Based on many reports, an unmistakable link probably exists between diabetes mellitus and COVID-19. A major predisposing factor determining severity and mortality of COVID-19 is diabetes mellitus, diabetic patients were shown to be at higher risk for developing severe COVID-19 disease than non-diabetics; many recent studies reported a striking prevalence of DM in those diagnosed with COVID-19. Accordingly, antidiabetic drugs can possibly impact the clinical course and / or the outcome of this infection, either by alleviating diabetes-associated symptoms, minimizing its complications, or by mitigating or aggravating COVID-19 disease by effects independent from their direct antidiabetic effects. Several antidiabetic drug classes were shown to have varying effects, like blocking viral entry to cells, as well as having immunomodulatory, anti-inflammatory, antifibrotic, or cardioprotective effects; such effects could prove beneficial for COVID-19 patients. On the other hand, some antidiabetic agents may have adverse effects that aggravate patients' condition like hypoglycemia, fluid retention, increased weight or lactic acidosis, which require special consideration in patient management. Some of the drugs were found in observational studies to either reduce mortality from COVID-19 or pose no harm, but more solid evidence from clinical trials is still lacking.
Background and objectives: Hypertension is an extremely common co-morbid condition in diabetes. Peripheral insulin resistance (IR) plus compensatory hyperinsulinaemia is a common mechanism underlying both hypertension and diabetes. The aim of this study was to compare the effects of telmisartan and captopril on IR in type2 diabetes mellitus with hypertension. . Sixty-eight patients on oral hypoglycemic agents were assigned to receive two month treatment of either telmisartan (n = 34) or captopril (n = 34). Forty diabetic normotensive patients, with age and BMI, matched to the diabetic hypertensive patients, served as a control group. The oral hypoglycemic agents remained unchanged during the two-months study period. Insulin resistance was estimated by homeostasis model assessment of insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI). Results: This study showed that the two groups of diabetic hypertensive patients who were assigned to receive captopril or telmisartan have a non-significant difference in fasting serum glucose (FSG), fasting serum insulin (FSI), QUICKI and HOMA-IR before starting therapy. Telmisartan and captopril groups showed insignificant change in body mass index (BMI). HOMA-IR, QUICKI, FSI and FSG were changed non-significantly in telmisartan group; while FSI, FSG and HOMA-IR decreased significantly (from 18.1± 9.69 to 15.14 ± 7.49, p=0.022; and from 187.32± 65.34 to 162.95 ± 56.87, p=0.048; and from 8.27 ± 6.28 to 6.02 ± 3.73, p-value= 0.027, respectively) and QUICKI increased significantly (from 0.293 ± 0.024 to 0.306 ± 0.031, p-value = 0.022) in the captopril group versus baseline. Conclusion: Captopril, but not telmisartan, significantly improves insulin sensitivity in diabetic hypertensive patients.
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