COVID-19 Severity is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes

Gregory, Justin M.; Slaughter, James C.; Duffus, Sara H.; Smith, T. Jordan; LeStourgeon, Lauren M.; Jaser, Sarah S.; McCoy, Allison B.; Luther, James M.; Giovannetti, Erin R.; Boeder, Schafer; Pettus, Jeremy; Moore, Daniel J.

doi:10.2337/figshare.13235066

Cited by 59 publications

(86 citation statements)

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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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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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“…Diabetes mellitus (DM) has been recognized as a major risk factor for unfavorable outcomes in patients with COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. The underlying pathophysiology of COVID-19 and DM intertwining has not been totally explained; however, diabetes patients have an increased risk of infection and acute respiratory distress syndrome compared with the general population [2] [3] [4] [5] [6], while direct cytopathic effects of SARS-CoV-2 on pancreatic b-cell populations have been proposed [7]. COVID-19 is associated with hyperglycaemic emergencies as diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar State (HHS), euglycaemic diabetic ketoacidosis (EDKA), and combined DKA/HHS [8] [9].…”

Section: Text Introductionmentioning

confidence: 99%

Mortality of Diabetes-related Acute Metabolic Emergencies in COVID-19 patients: a systematic review and meta-analysis

Papadopoulos¹,

Avramidou²,

Bakola³

et al. 2021

Preprint

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PurposeLittle is known on the mortality rate in COVID-19 related acute metabolic emergencies, namely diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS), combined DKA/HHS, and euglycaemic diabetic ketoacidosis (EDKA).MethodsA systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 1, 2020 to January 9, 2021 to identify all case report series, cross-sectional studies, and meta-analyses of case reports describing mortality rate in DKA, HHS, and EDKA, in COVID-19 patients. The Joanna Briggs Institute critical appraisal checklist for case reports was used for quality assessment.ResultsFrom 313 identified publications, 4 fulfilled the inclusion criteria and analyzed qualitatively and quantitatively. A systematic review and meta-analysis with subgroup analyses examined mortality rate in a total of 152 COVID-19 patients who had developed DKA, HHS, combined DKA/HHS, or EDKA. Combined mortality rate and confidence intervals (CI) were estimated using random effects model. The study was registered to PROSPERO database (ID: 230737).ResultsCombined mortality rate was found to be 27.1% [95% CI: 11.2-46.9%]. Heterogeneity was considerable (I2=83%; 95% CI: 56-93%), corrected to 67% according to Von Hippel adjustment for small meta-analyses. Funnel plot presented no apparent asymmetry; Egger’s and Begg’s test yielded in P=0.44 and P=0.50, respectively. Sensitivity analysis failed to explain heterogeneity.ConclusionCOVID-19 related acute metabolic emergencies (DKA, HHS, and EDKA) are characterized by considerable mortality; thus, clinicians should be aware of timely detection and immediate treatment commencing.

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“…Patients with both type 1 and type 2 diabetes had a greater chance of increased morbidity compared to patients without diabetes, but those with type 2 diabetes have it worse than those with type 1 diabetes while those with type 1 have it worse than those without diabetes [ 28 ]. While the possibility of hospitalization and a more severe course of SARS-CoV-2 is almost equally likely in both patients with T1DM and T2DM, they are both 3–4 times more likely to have these possibilities than those without diabetes [ 15 , 28 ]. Interestingly, no significant correlation was observed between the duration of diabetes type 1 and the severity of COVID-19, taking into account age and sex [ 28 ].…”

Section: The Specificity Of Sars-cov-2 Infections In Patients Withmentioning

confidence: 99%

“…While the possibility of hospitalization and a more severe course of SARS-CoV-2 is almost equally likely in both patients with T1DM and T2DM, they are both 3–4 times more likely to have these possibilities than those without diabetes [ 15 , 28 ]. Interestingly, no significant correlation was observed between the duration of diabetes type 1 and the severity of COVID-19, taking into account age and sex [ 28 ].…”

Section: The Specificity Of Sars-cov-2 Infections In Patients Withmentioning

confidence: 99%

What Every Diabetologist Should Know about SARS-CoV-2: State of Knowledge at the Beginning of 2021

Abramczyk¹,

Kuzan

2021

JCM

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For almost a year, the major medical problem has been the pandemic caused by the SARS-CoV-2 virus. People with diabetes who contract COVID-19 are likely to experience more serious symptoms than patients without diabetes. This article presents new research about the epidemiology of COVID-19 in a group of patients with diabetes. It details the mortality and prognosis in such patients, as well as the relationship between COVID-19 and the diseases most often coexisting with diabetes: obesity, atherosclerosis, hypertension, and increased risk for infection. It also details how the virus infects and affects patients with hyperglycemia. The context of glycation and receptors for advanced glycation products (RAGE) seems to be of particular importance here. We also present a hypothesis related to the cause-and-effect axis—it turns out that diabetes can be both the cause of the more difficult course of COVID-19 and the result of SARS-CoV-2 infection. The last part of this article discusses the impact of antihyperglycemic drugs on the development of COVID-19 and other pharmacological implications, including which non-classical antihyperglycemic drugs seem to be effective in both the treatment of coronavirus infection and glucose homeostasis, and what strategies related to RAGE and glycation should be considered.

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COVID-19 Severity is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes

Cited by 59 publications

References 0 publications

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

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

Mortality of Diabetes-related Acute Metabolic Emergencies in COVID-19 patients: a systematic review and meta-analysis

What Every Diabetologist Should Know about SARS-CoV-2: State of Knowledge at the Beginning of 2021

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