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1.
Lancet Diabetes Endocrinol ; 9(5): 293-303, 2021 05.
Article in English | MEDLINE | ID: covidwho-1531930

ABSTRACT

BACKGROUND: In patients with type 2 diabetes, hyperglycaemia is an independent risk factor for COVID-19-related mortality. Associations between pre-infection prescription for glucose-lowering drugs and COVID-19-related mortality in people with type 2 diabetes have been postulated but only investigated in small studies and limited to a few agents. We investigated whether there are associations between prescription of different classes of glucose-lowering drugs and risk of COVID-19-related mortality in people with type 2 diabetes. METHODS: This was a nationwide observational cohort study done with data from the National Diabetes Audit for people with type 2 diabetes and registered with a general practice in England since 2003. Cox regression was used to estimate the hazard ratio (HR) of COVID-19-related mortality in people prescribed each class of glucose-lowering drug, with covariate adjustment with a propensity score to address confounding by demographic, socioeconomic, and clinical factors. FINDINGS: Among the 2 851 465 people with type 2 diabetes included in our analyses, 13 479 (0·5%) COVID-19-related deaths occurred during the study period (Feb 16 to Aug 31, 2020), corresponding to a rate of 8·9 per 1000 person-years (95% CI 8·7-9·0). The adjusted HR associated with recorded versus no recorded prescription was 0·77 (95% CI 0·73-0·81) for metformin and 1·42 (1·35-1·49) for insulin. Adjusted HRs for prescription of other individual classes of glucose-lowering treatment were as follows: 0·75 (0·48-1·17) for meglitinides, 0·82 (0·74-0·91) for SGLT2 inhibitors, 0·94 (0·82-1·07) for thiazolidinediones, 0·94 (0·89-0·99) for sulfonylureas, 0·94 (0·83-1·07) for GLP-1 receptor agonists, 1·07 (1·01-1·13) for DPP-4 inhibitors, and 1·26 (0·76-2·09) for α-glucosidase inhibitors. INTERPRETATION: Our results provide evidence of associations between prescription of some glucose-lowering drugs and COVID-19-related mortality, although the differences in risk are small and these findings are likely to be due to confounding by indication, in view of the use of different drug classes at different stages of type 2 diabetes disease progression. In the context of the COVID-19 pandemic, there is no clear indication to change prescribing of glucose-lowering drugs in people with type 2 diabetes. FUNDING: None.


Subject(s)
COVID-19/mortality , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/adverse effects , Aged , COVID-19/complications , Cohort Studies , England , Female , Humans , Male , Middle Aged , Proportional Hazards Models
2.
Front Endocrinol (Lausanne) ; 12: 708494, 2021.
Article in English | MEDLINE | ID: covidwho-1450802

ABSTRACT

Aims: We conducted a systematic review and meta-analysis to assess various antidiabetic agents' association with mortality in patients with type 2 diabetes (T2DM) who have coronavirus disease 2019 (COVID-19). Methods: We performed comprehensive literature retrieval from the date of inception until February 2, 2021, in medical databases (PubMed, Web of Science, Embase, and Cochrane Library), regarding mortality outcomes in patients with T2DM who have COVID-19. Pooled OR and 95% CI data were used to assess relationships between antidiabetic agents and mortality. Results: Eighteen studies with 17,338 patients were included in the meta-analysis. Metformin (pooled OR, 0.69; P=0.001) and sulfonylurea (pooled OR, 0.80; P=0.016) were associated with lower mortality risk in patients with T2DM who had COVID-19. However, patients with T2DM who had COVID-19 and received insulin exhibited greater mortality (pooled OR, 2.20; P=0.002). Mortality did not significantly differ (pooled OR, 0.72; P=0.057) between DPP-4 inhibitor users and non-users. Conclusions: Metformin and sulfonylurea could be associated with reduced mortality risk in patients with T2DM who have COVID-19. Furthermore, insulin use could be associated with greater mortality, while DPP-4 inhibitor use could not be. The effects of antidiabetic agents in patients with T2DM who have COVID-19 require further exploration. Systematic Review Registration: PROSPERO (identifier, CRD42021242898).


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/adverse effects , Diabetes Mellitus, Type 2/complications , Humans , Hypoglycemic Agents/therapeutic use , Risk Assessment
3.
Cardiovasc Diabetol ; 20(1): 198, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1448234

ABSTRACT

Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available-but currently limited-evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care.


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Glycemic Control , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Humans , Hypoglycemic Agents/adverse effects , Practice Guidelines as Topic , Risk Factors , Time Factors
4.
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
5.
Expert Opin Drug Saf ; 20(11): 1309-1315, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1366929

ABSTRACT

INTRODUCTION: A number of anti-diabetic treatments have been favored during the continuing spread of the current SARS-CoV-2 pandemic. Glucagon like peptide-1 receptor agonists (GLP1-RAs) are a group of antidiabetic drugs, the glucose reducing effect of which is founded on augmenting glucose-dependent insulin secretion with concomitant reduction of glucagon secretion and delayed gastric emptying. Apart from their glucose lowering effects, GLP1-RAs also exert a plethora of pleiotropic activities in the form of anti-inflammatory, anti-thrombotic and anti-obesogenic properties, with beneficial cardiovascular and renal impact. All these make this class of drugs a preferred option for managing patients with type 2 diabetes (T2D), and potentially helpful in those with SARS-CoV2 infection. AREAS COVERED: In the present article we propose a hypothetical molecular mechanism by which GLP1-RAs may interact with SARS-CoV-2 activity. EXPERT OPINION: The beneficial properties of GLP1-RAs may be of specific importance during COVID-19 infection for the most fragile patients with chronic comorbid conditions such as T2D, and those at higher cardiovascular and renal disease risk. Yet, further studies are needed to confirm our hypothesis and preliminary findings available in the literature.


Subject(s)
COVID-19/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Glucagon-Like Peptide-1 Receptor/agonists , Hypoglycemic Agents/therapeutic use , Incretins/therapeutic use , Animals , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/virology , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/metabolism , Glucagon-Like Peptide-1 Receptor/metabolism , Humans , Hypoglycemic Agents/adverse effects , Incretins/adverse effects , Signal Transduction , Treatment Outcome
6.
Am J Case Rep ; 22: e930733, 2021 Apr 28.
Article in English | MEDLINE | ID: covidwho-1206459

ABSTRACT

BACKGROUND Intravenous (IV) dexamethasone is widely used in critical illness, chemotherapy, or severe COVID-19. Although glucocorticoid-induced hyperglycemia (GCIH) is well-known, there is no report describing the glycemic profile following a single dose of IV dexamethasone as captured on continuous glucose monitoring (CGM) in a patient with diabetes treated with insulin. CASE REPORT A 70-year-old woman with diabetes and pancreatic adenocarcinoma was treated with chemotherapy containing dexamethasone every other week. CGM data of 23 cycles revealed a reproducible triphasic glycemic pattern consisting of a constant hyperglycemia period, followed by a transient improvement, and ending with another hyperglycemic plateau. Given this recurrent pattern, basal insulin and correction insulin were adjusted with subsequent GCIH attenuation. CONCLUSIONS This is the first report of CGM glycemic profile following recurring doses of IV dexamethasone in a patient with diabetes treated with basal-bolus insulin. The understanding of triphasic glycemic pattern allows optimal glycemic management.


Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Agents, Hormonal/adverse effects , Blood Glucose Self-Monitoring/adverse effects , Dexamethasone/administration & dosage , Diabetes Mellitus, Type 2/drug therapy , Hyperglycemia/chemically induced , Insulin/adverse effects , Pancreatic Neoplasms/drug therapy , Administration, Intravenous , Aged , Antineoplastic Agents, Hormonal/administration & dosage , Antineoplastic Agents, Hormonal/therapeutic use , Blood Glucose , COVID-19/drug therapy , Dexamethasone/adverse effects , Female , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Hypoglycemic Agents/adverse effects , Insulin/administration & dosage , Neoplasm Recurrence, Local , Pancreatic Neoplasms/pathology , SARS-CoV-2
9.
Eur J Pharmacol ; 898: 173934, 2021 May 05.
Article in English | MEDLINE | ID: covidwho-1086916

ABSTRACT

Metformin is the most commonly prescribed oral antidiabetic medication. Direct/indirect activation of Adenosine Monophosphate-activated protein kinase (AMPK) and non-AMPK pathways, amongst others, are deemed to explain the molecular mechanisms of action of metformin. Metformin is an established insulin receptor sensitising antihyperglycemic agent, is highly affordable, and has superior safety and efficacy profiles. Emerging experimental and clinical evidence suggests that metformin has pleiotropic non-glycemic effects. Metformin appears to have weight stabilising, renoprotective, neuroprotective, cardio-vascular protective, and antineoplastic effects and mitigates polycystic ovarian syndrome. Anti-inflammatory and antioxidant effects of metformin seem to qualify it as an adjunct therapy in treating infectious diseases such as tuberculosis, viral hepatitis, and the current novel Covid-19 infections. So far, metformin is the only prescription medicine relevant to the emerging field of senotherapeutics. Non-glycemic effects of metformin favourable to its repurposing in therapeutic use are hereby discussed.


Subject(s)
Anti-Infective Agents/therapeutic use , Antineoplastic Agents/therapeutic use , Hypoglycemic Agents/therapeutic use , Immunologic Factors/therapeutic use , Metformin/therapeutic use , Protective Agents/therapeutic use , Animals , Anti-Infective Agents/adverse effects , Antineoplastic Agents/adverse effects , COVID-19/drug therapy , COVID-19/epidemiology , Cardiovascular Diseases/prevention & control , Female , Humans , Hypoglycemic Agents/adverse effects , Immunologic Factors/adverse effects , Kidney Diseases/prevention & control , Metabolic Syndrome/drug therapy , Metformin/adverse effects , Obesity/drug therapy , Pandemics , Polycystic Ovary Syndrome/drug therapy , Protective Agents/adverse effects , SARS-CoV-2
10.
Acta Diabetol ; 58(6): 771-778, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1083192

ABSTRACT

AIMS: The relationship between metformin therapy and the risk of coronavirus disease (COVID-19) has not been reported among patients with type 2 diabetes mellitus (DM). We aimed to investigate whether metformin therapy was associated with the incidence of COVID-19 among type 2 DM patients in South Korea. METHODS: The National Health Insurance Service-COVID-19 cohort database, comprising COVID-19 patients from 1 January 2020 to 4 June 2020, was used for this study. Among them, adult patients with type 2 DM were included in this study. Metformin users were defined as those who had been prescribed continuous oral metformin for over a period of ≥ 90 days, and the control group was defined as all other patients. RESULTS: Overall, 27,493 patients with type 2 DM (7204, metformin user group; 20,289, control group) were included. After propensity score matching, 11,892 patients (5946 patients in each group) were included in the final analysis. In the logistic regression analysis, the odds of metformin users developing COVID-19 was 30% lower than that of the control group [odds ratio (OR): 0.70, 95% confidence interval (CI): 0.61-0.80; P < 0.001]. However, in the multivariate model, metformin use was not associated with hospital mortality when compared with that of the control group (OR: 1.26, 95% CI: 0.81-1.95; P = 0.301). CONCLUSIONS: Metformin therapy might have potential benefits for the prevention of COVID-19 among patients with type 2 DM in South Korea. However, it did not affect the hospital mortality of type 2 DM patients diagnosed with COVID-19.


Subject(s)
COVID-19/epidemiology , Databases, Factual/trends , Diabetes Mellitus, Type 2/epidemiology , Hypoglycemic Agents/therapeutic use , Metformin/therapeutic use , National Health Programs/trends , Adult , Aged , COVID-19/chemically induced , COVID-19/prevention & control , Cohort Studies , Diabetes Mellitus, Type 2/drug therapy , Hospital Mortality/trends , Humans , Hypoglycemic Agents/adverse effects , Male , Metformin/adverse effects , Middle Aged , Republic of Korea/epidemiology , Risk Factors
11.
Epidemiol Prev ; 44(5-6 Suppl 2): 315-322, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068153

ABSTRACT

OBJECTIVES: to evaluate the effects of a pre-existing condition of diabetes and of the use of antidiabetic drugs in the Sicilian population on different outcomes of the COVID-19 disease. DESIGN: a retrospective observational study based was used. Data deriving from the COVID-19 epidemic surveillance and from the collection of information on drugs consume by Sicilian residents. SETTING AND PARTICIPANTS: due to the data availability, the study was calibrated on the Region and included all population distinguishing by gender and age groups. MAIN OUTCOME MEASURES: the risks of cumulative incidence for COVID-19 were investigated in people who had diabetes comorbidities to incur a hospitalization for COVID-19, to be treated within an intensive care unit, and lethality. The role of previous antidiabetic drug treatments with respect to each study outcome was also investigated. RESULTS: in Sicily, from 01.03.2020 to 26.06.2020, a number of 172 cases of COVID-19 disease with diabetes comorbidity were diagnosed. The data did not show any difference in the cumulative incidence for COVID-19 between diabetics (64.2/100,000 inhabitants) and non-diabetics (56.9/100,000 inhabitants) patients. Diabetes increases the risk of hospitalization in the under 80 in both men and women (men: OR 2.62; women OR 4.31), for treatment in intensive care (men: OR 4,41; women: OR 7.74), and for death (men: OR 5.21; women OR 5.92). The analysis of drug using showed risks effect of insulin (OR 2.13) on hospitalization, sulfonylureas/glinides (OR 2.58) on intensive care and protective of metformin on death both in single component (OR 0.44) and in multicomponent (OR 0.43). CONCLUSIONS: data availability made it possible to monitor the occurrence and explore some of the characteristics of the cases with COVID-19 in Sicily. Diabetes does not seem to represent a risk factor for SARS-CoV-2 infection in Sicily, while previous diabetes condition seems to determine greater risk of hospitalization, treatment in intensive care, and lethality among over 80. There are also gender differences with almost double risks in women for hospitalization and intensive care only. Among the antidiabetic drugs investigated, there was a risk for hospitalization and intensive care while protective for deaths. This study represents an important tool for the activation of intervention programmes in the area aimed at populations with greater health risk deriving from the effects of this new pandemic.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hypoglycemic Agents/adverse effects , Pandemics , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/drug therapy , COVID-19/therapy , Child , Child, Preschool , Comorbidity , Diabetes Mellitus/drug therapy , Female , Humans , Hypoglycemic Agents/therapeutic use , Incidence , Infant , Infant, Newborn , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Retrospective Studies , Risk Factors , Sicily/epidemiology , Survival Analysis , Treatment Outcome , Young Adult
12.
Therapie ; 75(4): 327-333, 2020.
Article in English | MEDLINE | ID: covidwho-1005621

ABSTRACT

According to previous reports, diabetes seems to be a risk factor which worsens the serious clinical events caused by COVID-19. But is diabetes per se a risk factor that increases the probability of getting the virus? This paper will discuss this point. There are not many research data on antidiabetic drugs in this context. The potential influence of glucose-lowering agents on the severity of COVID-19 has not been described yet. Dipeptidylpeptidase-4 (DPP-4) is a cell surface protein ubiquitously expressed in many tissues and it is also a soluble molecule found in serum/plasma fluids. DPP-4 is involved in infection of cells by some viruses. This paper reviews data about the use of DPP-4 inhibitors and others diabetes drugs on COVID-19 patients. As such, no available evidence has yet suggested that glucose-lowering drugs - including those targeting DPP4-related pathways - produce any significant harm or benefit in the context of human infections. However, insulin must remain the first-choice agent in the management of critically ill-hospitalized patients, while it is recommended to suspend other agents in unstable patients. This paper provides related French and international recommendations for people with diabetes who got infected by COVID-19 and upholds that infections may alter glucose control and may require additional vigilance.


Subject(s)
Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Hypoglycemic Agents/administration & dosage , Pneumonia, Viral/epidemiology , Animals , COVID-19 , Coronavirus Infections/physiopathology , Diabetes Mellitus/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/administration & dosage , Dipeptidyl-Peptidase IV Inhibitors/adverse effects , Dipeptidyl-Peptidase IV Inhibitors/pharmacology , Humans , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/pharmacology , Insulin/administration & dosage , Pandemics , Pneumonia, Viral/physiopathology , Risk Factors , Severity of Illness Index
13.
Arch Endocrinol Metab ; 65(1): 117-119, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-977833

ABSTRACT

This is a retrospective report of the frequency of severe hypoglycemia and the association between common mental disorders and type 1 diabetes mellitus treated with insulin analogues. Patients with severe hypoglycemia compared with those without this complication had a higher prevalence of positive screening for common mental disorders (88% vs. 77%, respectively, p = 0.03).


Subject(s)
Diabetes Mellitus, Type 1 , Hypoglycemia , Mental Disorders , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Insulin/adverse effects , Mental Disorders/chemically induced , Mental Disorders/drug therapy , Retrospective Studies
14.
Diabetes Metab ; 47(2): 101213, 2021 03.
Article in English | MEDLINE | ID: covidwho-943029

ABSTRACT

Dipeptidyl peptidase-4 inhibitors (DPP-4is) have gained a key place in the management of type 2 diabetes mellitus (T2DM) essentially because of their good safety profile even in the frail population. DPP-4, originally known as 'T-cell antigen CD26', is expressed in many immune cells and regulates their functions, so the initial concern over the use of DPP-4is was the possible increased susceptibility to infections. Furthermore, because of the high affinity between human DPP-4 and the spike (S) receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it was suspected that this virus, responsible for coronavirus disease 2019 (COVID-19), might be able to use the DPP-4 enzyme as a functional receptor to gain entry into the host. However, DPP-4is also exert anti-inflammatory effects, which could be beneficial in patients exposed to cytokine storms due to COVID-19. Yet, when observational (mostly retrospective) studies compared clinical outcomes in DPP-4i users vs non-users among diabetes patients with COVID-19, the overall results regarding the risk of progression towards more severe forms of the disease and mortality were heterogeneous, thereby precluding any definite conclusions. Nevertheless, new expectations have arisen following recent reports of significant reductions in admissions to intensive care units and mortality in DPP-4i users. However, given the limitations inherent in such observational studies, any available results should be considered, at best, as hypothetical and only suggestive of potentially substantial benefits with DPP-4is in diabetes patients with COVID-19. While the safe use of DPP-4is in COVID-19 patients appears to be an acceptable hypothesis, all such positive findings still need to be confirmed in randomized controlled trials (a few of which are currently ongoing) before any recommendations can be made for clinical practice.


Subject(s)
COVID-19/complications , Dipeptidyl Peptidase 4/metabolism , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Hypoglycemic Agents/therapeutic use , Animals , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/adverse effects , Humans , Hypoglycemic Agents/adverse effects , SARS-CoV-2
15.
Nutr Metab Cardiovasc Dis ; 31(2): 396-398, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-807055

ABSTRACT

BACKGROUND AND AIMS: Diabetes mellitus (DM) has been associated with higher incidence of severe cases of COVID-19 in hospitalized patients, but it is unknown whether DM is a risk factor for the overall COVID-19 incidence. The aim of present study was to investigate whether there is an association of DM with COVID-19 prevalence and case fatality, and between different DM medications and risk for COVID-19 infection and death. METHODS AND RESULTS: retrospective observational study on all SARS-CoV-2 positive (SARS-CoV-2+) cases and deaths in Sicily up to 2020, May 14th. No difference in COVID-19 prevalence was found between people with and without DM (RR 0.92 [0.79-1.09]). Case fatality was significantly higher in SARS-CoV-2+ with DM (RR 4.5 [3.55-5.71]). No diabetes medication was associated with differences in risk for SARS-Cov2 infection. CONCLUSIONS: in Sicily, DM was not a risk factor for COVID-19 infection, whereas it was associated with a higher case fatality.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Child , Child, Preschool , Diabetes Mellitus/drug therapy , Female , Humans , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/therapeutic use , Incidence , Infant , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , SARS-CoV-2 , Sicily/epidemiology , Young Adult
16.
Clin Transl Sci ; 13(6): 1055-1059, 2020 11.
Article in English | MEDLINE | ID: covidwho-780813

ABSTRACT

The current outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread across the world. No specific antiviral agents have been adequately evidenced for the treatment of coronavirus disease 2019 (COVID-19). Although metformin has been recommended as a host-directed therapy for COVID-19, there are some opposite views. The effects of metformin on the disease severity of patients with COVID-19 with diabetes during hospitalization remains unclear. This study aimed to determine the effect of metformin on disease severity. We enrolled 110 hospitalized patients with COVID-19 with diabetes prescribed either metformin or non-metformin hypoglycemic treatment for a case-control study. The primary outcome was the occurrence of life-threatening complications. There were no differences between the two groups in age, sex, comorbidities, and clinical severity at admission. Blood glucose and lactate dehydrogenase levels of the metformin group were higher than those of the non-metformin group at admission. Other laboratory parameters at admission and treatments after admission were not different between the two groups. Strikingly, the percentage of patients who experienced life-threatening complications was significantly higher in the metformin group (28.6% (16/56) vs. 7.4% (4/54), P = 0.004). Antidiabetic therapy with metformin was associated with a higher risk of disease progression in patients with COVID-19 with diabetes during hospitalization (adjusted odds ratio = 3.964, 95% confidence interval 1.034-15.194, P = 0.045). This retrospective analysis suggested a potential safety signal for metformin, the use of which was associated with a higher risk of severe COVID-19. We propose that metformin withdrawal in patients with COVID-19 be considered to prevent disease progression.


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/adverse effects , Metformin/adverse effects , SARS-CoV-2 , Aged , Angiotensin-Converting Enzyme 2/physiology , Blood Glucose/analysis , Female , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Retrospective Studies
17.
Am J Obstet Gynecol MFM ; 2(4): 100210, 2020 11.
Article in English | MEDLINE | ID: covidwho-764099

ABSTRACT

Epidemiologic data available so far suggest that individuals with diabetes, especially when not well controlled, are at a greater risk than the general population for severe acute respiratory syndrome coronavirus 2 morbidity such as acute respiratory distress syndrome, multiorgan failure, and mortality. Given the significant correlation between severity of coronavirus disease 2019 and diabetes mellitus and the lack of pregnancy-specific recommendations, we aim to provide some guidance and practical recommendations for the management of diabetes in pregnant women during the pandemic, especially for general obstetricians-gynecologists and nonobstetricians taking care of these patients.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypoglycemic Agents , Pregnancy Complications, Infectious , Adult , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Female , Glycemic Control/methods , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/adverse effects , Medication Therapy Management/standards , Needs Assessment , Ohio , Patient Care Management/methods , Patient Care Management/standards , Patient Selection , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Risk Adjustment/methods , SARS-CoV-2/isolation & purification
18.
J Diabetes Investig ; 11(5): 1303-1306, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-710497

ABSTRACT

Diabetes is a risk factor for the severity of coronavirus disease 2019 (COVID-19). Little is known how the COVID-19 pandemic has disrupted diabetes-related acute care. We compared hospitalization rates for severe hyperglycemia or hypoglycemia during the COVID-19 outbreak in Hong Kong (study period: 25 January to 24 April 2020) with those during 25 January to 24 April 2019 (inter-year control) and 25 October 2019 to 24 January 2020 (intra-year control), using Poisson regression analysis. Hospitalization rates abruptly decreased after the first confirmed local COVID-19 case on 23 January 2020, by 27% and 23% compared with the inter-year and intra-year control periods, respectively (incidence rate ratio 0.73 and 0.77, P < 0.001). Hospitalizations were reduced for severe hyperglycemia and hypoglycemia, but not diabetic ketoacidosis. This significant reduction in hospitalization rates should alert endocrinologists to take proactive measures to optimize glycemic control of individuals with diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus/drug therapy , Diabetic Ketoacidosis/epidemiology , Hospitalization/statistics & numerical data , Hyperglycemia/epidemiology , Hypoglycemia/epidemiology , Hypoglycemic Agents/adverse effects , Acute Disease , Aged , Aged, 80 and over , Delivery of Health Care , Diabetes Complications/epidemiology , Female , Hong Kong/epidemiology , Humans , Hypoglycemia/chemically induced , Hypoglycemic Agents/therapeutic use , Incidence , Male , Middle Aged , Regression Analysis , Retrospective Studies , Severity of Illness Index
19.
Cardiovasc Diabetol ; 19(1): 115, 2020 07 22.
Article in English | MEDLINE | ID: covidwho-662457

ABSTRACT

The coronavirus disease 2019 (COVID-19) has been declared as pandemic by the World Health Organization and is causing substantial morbidity and mortality all over the world. Type 2 diabetes, hypertension, and cardiovascular disease significantly increase the risk for hospitalization and death in COVID-19 patients. Hypoglycemia and hyperglycemia are both predictors for adverse outcomes in hospitalized patients. An optimized glycemic control should be pursued in patients with diabetes and SARS-CoV-2 infection in order to reduce the risk of severe COVID-19 course. Both insulin and GLP-1RAs have shown optimal glucose-lowering and anti-inflammatory effects in type 2 diabetic patients and may represent a valid therapeutic option to treat asymptomatic and non-critically ill COVID-19 diabetic patients.


Subject(s)
Betacoronavirus/pathogenicity , Blood Glucose/drug effects , Coronavirus Infections/therapy , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Incretins/administration & dosage , Insulin/administration & dosage , Pneumonia, Viral/therapy , Biomarkers/blood , Blood Glucose/metabolism , COVID-19 , Clinical Decision-Making , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Glucagon-Like Peptide-1 Receptor/agonists , Host Microbial Interactions , Humans , Hypoglycemic Agents/adverse effects , Incretins/adverse effects , Insulin/adverse effects , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Treatment Outcome
20.
Cardiovasc Diabetol ; 19(1): 114, 2020 07 20.
Article in English | MEDLINE | ID: covidwho-656673

ABSTRACT

In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.


Subject(s)
Betacoronavirus/pathogenicity , Blood Glucose/drug effects , Coronavirus Infections/therapy , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Intensive Care Units , Pneumonia, Viral/therapy , Antihypertensive Agents/therapeutic use , Biomarkers/blood , Blood Glucose/metabolism , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/virology , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Dyslipidemias/drug therapy , Dyslipidemias/mortality , Host-Pathogen Interactions , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypertension/drug therapy , Hypertension/mortality , Hypoglycemic Agents/adverse effects , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Treatment Outcome
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