Since the initial COVID-19 outbreak in China, much attention has focused on people with diabetes because of poor prognosis in those with the infection. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk, but limitations to their use and potential interactions with COVID-19 treatments should be carefully assessed. Finally, severe acute respiratory syndrome coronavirus 2 infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through direct negative effects on β-cell function. These effects on β-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with unknown history of diabetes, and potentially new-onset diabetes.

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To explore whether at-admission hyperglycemia is associated with worse outcomes in patients hospitalized for coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS Hospitalized COVID-19 patients (N 5 271) were subdivided based on at-admission glycemic status: 1) glucose levels <7.78 mmol/L (NG) (N 5 149 [55.0%]; median glucose 5.99 mmol/L [range 5.38-6.72]), 2) known diabetes mellitus (DM) (N 5 56 [20.7%]; 9.18 mmol/L [7.67-12.71]), and 3) no diabetes and glucose levels ‡7.78 mmol/L (HG) (N 5 66 [24.3%]; 8.57 mmol/L [8.18-10.47]). RESULTS Neutrophils were higher and lymphocytes and PaO 2 /FiO 2 lower in HG than in DM and NG patients. DM and HG patients had higher D-dimer and worse inflammatory profile. Mortality was greater in HG (39.4% vs. 16.8%; unadjusted hazard ratio [HR] 2.20, 95% CI 1.27-3.81, P 5 0.005) than in NG (16.8%) and marginally so in DM (28.6%; 1.73, 0.92-3.25, P 5 0.086) patients. Upon multiple adjustments, only HG remained an independent predictor (HR 1.80, 95% CI 1.03-3.15, P 5 0.04). After stratification by quintile of glucose levels, mortality was higher in quintile 4 (Q4) (3.57, 1.46-8.76, P 5 0.005) and marginally in Q5 (29.6%) (2.32, 0.91-5.96, P 5 0.079) vs. Q1. CONCLUSIONS Hyperglycemia is an independent factor associated with severe prognosis in people hospitalized for COVID-19. Diabetes is common among persons hospitalized for coronavirus disease 2019 (COVID-19), and it is associated with increased risk of mortality (1). Stress-induced hyperglycemia occurring at hospital admission for acute medical or surgical illness in individuals with no history of diabetes (2) is a worse predictor than diabetes for poor clinical outcomes and mortality (3). In subjects with severe acute respiratory syndrome, at-admission hyperglycemia was an independent predictor for mortality (4). Therefore, we have evaluated the impact of at-admission plasma glucose levels in hospitalized COVID-19 patients. RESEARCH DESIGN AND METHODS We retrospectively analyzed 271 adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection consecutively admitted to the University

The implementation of a structured follow-up with the use of orthesis and shoes can reduce the incidence of DFU in diabetic patients who are at high ulcerative risk and its related costs.

The aim of this study was to evaluate the effect the lockdown imposed during COVID-19 outbreak on the glycemic control of people with Type 1 diabetes (T1D) using Continuous (CGM) or Flash Glucose Monitoring (FGM). Materials and methods: We retrospectively analyzed glucose reading obtained by FGM or CGM in T1D subjects. Sensor data from 2 weeks before the lockdown (Period 0, P 0), 2 weeks immediately after the lockdown (period 1, P 1), in mid-lockdown (Period 2, P 2) and immediately after end of lockdown (Period 3, P 3) were analyzed. Results: The study included 63 T1D patients, (FGM: 52, 82%; CGM:11, 18%). Sensor use (91%) were slightly reduced. Despite this reduction, Time in Range increased in P 1 (62%), P 2 (61%) and P 3 (62%) as compared to P 0 (58%, all p < 0.05 or less) with concomitant reduction in the Time Above Range (P 0 : 38%; P 1 : 34%, P 2 : 34%, P 3 : 32%, all p < 0.05 or less vs. P 0). Average glucose and GMI improved achieving statistical difference in P 3 (165 vs. 158 mg/dl, p = 0.040 and 7.2% (55 mmol/mol) vs. 7.0% (53 mmol/mol), p = 0.016) compared to P0. Time Below Range (TBR) and overall glucose variability remained unchanged. Bi-hourly analysis of glucose profile showed an improvement particularly in the early morning hours. Conclusions: In T1D subjects with good glycemic control on CGM or FGM, the lockdown had no negative impact. Rather a modest but significant improvement in glycemic control has been recorded, most likely reflecting more regular daily life activities and reduces workrelated distress.

Our data confirm that PTx with PED is not associated with an increased risk. The technique described has distinctive technical advantages and should be included in the repertoire of PTx.

Aims/hypothesis The effects of successful pancreas transplant alone (PTA) on chronic complications of diabetes, in particular diabetic retinopathy, remain disputed. We prospectively studied the course of diabetic retinopathy in PTA recipients and in non-transplanted (non-PTA) type 1 diabetic patients. Methods The PTA and non-PTA groups consisted respectively of 33 (follow-up: 30±11 months) and 35 patients (follow-up: 28±10 months). Best corrected visual acuity, slit lamp examination, intraocular pressure measurement, ophthalmoscopy, retinal photographs, and in selected cases angiography were performed. Diabetic retinopathy and its improvement/deterioration were assessed according to criteria proposed by the Eurodiab Study. Results At baseline, 9% of PTA and 6% of non-PTA patients had no diabetic retinopathy, 24 and 29% had non-proliferative diabetic retinopathy (NPDR), whereas 67 and 66% had laser-treated and/or proliferative diabetic retinopathy (LT/ PDR), respectively. No new case of diabetic retinopathy occurred in either group during follow-up. In the NPDR PTA group, 50% of patients improved by one grading, and 50% showed no change. In the LT/PDR PTA, stabilisation was observed in 86% of cases, whereas worsening of retinopathy occurred in 14% of patients. In the NPDR non-PTA group, diabetic retinopathy improved in 20% of patients, remained unchanged in 10%, and worsened in the remaining 70%. In the LT/PDR non-PTA group, retinopathy did not change in 43% and deteriorated in 57% of patients. Overall, the percentage of patients with improved or stabilised diabetic retinopathy was significantly higher in the PTA group. No differences were found between the two groups with regard to cataract lesions and intraocular pressure values. Conclusions/interpretation Despite a relatively short follow-up, our study shows that successful PTA can positively affect the course of diabetic retinopathy.

We experimentally prove high-speed underwater optical wireless transmission over 2.5 m distance, using different bit rates and modulation schemes. The system uses two low-cost Light Emitting Diodes (LEDs) arrays as optical transmitter and an avalanche photodiode module as receiver. The measurements are taken using an outdoor water tank having 3.3 m diameter, where two waterproof boxes containing the transmitter and the receiver are fixed underwater at the inner borders. We test 6.25 Mbit/s with Manchester coding, 12.5 Mbit/s with NRZ 8b/10b coding and 58 Mbit/s with Discrete Multitone modulation. Bit Error Rate measurements are collected over several hours under typical summer sunlight illumination conditions. In all the experimental conditions we achieve error free transmission