Diabetes is one of the most important comorbidities linked to the severity of all three known human pathogenic coronavirus infections, including severe acute respiratory syndrome coronavirus 2. Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure. Depending on the global region, 20-50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes. Given the importance of the link between COVID-19 and diabetes, we have formed an international panel of experts in the field of diabetes and endocrinology to provide some guidance and practical recommendations for the management of diabetes during the pandemic. We aim to briefly provide insight into potential mechanistic links between the novel coronavirus infection and diabetes, present practical management recommendations, and elaborate on the differential needs of several patient groups.

Our data show that RYGBP is associated with an improvement in the active GLP-1 and total PYY response to a liquid-meal intake. Moreover, we provide circumstantial evidence for a potential role of these gastrointestinal hormones on the decreased appetite after RYGBP.

Obesity is associated with insulin resistance, particularly when body fat has a central distribution. However, insulin resistance also frequently occurs in apparently lean individuals. It has been proposed that these lean insulin-resistant individuals have greater amounts of body fat than lean insulin-sensitive subjects. Alternatively, their body fat distribution may be different. Obesity is associated with elevated plasma leptin levels, but some studies have suggested that insulin sensitivity is an additional determinant of circulating leptin concentrations. To examine how body fat distribution contributes to insulin sensitivity and how these variables are related to leptin levels, we studied 174 individuals (73 men, 101 women), a priori classified as lean insulinsensitive (LIS, n ‫؍‬ 56), lean insulin-resistant (LIR, n ‫؍‬ 61), and obese insulin-resistant (OIR, n ‫؍‬ 57) based on their BMI and insulin sensitivity index (S I ). Whereas the BMI of the two lean groups did not differ, the S I of the LIR subjects was less than half that of the LIS group. The subcutaneous and intra-abdominal fat areas, determined by computed tomography, were 45 and 70% greater in the LIR subjects (P < 0.001) and 2.5-and 3-fold greater in the OIR group, as compared with the LIS group. Fasting plasma leptin levels were moderately increased in LIR subjects (10.8 ؎ 7.1 vs. 8.1 ؎ 6.4 ng/ml in LIS subjects; P < 0.001) and doubled in OIR subjects (21.9 ؎ 15.5 ng/ml; P < 0.001). Because of the confounding effect of body fat, we examined the relationships between adiposity, insulin sensitivity, and leptin concentrations by multiple regression analysis. Intraabdominal fat was the best variable predicting insulin sensitivity in both genders and explained 54% of the variance in S I . This inverse relationship was nonlinear (r ‫؍‬ ؊0.688). On the other hand, in both genders, fasting leptin levels were strongly associated with subcutaneous fat area (r ‫؍‬ 0.760) but not with intraabdominal fat. In line with these analyses, when LIS and LIR subjects were matched for subcutaneous fat area, age, and gender, they had similar leptin levels, whereas their intra-abdominal fat and insulin sensitivity remained different. Thus, accumulation of intra-abdominal fat correlates with insulin resistance, whereas subcutaneous fat deposition correlates with circulating leptin levels. We conclude that the concurrent increase in these two metabolically distinct fat compartments is a major explanation for the association between insulin resistance and elevated circulating leptin concentrations in lean and obese subjects. Diabetes 51: 1005-1015, 2002

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Diabetes Care 2019;42:777-788 | https://doi.org/10.2337/dc18-0836 OBJECTIVEThe long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention. RESEARCH DESIGN AND METHODSOverweight/obese adults with metabolic syndrome aged 55-75 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energyrestricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively. RESULTSDiet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P < 0.001), a mean difference of 22.5 kg (95% CI 23.1 to 21.9). Weight loss ‡5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P < 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P < 0.002). Reductions in insulin resistance, HbA 1c , and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P < 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts. CONCLUSIONSPREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.Clinical trial reg. no. ISRCTN89898870, www .isrctn.org This article contains Supplementary Data online at

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Background: The SARS-CoV2 virus pandemic pandemic has been characterized for its rapid global dispersion. Obesity is an independent risk factor for the most severe cases of COVID-19. The impact in Argentina differs from others since it was able to anticipate public health interventions in order to atten the contagion curve. Early quarantine achieved better control of the pandemic and, following the recommendations of scienti c societies in countries with higher affectation, elective bariatric surgeries (BS) and in-person consults were suspended. Objective: Bariatric surgeons were surveyed to assess the impact of the pandemic and the measures undertaken on the practice of BS in Argentina. Method: Between April 17 and 21, 2020, an online survey in Google forms was disseminated to bariatric surgeons residing in Argentina. It consists of 40 speci c and non-speci c questions regarding BS practice and COVID pandemic. Consent to participate was obtained from surgeons by completing the survey. Results: 83 surgeons averaging 47.17 years of age responded the survey. Together they performed 10515 BS in 2019. More than 65% stated that more than 50% of their income derives from this activity, and more than 40% depend on more than 75% of it. The average hospital stay was 1.6 days and 85% reported using Intensive Care Unit (ICU) in less than 1% of their patients. According to the scores of hospital affectation issued by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 54% reported being in Phase I and 34% had not yet been affected by the pandemic. All, except one, suspended the elective BS 7.7 days on average before the appearance of the rst local case. 95.7% offer virtual consults, but 48% obtain no retribution for them. 26% would consider performing BS without a previous endoscopic evaluation. 90% of the surgeons surveyed (75) continue performing other types of surgeries via laparoscopy. In case of operating a patient without suspected SARS-CoV-2 virus infection, 80% would use N95 masks and 56.6% would use face protection shields; two thirds would use smoke lters for the pneumoperitoneum and only 10.8% would continue with the usual protection measures. To restart the elective activity, 56.6% proposed that the hospital should be in phase 0 or I, that the patient should meet certain characteristics for their selection and that the scienti c society must recommend the way to restart of the activity. Patient selection criteria with greater consensus were testing to rule out asymptomatic COVID-positive patients, epidemiology, absence of chronic lung disease, age under 60, and immunological integrity. 19.2% regard sleeve gastrectomy as the ideal BS during the pandemic, and 88% of the surgeons would not change their chosen BS technique based on infection risk. Conclusion: Elective BS is currently suspended in Argentina, although epidemiologically the conditions in the country are not unfavorable. Economic impact for those involved is signi cant. Short-term vision is pessimistic, but recommendations originati...

Our data show that at 12 months after surgery, SG is as effective as GBP in inducing remission of T2DM and the MS. Furthermore, our data suggest that SG and GBP represent a successful an integrated strategy for the management of the different cardiovascular risk components of the MS in subjects with T2DM.