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1.
J Med Virol ; 94(5): 1967-1975, 2022 05.
Article in English | MEDLINE | ID: covidwho-1777577

ABSTRACT

We aimed to assess whether blood glucose control can be used as predictors for the severity of 2019 coronavirus disease (COVID-19) and to improve the management of diabetic patients with COVID-19. A two-center cohort with a total of 241 confirmed cases of COVID-19 with definite outcomes was studied. After the diagnosis of COVID-19, the clinical data and laboratory results were collected, the fasting blood glucose levels were followed up at initial, middle stage of admission and discharge, the severity of the COVID-19 was assessed at any time from admission to discharge. Hyperglycemia patients with COVID-19 were divided into three groups: good blood glucose control, fair blood glucose control, and blood glucose deterioration. The relationship of blood glucose levels, blood glucose control status, and severe COVID-19 were analyzed by univariate and multivariable regression analysis. In our cohort, 21.16% were severe cases and 78.84% were nonsevere cases. Admission hyperglycemia (adjusted odds ratio [aOR], 1.938; 95% confidence interval [95% CI], 1.387-2.707), mid-term hyperglycemia (aOR, 1.758; 95% CI, 1.325-2.332), and blood glucose deterioration (aOR, 22.783; 95% CI, 2.661-195.071) were identified as the risk factors of severe COVID-19. Receiver operating characteristic (ROC) curve analysis, reaching an area under ROC curve of 0.806, and a sensitivity and specificity of 80.40% and 68.40%, respectively, revealed that hyperglycemia on admission and blood glucose deterioration of diabetic patients are potential predictive factors for severe COVID-19. Our results indicated that admission hyperglycemia and blood glucose deterioration were positively correlated with the risk factor for severe COVID-19, and deterioration of blood glucose may be more likely to the occurrence of severe illness in COVID-19.


Subject(s)
COVID-19 , Diabetes Mellitus , Hyperglycemia , Blood Glucose/analysis , COVID-19/complications , COVID-19/epidemiology , Cohort Studies , Diabetes Mellitus/epidemiology , Humans , Hyperglycemia/epidemiology , Prognosis , Retrospective Studies , Risk Factors
2.
J Diabetes Complications ; 36(4): 108145, 2022 04.
Article in English | MEDLINE | ID: covidwho-1665158

ABSTRACT

AIMS: High rates of newly diagnosed diabetes mellitus (NDDM) have been reported in association with coronavirus disease-2019 (COVID-19). Factors associated with NDDM and long-term glycemic outcomes are not known. METHODS: Retrospective review of individuals admitted with COVID-19 and diabetes mellitus (DM; based on labs, diagnoses, outpatient insulin use, or severe inpatient hyperglycemia) between March and September 2020, with follow-up through July 2021. RESULTS: Of 1902 individuals admitted with COVID-19, 594 (31.2%) had DM; 77 (13.0%) of these had NDDM. Compared to pre-existing DM, NDDM was more common in younger patients and less common in those of non-Hispanic White race/ethnicity. Glycemic parameters were lower and inflammatory markers higher in patients with NDDM. In adjusted models, NDDM was associated with lower insulin requirements, longer length of stay, and intensive care unit admission but not death. Of 64 survivors with NDDM, 36 (56.3%) continued to have DM, 26 (40.6%) regressed to normoglycemia or pre-diabetes, and 2 were unable to be classified at a median follow-up of 323 days. 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. Approximately half of such individuals experience regression of DM.


Subject(s)
COVID-19 , Diabetes Mellitus , Hyperglycemia , Blood Glucose , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Humans , Hyperglycemia/diagnosis , Hyperglycemia/epidemiology , Phenotype , Retrospective Studies
3.
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
4.
J Clin Endocrinol Metab ; 107(1): e348-e360, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1592846

ABSTRACT

CONTEXT: A high prevalence of vitamin D (VD) deficiency in COVID-19 patients has been reported and hypothesized to increase COVID-19 severity likely because of its negative impact on immune and inflammatory responses. Furthermore, clear associations between hypovitaminosis D and fat body mass excess and diabetes, factors associated with COVID-19 severity, have been widely recognized. OBJECTIVE: The aim of this study was to evaluate in COVID-19 patients the relationship between VD levels and inflammatory response, body mass index (BMI), blood glucose (GLU), and disease severity. METHODS: Patients admitted to San Raffaele-Hospital for COVID-19 were enrolled in this study, excluding those with comorbidities and therapies influencing VD metabolism. 25-Hydroxyvitamin D levels, plasma GLU levels, BMI, and inflammatory parameters were evaluated at admission. RESULTS: A total of 88 patients were included. Median VD level was 16.3 ng/mL and VD deficiency was found in 68.2% of patients. VD deficiency was found more frequently in male patients and in those affected by severe COVID-19. Regression analyses showed a positive correlation between VD and PaO2/FiO2 ratio, and negative correlations between VD and plasma GLU, BMI, neutrophil/lymphocyte ratio, C-reactive protein, and interleukin 6. Patients with both hypovitaminosis D and diabetes mellitus, as well those with hypovitaminosis D and overweight, were more frequently affected by a severe disease with worse inflammatory response and respiratory parameters, compared to those without or just one of these conditions. CONCLUSION: We showed, for the first-time, a strict association of VD levels with blood GLU and BMI in COVID-19 patients. VD deficiency might be a novel common pathophysiological mechanism involved in the detrimental effect of hyperglycemia and adiposity on disease severity.


Subject(s)
Adiposity/immunology , COVID-19/diagnosis , Hyperglycemia/epidemiology , Vitamin D Deficiency/epidemiology , Vitamin D/analogs & derivatives , Aged , Biomarkers/blood , Blood Glucose/analysis , Body Mass Index , COVID-19/blood , COVID-19/immunology , COVID-19/virology , Female , Humans , Hyperglycemia/blood , Hyperglycemia/diagnosis , Hyperglycemia/immunology , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Severity of Illness Index , Vitamin D/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/immunology
5.
PLoS One ; 16(11): e0260389, 2021.
Article in English | MEDLINE | ID: covidwho-1533422

ABSTRACT

BACKGROUND: In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment. METHODS: Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion. RESULTS: 429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23-26.04, p<0.05). CONCLUSION: HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.


Subject(s)
Diabetes Mellitus/diagnosis , Hyperglycemia/diagnosis , Prediabetic State/diagnosis , Tuberculosis/complications , Adolescent , Adult , Bangladesh/epidemiology , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Disease Management , Female , Glycated Hemoglobin A/analysis , Humans , Hyperglycemia/blood , Hyperglycemia/epidemiology , Male , Middle Aged , Prediabetic State/blood , Prediabetic State/epidemiology , Prospective Studies , Risk Factors , Tuberculosis/diagnosis , Tuberculosis/therapy , Young Adult
6.
Front Endocrinol (Lausanne) ; 12: 741248, 2021.
Article in English | MEDLINE | ID: covidwho-1526766

ABSTRACT

Background: Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19. Methods: Consecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms. Results: As expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels. Conclusions: Blood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.


Subject(s)
COVID-19/mortality , Glycated Hemoglobin A/analysis , Hyperglycemia/epidemiology , Obesity, Morbid/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/blood , COVID-19/epidemiology , Comorbidity , Female , Hospital Mortality , Humans , Hyperglycemia/blood , Incidence , Italy , Male , Middle Aged , Obesity, Morbid/blood , Prognosis , Retrospective Studies , Risk , Sex Factors , Spain , Survival Rate
7.
Exp Biol Med (Maywood) ; 247(3): 200-206, 2022 02.
Article in English | MEDLINE | ID: covidwho-1477209

ABSTRACT

An observational study was conducted in Ukraine to determine the independent mortality risks among adult inpatients with COVID-19. The results of treatment of COVID-19 inpatients (n = 367) are presented, and waist circumference (WC) was measured. Logistic regression analysis was applied to evaluate the effects of factors on the risk of mortality. Odds ratios and 95% CIs for the association were calculated. One hundred and three of 367 subjects had fasting plasma glucose level that met the diabetes mellitus criteria (≥7.0 mmol/L), in 53 patients, diabetes mellitus was previously known. Two hundred and eleven patients did not have diabetes or hyperglycemia. Diabetes mellitus/hyperglycemia odds ratio 2.5 (CI 1.0-6.1), p = 0.045 loses statistical significance after standardization by age, waist circumference or fasting plasma glucose. No effect on gender, body mass index-determined obesity, or hypertension was found. The fasting plasma glucose (>8.5 mmol/L), age (≥61 years), and waist circumference (>105 cm) categories were associated with ORs 6.34 (CI 2.60-15.4); 4.12 (CI 1.37-12.4); 8.93 (CI 3.26-24.5), respectively. The optimal model of mortality risk with AUC 0.86 (CI 0.81-0.91) included the diabetes/heperglycemia and age categories as well as waist circumference as a continued variable. Waist circumference is an independent risk factor for mortality of inpatients with COVID-19.


Subject(s)
COVID-19/etiology , COVID-19/mortality , Hyperglycemia , Waist Circumference , Aged , Body Mass Index , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Diabetes Mellitus/epidemiology , Female , Humans , Hyperglycemia/complications , Hyperglycemia/epidemiology , Length of Stay , Leukocyte Count , Male , Middle Aged , Obesity, Abdominal/epidemiology , Risk Assessment , Treatment Outcome , Ukraine/epidemiology
8.
Metabolism ; 123: 154845, 2021 10.
Article in English | MEDLINE | ID: covidwho-1340768

ABSTRACT

PURPOSE: Individuals with diabetes/stress hyperglycemia carry an increased risk for adverse clinical outcome in case of SARS-CoV-2 infection. The purpose of this study was to evaluate whether this risk is, at least in part, modulated by an increase of thromboembolic complications. METHODS: We prospectively followed 180 hospitalized patients with confirmed COVID-19 pneumonia admitted to the Internal Medicine Units of San Raffaele Hospital. Data from 11 out of 180 patients were considered incomplete and excluded from the analysis. We analysed inflammation, tissue damage biomarkers, hemostatic parameters, thrombotic events (TEs) and clinical outcome according to the presence of diabetes/stress hyperglycemia. RESULTS: Among 169 patients, 51 (30.2%) had diabetes/stress hyperglycemia. Diabetes/stress hyperglycemia and fasting blood glucose (FBG) were associated with increased inflammation and tissue damage circulating markers, higher D-dimer levels, increased prothrombin time and lower antithrombin III activity. Forty-eight venous and 10 arterial TEs were identified in 49 (29%) patients. Diabetes/stress hyperglycemia (HR 2.71, p = 0.001), fasting blood glucose (HR 4.32, p < 0.001) and glucose variability (HR 1.6, p < 0.009) were all associated with an increased risk of thromboembolic complication. TEs significantly increased the risk for an adverse clinical outcome only in the presence of diabetes/stress hyperglycemia (HR 3.05, p = 0.010) or fasting blood glucose ≥7 mmol/L (HR 3.07, p = 0.015). CONCLUSIONS: Thromboembolism risk is higher among patients with diabetes/stress hyperglycemia and COVID-19 pneumonia and is associated to poor clinical outcome. In case of SARS-Cov-2 infection patients with diabetes/stress hyperglycemia could be considered for a more intensive prophylactic anticoagulation regimen.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hyperglycemia/epidemiology , Thromboembolism/etiology , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Diabetes Complications/therapy , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Hyperglycemia/diagnosis , Hyperglycemia/etiology , Hyperglycemia/therapy , Inflammation/complications , Inflammation/diagnosis , Inflammation/epidemiology , Inflammation/therapy , Italy/epidemiology , Male , Middle Aged , Mortality , Prognosis , Risk Factors , Stress, Psychological/complications , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Thromboembolism/diagnosis , Thromboembolism/epidemiology , Treatment Outcome
9.
Endocrinol Diabetes Metab ; 4(4): e00291, 2021 10.
Article in English | MEDLINE | ID: covidwho-1312722

ABSTRACT

AIM: Diabetes has been identified as a risk factor for poor outcomes in patients with COVID-19. We examined the association of hyperglycaemia, both in the presence and absence of pre-existing diabetes, with severity and outcomes in COVID-19 patients. METHODS: Data from 74,148 COVID-19-positive inpatients with at least one recorded glucose measurement during their inpatient episode were analysed for presence of pre-existing diabetes diagnosis and any glucose values in the hyperglycaemic range (>180 mg/dl). RESULTS: Among patients with and without a pre-existing diabetes diagnosis on admission, mortality was substantially higher in the presence of high glucose measurements versus all measurements in the normal range (70-180 mg/dl) in both groups (non-diabetics: 21.7% vs. 3.3%; diabetics 14.4% vs. 4.3%). When adjusting for patient age, BMI, severity on admission and oxygen saturation on admission, this increased risk of mortality persisted and varied by diabetes diagnosis. Among patients with a pre-existing diabetes diagnosis, any hyperglycaemic value during the episode was associated with a substantial increase in the odds of mortality (OR: 1.77, 95% CI: 1.52-2.07); among patients without a pre-existing diabetes diagnosis, this risk nearly doubled (OR: 3.07, 95% CI: 2.79-3.37). CONCLUSION: This retrospective analysis identified hyperglycaemia in COVID-19 patients as an independent risk factor for mortality after adjusting for the presence of diabetes and other known risk factors. This indicates that the extent of glucose control could serve as a mechanism for modifying the risk of COVID-19 morality in the inpatient environment.


Subject(s)
Blood Glucose , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hyperglycemia/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/blood , COVID-19/mortality , Diabetes Mellitus/blood , Diabetes Mellitus/mortality , Female , Humans , Hyperglycemia/blood , Hyperglycemia/mortality , Male , Middle Aged , Retrospective Studies , Risk Factors , Survival Rate
10.
Int J Gynaecol Obstet ; 154(2): 204-211, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1298485

ABSTRACT

BACKGROUND: Some maternal characteristics indicate worse prognosis in pregnant women with coronavirus disease 2019 (COVID-19). OBJECTIVE: To describe the prevalence of endocrine disorders in pregnancies involving COVID-19, and its impact on maternal outcomes. SEARCH STRATEGY: Search terms were "pregnancy" and "COVID-19". SELECTION: PubMed, Embase, medRxiv, and Cochrane worksheet from February to July 2020 were searched. DATA COLLECTION AND ANALYSIS: Articles describing endocrine disorders in pregnancies with and without COVID-19 involvement were considered. We performed meta-analyses of prevalence using random-effect models and estimated relative risk and 95% confidence intervals (CI) of maternal outcomes relative to presence of endocrine disorders. MAIN RESULTS: Articles included (n = 141) were divided into three data sets: individual (119 articles, 356 women), case series (17 articles, 1064 women), and national registries (7 articles, 10 178 women). Prevalence of obesity ranged from 16% to 46% and hyperglycemia in pregnancy (HIP) ranged from 8% to 12%. In data set 1, HIP and obesity were risk factors for severe disease in crude and age-adjusted models, although not for intensive care unit admission. In data from two national registries, risk of dying was 5.62 (95% CI 0.30-105.95) in women with diabetes and 2.26 (95% CI 1.03-4.96) in those with obesity. CONCLUSION: Obesity and HIP were prevalent in pregnant women with severe COVID-19.


Subject(s)
COVID-19 , Endocrine System Diseases/epidemiology , Hyperglycemia/epidemiology , Obesity/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Female , Hospitalization , Humans , Pregnancy , Pregnancy Outcome , Prevalence , SARS-CoV-2
11.
Nutrients ; 13(7)2021 Jun 26.
Article in English | MEDLINE | ID: covidwho-1288965

ABSTRACT

This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted from the hospital database. HG was defined as BG > 200 mg/dL. Patients with type 1 diabetes or BG < 70 mg/dL were excluded. A total of 458 patients with T2D and 976 patients without T2D were included in the study. The mean ± SD age was 56 ± 17 years and 642 (45%) were female. HG occurred in 193 (42%) and 42 (4%) of patients with and without T2D, respectively. Overall, the in-hospital mortality rate was 9%. Among patients without T2D, HG was statistically significantly associated with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders (p < 0.05). However, only ICU admission and acute kidney injury were associated with HG among patients with T2D (p < 0.05). Among the 235 patients with HG, the presence of T2D was associated with decreased odds of mortality, ICU admission, intubation, and severe sepsis/septic shock, after adjusting for potential confounders, including BG (p < 0.05). In conclusion, HG in the subset of patients without T2D could be a strong indicator of high inflammatory burden, leading to a higher risk of severe COVID-19.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Hospitalization/statistics & numerical data , Hyperglycemia/epidemiology , Acute Kidney Injury/epidemiology , Adult , Aged , Blood Glucose , Boston/epidemiology , COVID-19/mortality , Cohort Studies , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Intubation/statistics & numerical data , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Sepsis/epidemiology , Severity of Illness Index , Urban Population/statistics & numerical data
13.
J Diabetes Sci Technol ; 15(5): 1181-1187, 2021 09.
Article in English | MEDLINE | ID: covidwho-1280566

ABSTRACT

Complications of Coronavirus Disease 2019 (COVID-19) occur with increased frequency in people admitted to the hospital with diabetes or hyperglycemia. The increased risk for COVID-19 infections in the presence of these metabolic conditions is in part due to overlapping pathophysiologic features of COVID-19, diabetes, and glucose control. Various antiviral treatments are being tested in COVID-19 patients. We believe that in these trials, it will be useful to evaluate treatment effect differences in patients stratified according to whether they have diabetes or hyperglycemia. In this way, it will be possible to better facilitate development of antiviral treatments that are most specifically beneficial for the large subset of COVID-19 patients who have diabetes or hyperglycemia.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Clinical Trials as Topic , Diabetes Mellitus , Hyperglycemia , Antiviral Agents/therapeutic use , Blood Glucose/metabolism , COVID-19/blood , COVID-19/complications , Clinical Trials as Topic/methods , Clinical Trials as Topic/statistics & numerical data , Data Accuracy , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Hospitalization/statistics & numerical data , Humans , Hyperglycemia/blood , Hyperglycemia/epidemiology , Hyperglycemia/therapy , Research Design , Risk Factors , SARS-CoV-2
14.
Endocr Pract ; 27(2): 95-100, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1198749

ABSTRACT

OBJECTIVE: To explore the relationship between hyperglycemia in the presence and absence of diabetes mellitus (DM) and adverse outcomes in critically ill patients with coronavirus disease 2019 (COVID-19). METHODS: The study included 133 patients with COVID-19 admitted to an intensive care unit (ICU) at an urban academic quaternary-care center between March 10 and April 8, 2020. Patients were categorized based on the presence or absence of DM and early-onset hyperglycemia (EHG), defined as a blood glucose >180 mg/dL during the first 2 days after ICU admission. The primary outcome was 14-day all-cause in-hospital mortality; also examined were 60-day all-cause in-hospital mortality and the levels of C-reactive protein, interleukin 6, procalcitonin, and lactate. RESULTS: Compared to non-DM patients without EHG, non-DM patients with EHG exhibited higher adjusted hazard ratios (HRs) for mortality at 14 days (HR 7.51, CI 1.70-33.24) and 60 days (HR 6.97, CI 1.86-26.13). Non-DM patients with EHG also featured higher levels of median C-reactive protein (306.3 mg/L, P = .036), procalcitonin (1.26 ng/mL, P = .028), and lactate (2.2 mmol/L, P = .023). CONCLUSION: Among critically ill COVID-19 patients, those without DM with EHG were at greatest risk of 14-day and 60-day in-hospital mortality. Our study was limited by its retrospective design and relatively small cohort. However, our results suggest the combination of elevated glucose and lactate may identify a specific cohort of individuals at high risk for mortality from COVID-19. Glucose testing and control are important in individuals with COVID-19, even those without preexisting diabetes.


Subject(s)
COVID-19 , Hyperglycemia , Blood Glucose , Critical Illness , Hospital Mortality , Humans , Hyperglycemia/epidemiology , Intensive Care Units , Retrospective Studies , SARS-CoV-2
15.
Adv Clin Exp Med ; 30(2): 127-134, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1089252

ABSTRACT

BACKGROUND: Currently, the only effective method to control the spread of the COVID-19 pandemic is social distancing. The lockdown measures during the epidemic may have an impact on the presentation of diabetes and may disturb metabolic control. OBJECTIVES: In order to address the hypothesis that the COVID-19 lockdown affected the incidence rate (IR) of type 1 diabetes (T1D) in the pediatric population of Lower Silesia and the patients' clinical status, the incidence of T1D during the COVID-19 pandemic was analyzed. MATERIAL AND METHODS: Incidence estimates were obtained from the T1D pediatric registry for Lower Silesia which has been maintained since January 1, 2000. The observation was completed on April 30, 2020. RESULTS: A total of 1961 cases were diagnosed (1054 boys, 53.72%). An increase in the T1D IR was observed, from 10.43/100,000/year in 2000 to 22.06/100,000/year in 2019. The seasonality of T1D incidence was also observed, with the highest IR appearing in January and February. There were half as many cases of T1D in March and April 2020 as in the same months in 2019 (p > 0.05). Diabetic ketoacidosis (DKA) occurred in 31.75% of patients in years 2000-2019, comparably (p > 0.05) to 2020 (36.67% patients), including March and April (50% of patients). The duration of hyperglycemia symptoms was 20.2 ±25.4 days, which was comparable to 2020 (13.1 ±10.96 days; p = 0.1675) and March and April of 2020 (9.67 ±5.63 days; p = 0.0831). Glycated hemoglobin (HbA1c) level was 11.79 ±2.63%, which was comparable to March and April of 2020 (13.06 ±2.35%; p = 0.1171), while in all of 2020 it was 13.41 ±2.50% (p = 0.0003). CONCLUSIONS: The IR of T1D in Lower Silesian children in the months of the COVID-19 pandemic was comparable to previous years, while their clinical condition at the time of diagnosis was worse than in previous years.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Child , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/diagnosis , Female , Glycated Hemoglobin A , Humans , Hyperglycemia/epidemiology , Incidence , Male , Pandemics , Poland/epidemiology , SARS-CoV-2
16.
Expert Rev Clin Immunol ; 17(3): 201-208, 2021 03.
Article in English | MEDLINE | ID: covidwho-1066078

ABSTRACT

INTRODUCTION: In people living with HIV (PLWH), immune activation and inflammation levels are high even when viral suppression is maintained, potentially contributing to several comorbidities, and hampering the immune response to infections such as the recent SARS-CoV-2 disease 2019 (COVID-19). AREAS COVERED: Immune activation and inflammation play a role in SARS-CoV-2 infection. Severe COVID-19 patients may experience cytokine release syndrome (CRS), leading to alveolar damage, pulmonary fibrinolysis, dysregulated coagulation, and pulmonary injury. Into the systemic circulation, cytokines in excess might leak out of pulmonary circulation, causing systemic symptoms and possibly a multiple-organ dysfunction syndrome. Preexisting comorbidities are also linked to worse COVID-19 outcome: studies suggest that diabetes and hypertension are linked to higher mortality rates. Such comorbidities are more frequent in PLWH, but it is unclear if they have worse outcomes in the case of COVID-19. The literature was searched in PubMed/MEDLINE and EMBASE, and manually in COVID-19 resources. EXPERT OPINION: A body of evidence shows that HIV and SARS-CoV-2 are able to activate inflammatory pathways, acute in the case of SARS-CoV-2, chronic in the case of HIV, while the comorbidities seem to represent, in the first case, a contributory cause, in the second an effect of the virus-induced damage.


Subject(s)
COVID-19/epidemiology , COVID-19/immunology , HIV Infections/epidemiology , HIV Infections/immunology , Blood Coagulation Disorders/epidemiology , Blood Coagulation Disorders/immunology , Comorbidity , Cytokines/immunology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/immunology , Humans , Hyperglycemia/epidemiology , Hyperglycemia/immunology , Hypertension/epidemiology , Hypertension/immunology , Inflammation , Metabolic Syndrome/epidemiology , Metabolic Syndrome/immunology , SARS-CoV-2
17.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1065842

ABSTRACT

BACKGROUND: Starting March 2020 the Italian Government imposed a lockdown to limit the spread of SARS-CoV-2. During lockdown outpatient visits were limited and telemedicine (TM) was encouraged. METHODS: We retrospectively analyzed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by subjects with type 1 diabetes and compared data obtained 4 weeks before and 4 weeks after structured telephonic visit. Variables considered were mean glucose, time spent in target (70-180 mg/dl), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl), coefficient of variation, and length of sensor use. RESULTS: During the 4 weeks following the telephonic visit there was an improvement of glycemic control, with a significant reduction of mean glucose values (161.1 before vs 156.3 mg/dl after, p = 0.001), an increase of the time spent in target (63.6 vs 66.3, p = 0.0009) and a reduction of time spent in hyperglycemia (33.4 vs 30.5, p = 0.002). No changes were observed regarding glucose variability, time spent in hypoglycemia, and length of sensor use. Similar results were observed in subjects treated with multiple daily injections or continuous subcutaneous insulin infusion. CONCLUSIONS: A structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1/drug therapy , Pandemics , Quarantine , Telemedicine/trends , Adult , Aged , Blood Glucose/analysis , Blood Glucose Self-Monitoring , Female , Glycemic Control , Humans , Hyperglycemia/epidemiology , Hypoglycemia/epidemiology , Hypoglycemic Agents/administration & dosage , Insulin Infusion Systems , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , Young Adult
18.
Diabetes Metab Syndr ; 15(1): 221-227, 2021.
Article in English | MEDLINE | ID: covidwho-1065020

ABSTRACT

BACKGROUND AND AIMS: The measurement of vital signs is an important part of clinical work up. Presently, measurement of blood glucose is a factor for concern mostly when treating individuals with diabetes. Significance of blood glucose measurement in prognosis of non-diabetic and hospitalized patients is not clear. METHODS: A systematic search of literature published in the Electronic databases, PubMed and Google Scholar was performed using following keywords; blood glucose, hospital admissions, critical illness, hospitalizations, cardiovascular disease (CVD), morbidity, and mortality. This literature search was largely restricted to non-diabetic individuals. RESULTS: Blood glucose level, even when in high normal range, or in slightly high range, is an important determinant of morbidity and mortality, especially in hospitalized patients. Further, even slight elevation of blood glucose may increase mortality in patients with COVID-19. Finally, blood glucose variability and hypoglycemia in critically ill individuals without diabetes causes excess in-hospital complications and mortality. CONCLUSION: In view of these data, we emphasize the significance of blood glucose measurement in all patients admitted to the hospital regardless of presence of diabetes. We propose that blood glucose be included as the "fifth vital sign" for any hospitalized patient.


Subject(s)
Blood Glucose/metabolism , COVID-19/blood , COVID-19/diagnosis , Hospitalization/trends , Vital Signs/physiology , COVID-19/epidemiology , Critical Illness/epidemiology , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Humans , Hyperglycemia/blood , Hyperglycemia/diagnosis , Hyperglycemia/epidemiology , Hypoglycemia/blood , Hypoglycemia/diagnosis , Hypoglycemia/epidemiology , Prognosis
19.
Diabetes Metab Syndr ; 15(1): 407-413, 2021.
Article in English | MEDLINE | ID: covidwho-1062312

ABSTRACT

BACKGROUND AND AIMS: Diabetes and coronavirus disease 2019 (COVID-19) share a bidirectional relationship. Hyperglycemia occurring in the setting of either previously diagnosed or undiagnosed diabetes is known to be associated with poor outcomes. Here, we aim to provide a simple and practical guidance on the diagnosis and management of hyperglycemia in admitted patients with COVID-19. METHODS: The guidance is formulated based on experience of authors and relevant literature on the subject searched using Pubmed. RESULTS: Every patient admitted to a COVID care facility should be investigated for hyperglycemia using a combination of tests including capillary blood glucose, fasting plasma glucose and HbA1c. Oral glucose lowering drugs can be considered in patients with mild COVID illness who have mild hyperglycemia [pre-meal blood glucose of <180 mg/dl (10 mmol/L) and post-meal blood glucose of <250 mg/dl (13.9 mmol/L)] and no contraindication to the use of these agents.. All patients with moderate-severe disease and/or hyperglycemia of greater severity should be initiated on insulin therapy. Hyperglycemia should be aggressively screened for and managed in patients receiving systemic glucocorticoids. CONCLUSION: This document provides a broad overview on the diagnosis and management of hyperglycemia at COVID care facilities and should be useful to a wide range of healthcare personnel involved in care of patients with COVID-19.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Hospitalization/trends , Hyperglycemia/diagnosis , Hyperglycemia/epidemiology , Mass Screening/trends , Blood Glucose/drug effects , Blood Glucose/metabolism , COVID-19/therapy , Disease Management , Humans , Hyperglycemia/therapy , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/therapeutic use , India/epidemiology , Mass Screening/standards
20.
Diabetes Metab Syndr ; 14(6): 1641-1644, 2020.
Article in English | MEDLINE | ID: covidwho-1059501

ABSTRACT

BACKGROUND & AIMS: At-admission hyperglycemia have been associated with poorer outcome during critical illnesses. At-admission hyperglycemia in previously unknown diabetes is not uncommonly encountered entity in patients with COVID-19. We sought to find out the outcomes of at-admission hyperglycemia and effect of early intervention to achieve optimal glycemic control in relation to COVID-19 patients. METHODS: We searched the PubMed and Google Scholar database up till August 20, 2020 using specific keywords related to our aims and objectives. RESULTS: All currently available evidences clearly hint that at-admission hyperglycemia in patients with COVID-19 is associated with a poorer outcome, compared with normoglycemic individuals. Fortunately, early intervention by achieving an optimal glycemic control has also been associated with a significant improvement in the outcomes in patients with COVID-19. CONCLUSION: At-admission hyperglycemia should be taken seriously by all clinicians treating patients with COVID-19. All efforts should be made towards an optimal glycemic control in patients with COVID-19, even in absence of pre-existing diabetes.


Subject(s)
Blood Glucose/metabolism , COVID-19/diagnosis , Early Medical Intervention/trends , Hyperglycemia/diagnosis , Patient Admission/trends , COVID-19/blood , COVID-19/epidemiology , Early Medical Intervention/methods , Humans , Hyperglycemia/blood , Hyperglycemia/epidemiology , Prognosis , Risk Factors , Treatment Outcome
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