COVID-19 in people with diabetes: understanding the reasons for worse outcomes

Apicella, Matteo; Campopiano, Maria Cristina; Mantuano, Michele; Mazoni, Laura; Coppelli, A; Prato, Stefano Del

doi:10.1016/s2213-8587(20)30238-2

Cited by 739 publications

(796 citation statements)

References 101 publications

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“…With the exception of a reduced prevalence of cough, patients with diabetes did not report different symptoms at the time of hospital admission than patients without diabetes (ESM Table 3). At the time of blood sampling for measuring the humoral response (median days: 10 [7-15.5] and 11 [7][8][9][10][11][12][13][14][15][16] Table 3).…”

Section: Prevalence Of Diabetes and Clinical Profile In Patients Withmentioning

confidence: 99%

“…severe acute respiratory syndrome (SARS) [9] and Middle East respiratory syndrome (MERS) [10,11]. Several putative pathophysiological mechanisms [12] have been proposed for the observed worse clinical outcome of COVID-19 pneumonia in patients with diabetes: (1) higher affinity cellular binding and more efficient virus entry [13][14][15][16]; (2) more common use of agents able to modulate ACE2 expression (glucose-lowering agents such as glucagon-like peptide-1 agonists and thiazolidinediones, antihypertensive drugs such as ACE inhibitors, and statins) [17][18][19]; (3) decreased viral clearance [20]; (4) increased susceptibility to hyperinflammation and cytokine storm syndrome [21]; (5) presence of comorbidities, such as hypertension and/or cardiovascular disease and/or obesity, as well as older age [3][4][5][6][7]; and (6) impaired immunological function [22]. However, many of these proposed mechanisms are predominantly untested hypotheses or theories, based on observational data.…”

Section: Introductionmentioning

confidence: 99%

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Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study

et al. 2020

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Aims/hypothesis The aim of the study was to characterise the humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with diabetes. Demonstrating the ability to mount an appropriate antibody response in the presence of hyperglycaemia is relevant for the comprehension of mechanisms related to the observed worse clinical outcome of coronavirus disease 2019 (COVID-19) pneumonia in patients with diabetes and for the development of any future vaccination campaign to prevent SARS-CoV-2 infection. Methods Using a highly specific and sensitive measurement of antibodies by fluid-phase luciferase immunoprecipitation assays, we characterised the IgG, IgM and IgA response against multiple antigens of SARS-CoV-2 in a cohort of 509 patients with documented diagnosis of COVID-19, prospectively followed at our institution. We analysed clinical outcomes and antibody titres according to the presence of hyperglycaemia, i.e., either diagnosed or undiagnosed diabetes, at the time of, or during, hospitalisation. Results Among patients with confirmed COVID-19, 139 (27.3%) had diabetes: 90 (17.7%) had diabetes diagnosed prior to the hospital admission (comorbid diabetes) while 49 (9.6%) had diabetes diagnosed at the time of admission (newly diagnosed). Diabetes was associated with increased levels of inflammatory biomarkers and hypercoagulopathy, as well as leucocytosis and neutrophilia. Diabetes was independently associated with risk of death (HR 2.32 [95% CI 1.44, 3.75], p = 0.001), even after adjustment for age, sex and other relevant comorbidities. Moreover, a strong association between higher glucose levels and risk of death was documented irrespective of diabetes diagnosis (HR 1.14 × 1.1 mmol/l [95% CI 1.08, 1.21], p < 0.001). The humoral response against SARS-CoV-2 in patients with diabetes was present and superimposable, as for timing and antibody titres, to that of non-diabetic patients, with marginal differences, and was not influenced by glucose levels. Of the measured antibody responses, positivity for IgG against the SARS-CoV-2 spike receptor-binding domain (RBD) was predictive of survival rate, both in the presence or absence of diabetes. Conclusions/interpretation The observed increased severity and mortality risk of COVID-19 pneumonia in patients with hyperglycaemia was not the result of an impaired humoral response against SARS-CoV-2. RBD IgG positivity was associated Electronic supplementary material The online version of this article (

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Section: Prevalence Of Diabetes and Clinical Profile In Patients Withmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study

et al. 2020

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“…More in general, cardiovascular disease is a predictor of mortality in infected patients regardless of diabetes and even in non COVID-19 patients [21]. Along the same line, Apicella et al [22] showed that, in COVID-19 patients, poorer prognosis of people with diabetes is likely to be the consequence of a syndromic nature of diabetes, in which hyperglycaemia, hypertension, obesity, and cardiovascular diseases all contribute to increase the risk of death. Therefore, albeit TD2 per se may not emerge as a risk factor, attention should be given to these patients who may be more fragile for comorbidities, especially the cardiovascular one.…”

Section: Discussionmentioning

confidence: 97%

Characteristics, Management, and Outcomes of Elderly Patients With Diabetes in a COVID-19 Unit: Lessons Learned.

Ricchio

Tassone

Pelle

et al. 2020

Preprint

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BackgroundDiabetes may affect in-hospital mortality of patients with Coronavirus disease 2019 (COVID-19). We have retrospectively evaluated clinical characteristics, diabetes management, and outcomes in a sample of COVID-19 patients with diabetes admitted to our hospital. MethodsAll patients admitted to the Infectious Diseases Unit from March 28th, 2020, to June 16th, 2020, were enrolled. Clinical information and biochemical parameters were collected at the time of admission. Patients were ranked according to diabetes and death. ResultsSixty-one patients with COVID-19 were analyzed. Most of them were from a long-term health care facility. Mean age was 77±16 years, and 19 had type 2 diabetes (T2D). Eighteen patients died, including 8 with T2D and 10 without T2D (p=0.15). Patients with diabetes were significantly older, had a higher prevalence of cardiovascular diseases, and a significantly lower lymphocyte count. No significant relationship was found between diabetes and in-hospital mortality [OR 2.3; CI 0.73-7.38, p=0.15]. Patients with diabetes were treated with insulin algorithm titration algorithm, with no severe hypoglycemic events, ketoacidosis and hyperosmolar hyperglycemias occurring during hospitalization. Mean fasting pre-meal capillary blood glucose was 157±45 mg/dL, and the coefficient of variation of glycaemia was 29%. ConclusionsOur study, albeit limited by the small number of subjects, did not describe any significant association between T2D diabetes and mortality. Clinical characteristics of patients, and acceptable glucose control prior and during hospitalization may have influenced the result, thus suggesting that the insulin algorithm titration algorithm applied should be validated.

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“…While recent studies have implicated the presence of comorbidities as well as pro-inflammatory and pro-coagulative states in severe COVID-19 outcomes, SARS-CoV-2 itself also has a negative effect on beta cell functions, precipitating acute metabolic complications . 13 Patients on dialysis have depressed immune systems and usually have other comorbidities . 14 A meta-analysis has shown that chronic kidney disease (CKD) seems to be associated with an enhanced risk of severe COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

Renin-angiotensin System Modulators and Other Risk Factors in COVID-19 Patients With Hypertension: A Korean Perspective

Kim

Kang

2020

Preprint

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Background: While hypertension is the most common comorbid condition in patients with coronavirus disease (COVID-19) in Korea, there is a lack of studies investigating risk factors in COVID-19 patients with hypertension in Korea. In this study, we aimed to examine the effects risk factors in hypertensive Korean COVID-19 patients.Methods: We selected patients from the database of the project #OpenData4Covid19. This information was linked to their 3-year historical healthcare data. The severity of the disease was classified into five levels. We also clustered the levels into two grades.Results: The risk factors associated with COVID-19 severity were old age, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), malignancy, and renal replacement therapy. The use of ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) both before and after a diagnosis of COVID-19 were not associated with COVID-19 severity. A multivariate analysis revealed that old age, male sex, diabetes mellitus, and renal replacement therapy were risk factors for severe COVID-19Conclusion: The results suggest that in hypertensive patients with COVID-19, older age, male sex, a diagnosis of diabetes mellitus, and renal replacement therapy were risk factors for a severe clinical course. In addition, the use of ARBs and ACEIs before or after COVID-19 infection did not affect a patient’s risk of contracting COVID-19 nor did it contribute to a worse prognosis for the disease. These results highlighted that precautions should be considered for hypertensive patients with those risk factors and do not support discontinuation of ARBs and ACEIs during COVID-19 pandemic.

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COVID-19 in people with diabetes: understanding the reasons for worse outcomes

Cited by 739 publications

References 101 publications

Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study

Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study

Characteristics, Management, and Outcomes of Elderly Patients With Diabetes in a COVID-19 Unit: Lessons Learned.

Renin-angiotensin System Modulators and Other Risk Factors in COVID-19 Patients With Hypertension: A Korean Perspective

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