COVID-19 and type 1 diabetes: dealing with the difficult duo

Chowdhury, Subhankar; Goswami, Soumik

doi:10.1007/s13410-020-00846-z

Cited by 34 publications

(40 citation statements)

References 43 publications

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“…SARS-CoV-2 enters into the pancreas thereby triggering autoimmunity and resulting in pancreatic cell destruction; this is particularly prevalent in severe COVID-19 cases[ 81 - 84 ]. This pathway, activated due to viral infection, may lead to the production of cross-reactive antibodies against pancreatic cells (molecular mimicry hypothesis)[ 85 , 86 ]. Thus, the hypothesis of the bidirectional involvement of DM-COVID-19 holds, which states that the SARS-CoV-2 infection results in direct damage to pancreatic islet cells, leading to the impairment of insulin levels[ 79 , 87 ] and potentially triggering DM (shown in pathway-IV in Figure 1 ).…”

Section: How Can Covid-19 Lead To New-onset or Worsening Of Pre-existmentioning

confidence: 99%

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Viswanathan¹,

Puvvula²,

Jamthikar³

et al. 2021

WJD

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Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.

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Section: How Can Covid-19 Lead To New-onset or Worsening Of Pre-existmentioning

confidence: 99%

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Viswanathan¹,

Puvvula²,

Jamthikar³

et al. 2021

WJD

View full text Add to dashboard Cite

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“…COVID-19 might either induce new onset diabetes or unmask previously undiagnosed diabetes [3]. Diabetes patients have an increased risk of infection and acute respiratory distress syndrome compared with the general population and the risk is similar [4] or even greater in those with type 1 diabetes mellitus (T1D) than in T2D [5][6][7][8]; direct cytopathic effects of SARS-CoV-2 on pancreatic b-cell populations [9] as well as the over-activity of immune system might further explain COVID-19-related severe and resistant to conventional therapy DKA episodes [10,11]. However, whether SARS-CoV-2 directly infects b-cells in vivo has been debated [12].…”

Section: Introductionmentioning

confidence: 99%

Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Papadopoulos

Koutroulos²,

Zikoudi³

et al. 2021

Diabetol Int

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Aims COVID-19 is associated with diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and euglycaemic DKA (EDKA); however, evidence regarding parameters affecting outcome and mortality rates is scarce. Methods A systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 2020 to 7 January 2021 to identify all studies describing clinical profile, outcome and mortality rates regarding DKA, HHS, DKA/HHS and EDKA cases in COVID-19 patients. The appropriate Joanna Briggs Institute tools were used for quality assessment; quality of evidence was approached using GRADE. Univariate and multivariate analyses were used to assess correlations between clinical characteristics and outcome based on case reports. Combined mortality rates (CMR) were estimated from data reported in case report series, cross-sectional studies, and meta-analyses. The protocol was submitted to PROSPERO (ID: 229356/230737). Results From 312 identified publications, 44 were qualitatively and quantitatively analyzed. Critical COVID-19 necessitating ICU (P = 3 × 10-8), DKA/HHS presence (P = 0.021), and AKI (P = 0.037) were independently correlated with death. Increased COVID-19 severity (P = 0.003), elevated lactates (P < 0.001), augmented anion gap (P < 0.001), and AKI (P = 0.002) were associated with DKA/HHS. SGLT-2i were linked with EDKA (P = 0.004) and negatively associated with AKI (P = 0.023). CMR was 27.1% (95% CI 11.2-46.9%) with considerable heterogeneity (I 2 = 67%). Conclusion Acute diabetes-related metabolic emergencies in COVID-19 patients lead to increased mortality; key determinants are critical COVID-19 illness, coexistence of DKA/HHS and AKI. Previous SGLT-2i treatment, though associated with EDKA, might preserve renal function in COVID-19 patients.

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“…COVID-19 might either induce new onset diabetes or unmask previously undiagnosed diabetes [3]. Diabetes patients have an increased risk of infection and acute respiratory distress syndrome compared with the general population and the risk is similar [4] or even greater in those with T1D than in T2D [5][6][7][8]; direct cytopathic effects of SARS-CoV-2 on pancreatic b-cell populations [9] as well as the over-activity of immune system might further explain COVID-19-related severe and resistant to conventional therapy DKA episodes [10]. However, Coate et al report findings that reduce the likelihood that SARS-CoV-2 directly infects b cells in vivo through ACE2 and TMPRSS2 [11].…”

Section: Introductionmentioning

confidence: 99%

Acute Metabolic Emergencies in Diabetes and COVID-19: a systematic review and meta-analysis of case reports

Papadopoulos¹,

Koutroulos²,

Zikoudi³

et al. 2021

Preprint

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BackgroundCOVID-19 is associated with DKA (Diabetic Ketoacidosis), HHS (Hyperglycaemic Hyperosmolar State) and EDKA (Euglycaemic DKA). High mortality has been observed in COVID-19-related diabetic ketoacidosis; however, evidence is scarce.MethodsA systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January to December 2020 to identify all case reports describing DKA, HHS, and EDKA, in COVID-19 patients. The Joanna Briggs Institute critical appraisal checklist for case reports was used for quality assessment. Univariate and multivariate analysis assessed correlations of study origin, combined DKA/HHS, age, BMI, HbA1c, administered antidiabetics, comorbidities, symptoms onset, disease status (DS), CRP, ferritin, d-dimers, glucose, osmolarity, pH, bicarbonates, ketones, lactates, β-hydroxybutyric acid, anion gap, and acute kidney injury (AKI) with outcome. The relevant protocol was submitted to PROSPERO database (ID: 229356).ResultsFrom 312 identified publications, 41 including 71 cases analyzed qualitatively and quantitatively. The types of acute metabolic emergencies observed were DKA (45/71, 63.4%), EDKA (6/71, 8.5%), combined DKA/HHS (19/71, 26.8%), and HHS (1/71, 1.4%). Overall mortality was 32.4% (22/68 patients; 3 missing). Multivariate analysis by classical regression demonstrated that COVID-19 DS4 (P=3•10−8), presence of DKA/HHS (P=0.021), and development of AKI (P=0.037) were all independently correlated with death. Increased DS (P=0.003), elevated lactates (P<0.001), augmented anion gap (P<0.001), and presence of AKI (P=0.002) were associated with DKA/HHS. SGLT-2i administration was linked with EDKA (P=0.004); however, a negative association with AKI was noted (P=0.023).ConclusionCOVID-19 intertwines with acute metabolic emergencies in diabetes leading to increased mortality. Key determinants are critical COVID-19 illness, coexistence of DKA/HHS and AKI. Awareness of clinicians to timely assess them might enable early detection and immediate treatment commencing. As previous treatment with was negatively associated with AKI, thus implying a prophylactic effect on renal function, the issue of discontinuation of SGLT-2i in COVID-19 patients remains to be further evaluated.Key messagesWhat is already known on this subject▸Diabetes mellitus (DM) is a risk factor for poor outcomes in COVID-19 patients.▸Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) are not rare in COVID-19 diabetic and non-diabetic patients; key determinants of outcome remain unknown.What this study adds▸COVID-19 intertwines with acute metabolic emergencies in diabetes leading to increased mortality; key determinants are critical COVID-19 illness, coexistence of DKA and HHS as well as development of acute kidney injury.▸SGLT2-i administration is linked with euglycaemic DKA in patients with COVID-19, though preserving renal function.

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COVID-19 and type 1 diabetes: dealing with the difficult duo

Cited by 34 publications

References 43 publications

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Acute Metabolic Emergencies in Diabetes and COVID-19: a systematic review and meta-analysis of case reports

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