombosis caused by coronavirus disease 2019 (COVID-19) are related to the higher mortality rate. Because of limited data on the antiplatelet effect, we aimed to evaluate the impact of aspirin add-on therapy on the outcome of the patients hospitalized due to severe COVID-19. In this cohort study, patients with a confirmed diagnosis of severe COVID-19 admitted to Imam Hossein Medical Center, Tehran, Iran from March 2019 to July 2020 were included. Demographics and related clinical data during their hospitalization were recorded. The mortality rate of the patients was considered as the primary outcome and its association with aspirin use was assessed. Nine hundred and ninety-one patients were included, of that 336 patients (34%) received aspirin during their hospitalization and 655 ones (66%) did not. Comorbidities were more prevalent in the patients who were receiving aspirin. Results from the multivariate COX proportional model demonstrated a significant independent association between aspirin use and reduction in the risk of in-hospital mortality (0.746 [0.560-0.994], p = 0.046). Aspirin use in hospitalized patients with COVID-19 is associated with a significant decrease in mortality rate. Further prospective randomized controlled trials are needed to assess the efficacy and adverse effects of aspirin administration in this population.


Subject(s)
Aspirin/therapeutic use , COVID-19/drug therapy , Disseminated Intravascular Coagulation/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Pulmonary Embolism/drug therapy , SARS-CoV-2/pathogenicity , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adult , Aged , Alanine/analogs & derivatives , Alanine/therapeutic use , Antiviral Agents/therapeutic use , Blood Platelets/drug effects , Blood Platelets/pathology , Blood Platelets/virology , COVID-19/complications , COVID-19/mortality , COVID-19/virology , Coronary Artery Disease/complications , Coronary Artery Disease/drug therapy , Coronary Artery Disease/mortality , Coronary Artery Disease/virology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/mortality , Diabetes Mellitus/virology , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/mortality , Disseminated Intravascular Coagulation/virology , Drug Combinations , Female , Hospital Mortality , Humans , Hypertension/complications , Hypertension/drug therapy , Hypertension/mortality , Hypertension/virology , Iran , Lopinavir/therapeutic use , Lung/blood supply , Lung/drug effects , Lung/pathology , Lung/virology , Male , Middle Aged , Pulmonary Embolism/complications , Pulmonary Embolism/mortality , Pulmonary Embolism/virology , Respiration, Artificial/mortality , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Ritonavir/therapeutic use , SARS-CoV-2/drug effects , Severity of Illness Index , Survival Analysis , Treatment Outcome
20.
Front Endocrinol (Lausanne) ; 12: 696087, 2021.
Article in English | MEDLINE | ID: covidwho-1348473

ABSTRACT

Background and Objective: Recently, insulin treatment has been found to be associated with increased mortality and other adverse outcomes in patients with coronavirus disease 2019 (COVID-19) and diabetes, but the results remain unclear and controversial, therefore, we conducted this meta-analysis. Methods: Four databases, namely, PubMed, Web of Science, EMBASE and the Cochrane Library, were used to identify all studies concerning insulin treatment and the adverse effects of COVID-19, including mortality, incidence of severe/critical complications, in-hospital admission and hospitalization time. To assess publication bias, funnel plots, Begg's tests and Egger's tests were used. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the effect of insulin therapy on mortality, severe/critical complications and in-hospital admission. The association between insulin treatment and hospitalization time was calculated by the standardized mean difference (SMD) with 95% CIs. Results: Eighteen articles, involving a total of 12277 patients with COVID-19 and diabetes were included. Insulin treatment was significantly associated with an increased risk of mortality (OR=2.10; 95% CI, 1.51-2.93) and incidence of severe/critical COVID-19 complications (OR=2.56; 95% CI, 1.18-5.55). Moreover, insulin therapy may increase in-hospital admission in patients with COVID-19 and diabetes (OR=1.31; 95% CI, 1.06-1.61). However, there was no significant difference in the hospitalization time according to insulin treatment (SMD=0.21 95% CI, -0.02-0.45). Conclusions: Insulin treatment may increase mortality and severe/critical complications in patients with COVID-19 and diabetes, but more large-scale studies are needed to confirm and explore the exact mechanism.


Subject(s)
COVID-19/drug therapy , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , COVID-19/complications , Humans , Treatment Outcome
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