Commentary: COVID-19 in patients with diabetes

Hill, Michael A.; Mantzoros, Christos S.; Sowers, James R.

doi:10.1016/j.metabol.2020.154217

Cited by 159 publications

(160 citation statements)

References 12 publications

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“…39,40 The highest SARS-CoV-2 mortality and morbidity have been reported in older patients and in those with underlying chronic diseases that are associated with inflammation, such as hypertension, obesity, diabetes mellitus, and coronary artery disease. [41][42][43] Interestingly, these subjects were also reported to have a lower abundance of Bacteroides species than healthy individuals. [17][18][19][20] These findings altogether suggest that an individual's gut microbiome configuration may affect the subject's susceptibility and response to SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization

et al. 2020

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BACKGROUND & AIMS: Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects gastrointestinal tissues, little is known about the roles of gut commensal microbes in susceptibility to and severity of infection. We investigated changes in fecal microbiomes of patients with SARS-CoV-2 infection during hospitalization and associations with severity and fecal shedding of virus. METHODS: We performed shotgun metagenomic sequencing analyses of fecal samples from 15 patients with Coronavirus Disease 2019 (COVID-19) in Hong Kong, from February 5 through March 17, 2020. Fecal samples were collected 2 or 3 times per week from time of hospitalization until discharge; disease was categorized as mild (no radiographic evidence of pneumonia), moderate (pneumonia was present), severe (respiratory rate !30/min, or oxygen saturation 93% when breathing ambient air), or critical (respiratory failure requiring mechanical ventilation, shock, or organ failure requiring intensive care). We compared microbiome data with those from 6 subjects with communityacquired pneumonia and 15 healthy individuals (controls). We assessed gut microbiome profiles in association with disease severity and changes in fecal shedding of SARS-CoV-2. RESULTS: Patients with COVID-19 had significant alterations in fecal microbiomes compared with controls, characterized by enrichment of opportunistic pathogens and depletion of beneficial commensals, at time of hospitalization and at all timepoints during hospitalization. Depleted symbionts and gut dysbiosis persisted even after clearance of SARS-CoV-2 (determined from throat swabs) and resolution of respiratory Gastroenterology 2020;159:944-955 BASIC AND TRANSLATIONAL AT symptoms. The baseline abundance of Coprobacillus, Clostridium ramosum, and Clostridium hathewayi correlated with COVID-19 severity; there was an inverse correlation between abundance of Faecalibacterium prausnitzii (an antiinflammatory bacterium) and disease severity. Over the course of hospitalization, Bacteroides dorei, Bacteroides thetaiotaomicron, Bacteroides massiliensis, and Bacteroides ovatus, which downregulate expression of angiotensin-converting enzyme 2 (ACE2) in murine gut, correlated inversely with SARS-CoV-2 load in fecal samples from patients. CONCLUSIONS: In a pilot study of 15 patients with COVID-19, we found persistent alterations in the fecal microbiome during the time of hospitalization, compared with controls. Fecal microbiota alterations were associated with fecal levels of SARS-CoV-2 and COVID-19 severity. Strategies to alter the intestinal microbiota might reduce disease severity.

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Section: Discussionmentioning

confidence: 99%

Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization

et al. 2020

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“…For instance, several changes in the immune system including alterations in specific cytokines and chemokines, shifts in the number and activation state of various leukocyte populations, and increased apoptosis and tissue fibrosis are present in obesity and type 2 diabetes, suggesting that inflammation has an active role in the pathogenesis of hyperglycemia, progression to clinically overt type 2 diabetes, and chronic complications (11)(12)(13)(14). We believe that this baseline inflammatory state could set the stage and background for further elevations in the levels of inflammatory cytokines, particularly as seen in acute infectious diseases such as COVID-19, further increasing insulin resistance, promoting proinflammatory effects of acute (stress) hyperglycemia, and ultimately leading to a poor prognosis of such patients with diabetes (15)(16)(17)(18). Our observations are corroborated by the recent retrospective multicentered study of over 7,000 cases of COVID-19 in Hubei Province, China (17).…”

Section: Hyperglycemia and Covid-19 Infectionsmentioning

confidence: 99%

Managing Hyperglycemia in the COVID-19 Inflammatory Storm

et al. 2020

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A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) is now at global pandemic levels causing significant morbidity and mortality. Patients with diabetes are particularly vulnerable and more likely to get severe complications when infected with this virus. Although the information continues to emerge, here we provide our perspective on initial outcomes observed in hospitalized patients with diabetes and the potential role played by the proinflammatory metabolic state in these patients that promotes fertile ground for the virus’ inflammatory surge, resulting in severe insulin resistance and severe hyperglycemia. The rapidly evolving renal failure, hypotension, pressor and steroid use, and variable nutritional support further complicates their management. Thus, timely implementation of glucose management protocols addressing these complex scenarios while also following COVID-19–related trajectories in inflammatory biomarkers and being cognizant of the health care provider exposure may substantially affect morbidity and mortality.

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“…Previous studies have reported that diabetes and uncontrolled glycemia were significant predictors of severity and mortality in patients infected with lower respiratory tract infections (7,8), 2009 pandemic influenza A (H1N1) (9), severe acute respiratory syndrome coronavirus (SARS-CoV) (10), and Middle East respiratory syndrome coronavirus (MERS-CoV) (11,12). However, it remains controversial whether diabetes is related to adverse outcomes among patients with COVID-19 (13,14). Most studies reported that diabetes was associated with higher risks for severe events and mortality (3)(4)(5)(15)(16)(17), whereas others showed no clear association (18,19).…”

Section: Introductionmentioning

confidence: 99%

Impaired Fasting Glucose and Diabetes Are Related to Higher Risks of Complications and Mortality Among Patients With Coronavirus Disease 2019

et al. 2020

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Background: Diabetes correlates with poor prognosis in patients with COVID-19, but very few studies have evaluated whether impaired fasting glucose (IFG) is also a risk factor for the poor outcomes of patients with COVID-19. Here we aimed to examine the associations between IFG and diabetes at admission with risks of complications and mortality among patients with COVID-19. Methods: In this multicenter retrospective cohort study, we enrolled 312 hospitalized patients with COVID-19 from 5 hospitals in Wuhan from Jan 1 to Mar 17, 2020. Clinical information, laboratory findings, complications, treatment regimens, and mortality status were collected. The associations between hyperglycemia and diabetes status at admission with primary composite end-point events (including mechanical ventilation, admission to intensive care unit, or death) were analyzed by Cox proportional hazards regression models. Results: The median age of the patients was 57 years (interquartile range 38-66), and 172 (55%) were women. At the time of hospital admission, 84 (27%) had diabetes (and 36 were new-diagnosed), 62 (20%) had IFG, and 166 (53%) had normal fasting glucose (NFG) levels. Compared to patients with NFG, patients with IFG and diabetes developed more primary composite end-point events (9 [5%], 11 [18%], 26 [31%]), including receiving mechanical ventilation (5 [3%], 6 [10%], 21 [25%]), and death (4 [2%], 9 [15%], 20 [24%]). Multivariable Cox regression analyses showed diabetes was Zhang et al. IFG and Diabetes and the Severity of COVID-19 associated increased risks of primary composite end-point events (hazard ratio 3.53; 95% confidence interval 1.48-8.40) and mortality (6.25; 1.91-20.45), and IFG was associated with an increased risk of mortality (4.11; 1.15-14.74), after adjusting for age, sex, hospitals and comorbidities. Conclusion: IFG and diabetes at admission were associated with higher risks of adverse outcomes among patients with COVID-19.

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Commentary: COVID-19 in patients with diabetes

Cited by 159 publications

References 12 publications

Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization

Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization

Managing Hyperglycemia in the COVID-19 Inflammatory Storm

Impaired Fasting Glucose and Diabetes Are Related to Higher Risks of Complications and Mortality Among Patients With Coronavirus Disease 2019

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