Diabetes, obesity and <scp>COVID</scp>‐19: A complex interplay

Vas, Prashanth; Hopkins, David; Feher, Michael; Rubino, Francesco; Whyte, Martin

doi:10.1111/dom.14134

Cited by 60 publications

(72 citation statements)

References 58 publications

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“…These conditions all represent risk factors that could trigger poorer prognoses in cases of COVID-19 [11] . On the other hand, metformin is more commonly used in obese patients with T2DM [10] , and obesity has been demonstrated to be associated with a greater risk of severe COVID-19 infection and a higher mortality rate [11] , [12] .…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, it has been the most popular glucose-lowering agent during the past two decades worldwide, and around two-thirds to three-quarters of patients with T2DM are treated with metformin alone or in combination. The United Kingdom Prospective Diabetes Study (UKPDS) [10] showed that metformin reduces mortality in obese patients with newly diagnosed T2DM, and obesity has been reported to be a major risk factor for developing severe COVID-19 [11] , [12] . Thus, it is of major importance to know the effect of metformin on the clinical outcomes of patients with T2DM during the COVID-19 outbreak.…”

Section: Introductionmentioning

confidence: 99%

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Metformin and COVID-19: From cellular mechanisms to reduced mortality

Scheen

2020

Diabetes & Metabolism

154

127

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Type 2 diabetes mellitus (T2DM) is associated with both poorer clinical outcomes during the COVID-19 pandemic and an increased risk of death in such hospitalized patients. While the role of glucose control has been emphasized to improve the prognosis, the impact of different glucose-lowering agents remains largely unknown. Metformin remains the first-line pharmacological choice for the management of hyperglycaemia in T2DM. Because metformin exerts various effects beyond its glucose-lowering action, among which are anti-inflammatory effects, it may be speculated that this biguanide might positively influence the prognosis of patients with T2DM hospitalized for COVID-19. The present concise review summarizes the available data from observational retrospective studies that have shown a reduction in mortality in metformin users compared with non-users, and briefly discusses the potential underlying mechanisms that might perhaps explain this favourable impact. However, given the potential confounders inherently found in observational studies, caution is required before drawing any firm conclusions in the absence of randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metformin and COVID-19: From cellular mechanisms to reduced mortality

Scheen

2020

Diabetes & Metabolism

154

127

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“…The available data do show no increased or even lower maternal mortality rate after infection [25], but it does not mean that pregnancy is a protective factor for severe infection. It was reported that severe infection mostly occurred in the elderly (> 60 years old), patients with basic diseases, such as diabetes, obesity, hypertension, coronary heart disease, cerebrovascular diseases, and other chronic diseases [26][27][28][29][30], as well as those who did not receive timely treatment or delay treatment [31]. Pregnant women are usually younger without primary diseases.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Gao

Zhang

et al. 2020

BMC Infect Dis

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Background: The recent COVID-19 outbreak in Wuhan, China, has quickly spread throughout the world. In this study, we systematically reviewed the clinical features and outcomes of pregnant women with COVID-19. Methods: PubMed, Web of Science, EMBASE and MEDLINE were searched from January 1, 2020, to April 16, 2020. Case reports and case series of pregnant women infected with SARS-CoV-2 were included. Two reviewers screened 366 studies and 14 studies were included. Four reviewers independently extracted the features from the studies. We used a random-effects model to analyse the incidence (P) and 95% confidence interval (95% CI). Heterogeneity was assessed using the I 2 statistic. Results: The meta-analysis included 236 pregnant women with COVID-19. The results were as follows: positive CT findings (71%; 95% CI, 0.49-0.93), caesarean section (65%; 95% CI, 0.42-0.87), fever (51%; 95% CI, 0.35-0.67), lymphopenia (49%; 95% CI, 0.29-0.70), coexisting disorders (33%; 95% CI, 0.21-0.44), cough (31%; 95% CI, 0.23-0.39), fetal distress (29%; 95% CI, 0.08-0.49), preterm labor (23%; 95% CI, 0.14-0.32), and severe case or death (12%; 95% CI, 0.03-0.20). The subgroup analysis showed that compared with non-pregnant patients, pregnant women with COVID-19 had significantly lower incidences of fever (pregnant women, 51%; non-pregnant patients, 91%; P < 0.00001) and cough (pregnant women, 31%; non-pregnant patients, 67%; P < 0.0001). Conclusions: The incidences of fever, cough and positive CT findings in pregnant women with COVID-19 are less than those in the normal population with COVID-19, but the rate of preterm labor is higher among pregnant with COVID-19 than among normal pregnant women. There is currently no evidence that COVID-19 can spread through vertical transmission.

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“…Other studies showed various percentages of COVID-19 patients with type 2 diabetes, as 20% [ 15 ], 52% [ 16 ], 24.9% [ 17 ], 14.5% [ 18 ], and 21.8% [ 19 ]. However, a number of studies have shown that the severity and complications of COVID-19 disease and the need for ICU stay were higher in diabetic patients than in non-diabetic individuals [ 9 , 14 , 15 , 17 , 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The higher rate of mortality in diabetic patients can be due to their weakened immune system [ 26 ], poor lung function, and reduced lung capacity along with their common respiratory problems [ 18 ]. Furthermore, COVID-19 can affect diabetes pathogenicity as well as blood sugar control [ 20 ], all of which together can lead to increased mortality rate among these people. However, further research is needed to find out if COVID-19-related mortality was actually caused by diabetes or other factors, as most of these people are elderly and may have at the same time some other chronic diseases, including hypertension and cardiovascular disease, which makes it a little difficult for us to identify the main cause of death due to COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological characteristics and outcomes of COVID-19 in diabetic versus non-diabetic patients

Moftakhar¹,

Moftakhar

Piraee

et al. 2021

Int J Diabetes Dev Ctries

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Objectives and background People with diabetes (PWD) are one of the high-risk groups for coronavirus disease 2019 (COVID-19) infection, increasing the disease mortality. This study was aimed to compare the epidemiological characteristics and outcomes of COVID-19 in diabetic versus non-diabetic individuals. Methods In this retrospective observational study, the epidemiological characteristics of the two groups of diabetic ( n =1365) and non-diabetic ( n =15,026) subjects with definite diagnosis of COVID-19 in the southwestern region of Iran were compared. All clinical signs and comorbidities of the patients were evaluated. Chi-square test was used to examine the differences in qualitative variables between diabetic and non-diabetic groups. Results Of 16,391 enrolled subjects, 8.3% had diabetes, and 28.3% of COVID-19-related deaths occurred in diabetics. Also, the mortality rate among diabetics was reported as 14.3%. The average age of diabetic patients and non-diabetic patients was 59 and 37 years, respectively. The odds of fever, cough, shortness of breath, headache, and underlying diseases, such as hypertension, cardiovascular disease, chronic lung disease, immune deficiency, and hyperlipidemia, were significantly higher in diabetic patients than in non-diabetics. Conclusion Diabetes is associated with increased mortality rate in patients with COVID-19 and is considered as a major risk factor for COVID-19 infection, posing a major public health challenge for health policymakers in managing and controlling the disease. Therefore, development of prevention and treatment strategies aimed at reducing COVID-19 morbidity and mortality in diabetes patients is of significant importance.

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Diabetes, obesity and COVID‐19: A complex interplay

Cited by 60 publications

References 58 publications

Metformin and COVID-19: From cellular mechanisms to reduced mortality

Metformin and COVID-19: From cellular mechanisms to reduced mortality

Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Epidemiological characteristics and outcomes of COVID-19 in diabetic versus non-diabetic patients

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