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Microvasc Res ; 140: 104310, 2022 03.
Article in English | MEDLINE | ID: covidwho-1586954


Evidence suggests severe coronavirus disease-19 (COVID-19) infection is characterised by pulmonary and systemic microvasculature dysfunction, specifically, acute endothelial injury, hypercoagulation and increased capillary permeability. Diabetes, which is also characterised by vascular injury in itself, confers an increased risk of adverse COVID-19 outcomes. It has been suggested that pre-existing endothelial dysfunction and microvascular disease in diabetes will exacerbate the vascular insults associated with COVID-19 and thus lead to increased severity of COVID-19 infection. In this article, we evaluate the current evidence exploring the impact of microvascular complications, in the form of diabetic retinopathy and nephropathy, in individuals with COVID-19 and diabetes. Future insights gained from exploring the microvascular injury patterns and clinical outcomes may come to influence care delivery algorithms for either of these conditions.

COVID-19/physiopathology , Diabetic Angiopathies/physiopathology , Endothelium, Vascular/pathology , Microcirculation , Pandemics , SARS-CoV-2 , Thrombophilia/etiology , Albuminuria/etiology , COVID-19/complications , Capillary Permeability , Delivery of Health Care , Diabetic Angiopathies/complications , Diabetic Nephropathies/complications , Diabetic Nephropathies/physiopathology , Diabetic Neuropathies/complications , Diabetic Neuropathies/physiopathology , Diabetic Retinopathy/complications , Diabetic Retinopathy/physiopathology , Endothelium, Vascular/injuries , Humans , Obesity/complications , Obesity/physiopathology , Pulmonary Circulation , Pulmonary Edema/etiology , Pulmonary Edema/physiopathology , Severity of Illness Index , Thrombophilia/physiopathology , Treatment Outcome
Nutrients ; 13(11)2021 Oct 25.
Article in English | MEDLINE | ID: covidwho-1547463


Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes that affects approximately half of the diabetic population. Up to 53% of DPN patients experience neuropathic pain, which leads to a reduction in the quality of life and work productivity. Tocotrienols have been shown to possess antioxidant, anti-inflammatory, and neuroprotective properties in preclinical and clinical studies. This study aimed to investigate the effects of tocotrienol-rich vitamin E (Tocovid SuprabioTM) on nerve conduction parameters and serum biomarkers among patients with type 2 diabetes mellitus (T2DM). A total of 88 patients were randomized to receive 200 mg of Tocovid twice daily, or a matching placebo for 12 months. Fasting blood samples were collected for measurements of HbA1c, renal profile, lipid profile, and biomarkers. A nerve conduction study (NCS) was performed on all patients at baseline and subsequently at 2, 6, 12 months. Patients were reassessed after 6 months of washout. After 12 months of supplementation, patients in the Tocovid group exhibited highly significant improvements in conduction velocity (CV) of both median and sural sensory nerves as compared to those in the placebo group. The between-intervention-group differences (treatment effects) in CV were 1.60 m/s (95% CI: 0.70, 2.40) for the median nerve and 2.10 m/s (95% CI: 1.50, 2.90) for the sural nerve. A significant difference in peak velocity (PV) was also observed in the sural nerve (2.10 m/s; 95% CI: 1.00, 3.20) after 12 months. Significant improvements in CV were only observed up to 6 months in the tibial motor nerve, 1.30 m/s (95% CI: 0.60, 2.20). There were no significant changes in serum biomarkers, transforming growth factor beta-1 (TGFß-1), or vascular endothelial growth factor A (VEGF-A). After 6 months of washout, there were no significant differences from baseline between groups in nerve conduction parameters of all three nerves. Tocovid at 400 mg/day significantly improve tibial motor nerve CV up to 6 months, but median and sural sensory nerve CV in up to 12 months of supplementation. All improvements diminished after 6 months of washout.

Diabetic Neuropathies/therapy , Dietary Supplements , Neural Conduction/drug effects , Tocotrienols/administration & dosage , Vitamin E/administration & dosage , Aged , Biomarkers/blood , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/physiopathology , Diabetic Neuropathies/etiology , Diabetic Neuropathies/physiopathology , Double-Blind Method , Female , Humans , Male , Median Nerve/drug effects , Middle Aged , Motor Neurons/drug effects , Sural Nerve/drug effects , Tibia/innervation , Transforming Growth Factor beta1/blood , Treatment Outcome , Vascular Endothelial Growth Factor A/blood
Diabetes Res Clin Pract ; 172: 108631, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-987443


AIMS: To characterize the distribution and severity of sensory neuropathy using a portable quantitative sensory testing (QST) device in diabetic patients (DM) hospitalized with severe COVID-19 infection. METHODS: Four patients with diabetes and severe SARS-CoV-2 requiring non-invasive ventilation for a protracted duration underwent clinical, laboratory and radiologic assessment and detailed evaluation of neuropathic symptoms, neurological assessment, QST on the dorsum of the foot and face using NerveCheck Master with assessment of taste and smell. RESULTS: All four subjects developed neuropathic symptoms characterized by numbness in the feet with preserved reflexes. QST confirmed symmetrical abnormality of vibration and thermal thresholds in both lower limbs in all patients and an abnormal heat pain threshold on the face of two patients and altered taste and smell. CONCLUSIONS: Severe COVID-19 infection with hypoxemia is associated with neuropathic symptoms and widespread sensory dysfunction in patients with DM.

COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Diabetic Neuropathies/epidemiology , SARS-CoV-2 , Sensation Disorders/epidemiology , Sensory Thresholds/physiology , Aged , Comorbidity , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/etiology , Diabetic Neuropathies/physiopathology , Female , Humans , Male , Middle Aged , Neurologic Examination , Sensation Disorders/etiology , Sensation Disorders/physiopathology