COVID-19 and Risk of Acute Ischemic Stroke and Acute Lung Injury in Patients With Type II Diabetes Mellitus: The Anti-inflammatory Role of Metformin

Al-Kuraishy, Hayder M; Al-Gareeb, Ali I; Alblihed, Mohamed A.; Cruz‐Martins, Natália; Batiha, Gaber El Saber

doi:10.3389/fmed.2021.644295

Cited by 79 publications

(77 citation statements)

References 52 publications

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“…Into the bargain, the retrospective study by Wang et al ( 105 ), involving 307 COVID-19 patients, shows that early definitive diagnosis could be grasped by age-related clinical and CT scan findings. Moreover, lung CT scan findings were correlated with COVID-19 severity and development of acute ischemic stroke in T2DM patients with COVID-19 ( 106 ).…”

Section: Diabetes Complicationsmentioning

confidence: 98%

“…For example, in India, the T2DM treatment with hydroxychloroquine has been approved as an alternative for patients with a non-controlled DM with other hypoglycemic agents (i.e., stable-dose insulin therapy with metformin and glimepiride) ( 125 ). Moreover, despite inflammation being linked to impaired glucose regulation, the underlying mechanism of the hypoglycemic effect of hydroxychloroquine is still not clear ( 106 ).…”

Section: Control Of Dm Patients With Covid-19mentioning

confidence: 99%

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Factors Behind the Higher COVID-19 Risk in Diabetes: A Critical Review

Beshbishy

Oti

Hussein

et al. 2021

Front. Public Health

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Diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19) are public health issues worldwide, and their comorbidities trigger the progress to severe disease and even death in such patients. Globally, DM has affected an estimated 9.3% adults, and as of April 18, 2021, the World Health Organization (WHO) has confirmed 141,727,940 COVID-19 confirmed cases. The virus is spread via droplets, aerosols, and direct touch with others. Numerous predictive factors have been linked to COVID-19 severity, including impaired immune response and increased inflammatory response, among others. Angiotensin receptor blockers and angiotensin converting enzyme 2 have also been identified as playing a boosting role in both susceptibility and severity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Specifically, in DM patients, both their control and management during this pandemic is herculean as the restriction periods have markedly hampered the maintenance of means to control glycemia, hypertension, and neuroendocrine and kidney diseases. In addition, as a result of the underlyin cardio-metabolic and immunological disorders, DM patients are at a higher risk of developing the severe form of COVID-19 despite other comorbidities, such as hypertension, also potentially boosting the development of higher COVID-19 severity. However, even in non-DM patients, SARS-CoV-2 may also cause transient hyperglycemia through induction of insulin resistance and/or pancreatic β-cell injury. Therefore, a strict glucose monitoring of DM patients with COVID-19 is mandatory to prevent life-threatening complications.

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Section: Diabetes Complicationsmentioning

confidence: 98%

Section: Control Of Dm Patients With Covid-19mentioning

confidence: 99%

Factors Behind the Higher COVID-19 Risk in Diabetes: A Critical Review

Beshbishy

Oti

Hussein

et al. 2021

Front. Public Health

Self Cite

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show abstract

“…Thus, regardless of its glucose-lowering abilities, metformin is recommended in COVID-19 pneumonia due to its potent anti-inflammatory effects. Al-kuraishy et al ( 73 ) observed that metformin is effective in the reduction of COVID-19 severity and associated complications, such as ALI and acute ischemic stroke (AIS), through the modulation of SARS-CoV-2-induced inflammatory reactions in COVID-19 patients with T2DM. Nonetheless, its use is contraindicated in COVID-19 patients with lactic acidosis, multiorgan failure, severe gastrointestinal disorders, and hypoxia ( 74 ).…”

Section: Diabetic Pharmacotherapy and Covid-19mentioning

confidence: 99%

COVID-19 in Relation to Hyperglycemia and Diabetes Mellitus

Al-Kuraishy¹,

Al-Gareeb²,

Alblihed

et al. 2021

Front. Cardiovasc. Med.

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Coronavirus disease 2019 (COVID-19), triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), may lead to extrapulmonary manifestations like diabetes mellitus (DM) and hyperglycemia, both predicting a poor prognosis and an increased risk of death. SARS-CoV-2 infects the pancreas through angiotensin-converting enzyme 2 (ACE2), where it is highly expressed compared to other organs, leading to pancreatic damage with subsequent impairment of insulin secretion and development of hyperglycemia even in non-DM patients. Thus, this review aims to provide an overview of the potential link between COVID-19 and hyperglycemia as a risk factor for DM development in relation to DM pharmacotherapy. For that, a systematic search was done in the database of MEDLINE through Scopus, Web of Science, PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), and Wanfang Data. Data obtained underline that SARS-CoV-2 infection in DM patients is more severe and associated with poor clinical outcomes due to preexistence of comorbidities and inflammation disorders. SARS-CoV-2 infection impairs glucose homeostasis and metabolism in DM and non-DM patients due to cytokine storm (CS) development, downregulation of ACE2, and direct injury of pancreatic β-cells. Therefore, the potent anti-inflammatory effect of diabetic pharmacotherapies such as metformin, pioglitazone, sodium-glucose co-transporter-2 inhibitors (SGLT2Is), and dipeptidyl peptidase-4 (DPP4) inhibitors may mitigate COVID-19 severity. In addition, some antidiabetic agents and also insulin may reduce SARS-CoV-2 infectivity and severity through the modulation of the ACE2 receptor expression. The findings presented here illustrate that insulin therapy might seem as more appropriate than other anti-DM pharmacotherapies in the management of COVID-19 patients with DM due to low risk of uncontrolled hyperglycemia and diabetic ketoacidosis (DKA). From these findings, we could not give the final conclusion about the efficacy of diabetic pharmacotherapy in COVID-19; thus, clinical trial and prospective studies are warranted to confirm this finding and concern.

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“…Dysfunctional RAS with high angiotensin II (AngII) has been linked to acute lung injury (ALI) through intensification of inflammatory changes and lung vascular permeability [ 4 ]. Moreover, SARS-CoV-2 triggers a local immune response, through recruiting monocytes and macrophages to the site of infection with activation of cellular immune response [ 5 ]. However, an abnormal immune response and high viral replication may cause pyroptosis (inflammatory program cell death) through induction of IL-1β release [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The potential role of neopterin in Covid-19: a new perspective

et al. 2021

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Neopterin (NPT) is a member of pteridines group, synthesized by macrophages when stimulated by interferon gamma (INF-γ). NPT is regarded as a macrophage stimulation indicator, marker of cellular immune activation and T helper 1 (Th1) type 1 immune response. Here, we aimed to provide a view point on the NPT features and role in Covid-19. Serum NPT level is regarded as an independent prognostic factor for Covid-19 severity, with levels starting to increase from the 3rd day of SARS-CoV-2 infection, being associated with severe dyspnea, longer hospitalization period and complications. Also, early raise of NPT reflects monocytes/macrophages activation before antibody immune response, despite the NPT level may also remain high in Covid-19 patients or at the end of incubation period before the onset of clinical symptoms. On the other hand , NPT attenuates the activity of macrophage foam cells and is linked to endothelial inflammation through inhibition of adhesion molecules and monocytes migration. However, NPT also exerts anti-inflammatory and antioxidant effects by suppressing NF-κB signaling and NLRP3 inflammasomes. NPT can be viewed as a protective compensatory mechanism to counterpoise hyper-inflammation, oxidative stress, and associated organ damage.

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COVID-19 and Risk of Acute Ischemic Stroke and Acute Lung Injury in Patients With Type II Diabetes Mellitus: The Anti-inflammatory Role of Metformin

Cited by 79 publications

References 52 publications

Factors Behind the Higher COVID-19 Risk in Diabetes: A Critical Review

Factors Behind the Higher COVID-19 Risk in Diabetes: A Critical Review

COVID-19 in Relation to Hyperglycemia and Diabetes Mellitus

The potential role of neopterin in Covid-19: a new perspective

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