Glycemic parameters in patients with new-onset diabetes during COVID-19 pandemic are more severe than in patients with new-onset diabetes before the pandemic: NOD COVID India Study

Ghosh, Amerta; Anjana, Ranjit Mohan; Rani, Coimbatore Subramanian Shanthi; Rani, Saravanan Jeba; Gupta, Ritesh; Jha, Alka; Gupta, Vimal; Kuchay, Mohammad Shafi; Luthra, Atul; Durrani, Suhail; Dutta, Koel; Tyagi, Kanika; Unnikrishnan, Ranjit; Srivastava, Bipin K.; Ramu, M; Sastry, Nadiminty Ganapathi; Gupta, Prabha Nini; UmaSankari, Ganesan; Jayashri, Ramamoorthy; Mohan, Viswanathan; Misra, Anoop

doi:10.1016/j.dsx.2020.12.033

Cited by 54 publications

(48 citation statements)

References 19 publications

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“…Type 2 diabetes mellitus (T2DM) has a bidirectional relationship with COVID-19 [ 15 , 16 ]. Poorly controlled diabetes increases the severity of COVID-19 and is associated with increased morbidity and mortality.…”

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confidence: 99%

Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management

Raveendran¹,

Misra

2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Presence of various health issues even after recovering from acute COVID19 is collectively called post COVID syndrome (PCS, or “long COVID”). The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate postural hypotension with tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction in patients with diabetes. Strict control of diabetes and other co-morbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS. Patients may suffer from several debilitating symptoms/signs that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks after infection, and are not explained by an alternative diagnosis [ 1 ]. Common symptoms include fatigue, breathlessness, myalgia, weakness, headache, cognitive blunting etc. This conglomeration of symptoms is called “Long COVID” or more appropriately as “Post COVID-19 Syndrome (PCS)” [ 2 ]. The aim of the brief review is to summarise current knowledge of health events occurring after COVID-19 in brief and relate them for patients with diabetes.

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confidence: 99%

Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management

Raveendran¹,

Misra

2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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“…Around 10.3% patients without pre-existing diabetes had a random plasma glucose > 200 mg/dL on admission labeled as ‘new-onset hyperglycemia’. Impaired glucose regulation is typically seen in COVID-19 patients leading to new-onset hyperglycemia, worsening control in DM, severe insulin resistance requiring high insulin dosages and even diabetic ketoacidosis (DKA) ( 27 , 28 , 29 , 30 ), and these are associated with increased levels of inflammatory cytokines ( 31 ). These changes can affect the functions of the skeletal muscle and liver, the organs responsible for the bulk insulin-mediated glucose uptake ( 32 ).…”

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confidence: 99%

Effect of plasma glucose at admission on COVID-19 mortality: experience from a tertiary hospital

Kumar

Mittal

Gopalakrishnan

et al. 2021

Endocrine Connections

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Objective: Plasma glucose has been correlated with in-hospital mortality among many diseases including infections. We aimed to study plasma glucose at admission of hospitalized patients with COVID-19 at a tertiary care referral hospital at Jodhpur, India and its relation with mortality. Design: A hospital-based clinical study of plasma glucose of COVID-19 patients conducted from May 15th to June 30th, 2020 after ethical approval. Measurements: Random blood samples at admission were collected for plasma glucose, interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP) after written informed consent. Plasma glucose was analyzed by automated analyzer, IL-6 by chemiluminescent immunoassay and hsCRP by immune-turbidimetric assay. Results: A total of 386 patients studied (female 39.6%); 11.1% had severe disease and 4.1% expired. There were 67 (17.4%) patients with known diabetes mellitus (DM). Patients with history of DM had three times higher mortality (6/66, 9%) than those without DM (10/319, 3.1%). Patients with moderate and severe disease according to ICMR and WHO grading had higher plasma glucose than those with asymptomatic or mild disease (p<0.0001). Plasma glucose levels at admission were significantly higher in non-survivors when compared to those who survived (297±117 vs. 131±73; p<0.0001). COVID-19 patients showed increasing mortality with incremental plasma glucose levels. Hazard ratio for mortality was 1.128 (95%CI 0.86-14.860),1.883 (95%CI 0.209-16.970), and 4.005 (95%CI 0.503-32.677) in random plasma glucose group of >100-200, >200-300 and >300mg/dl respectively compared to those with random plasma glucose of <100mg/dl at admission. Plasma glucose was strongly correlated with hsCRP (p<0.001) and IL-6 (p<0.0001). Conclusions: Plasma glucose at admission in hospitalized COVID-19 patients is a strong predictor of mortality.

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“…Ghosh et al [ 38 ] analyzed 282 patients with new-onset diabetes diagnosed during the COVID pandemic and compared them with 273 individuals newly diagnosed with diabetes immediately prior to the pandemic. They found that individuals with new-onset diabetes during the COVID pandemic had higher fasting and postprandial glucose levels and glycated hemoglobin compared to those diagnosed before the pandemic, even though the two groups did not differ significantly in any other respect including exposure to COVID (as measured by SARS-CoV2 antibody levels).…”

Section: Effect Of Covid19 On Hyperglycemiamentioning

confidence: 99%

Diabetes and COVID19: a bidirectional relationship

Unnikrishnan

Misra

2021

Eur J Clin Nutr

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The advent and rapid spread of the coronavirus disease-2019 (COVID19) pandemic across the world has focused attention on the relationship of commonly occurring comorbidities such as diabetes on the course and outcomes of this infection. While diabetes does not seem to be associated with an increased risk of COVID19 infection per se, it has been clearly demonstrated that the presence of hyperglycemia of any degree predisposes to worse outcomes, such as more severe respiratory involvement, ICU admissions, need for mechanical ventilation and mortality. Further, COVID19 infection has been associated with the development of new-onset hyperglycemia and diabetes, and worsening of glycemic control in pre-existing diabetes, due to direct pancreatic damage by the virus, body’s stress response to infection (including cytokine storm) and use of diabetogenic drugs such as corticosteroids in the treatment of severe COVID19. In addition, public health measures taken to flatten the pandemic curve (such as lockdowns) can also adversely impact persons with diabetes by limiting their access to clinical care, healthy diet, and opportunities to exercise. Most antidiabetic medications can continue to be used in patients with mild COVID19 but switching over to insulin is preferred in severe disease.

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Glycemic parameters in patients with new-onset diabetes during COVID-19 pandemic are more severe than in patients with new-onset diabetes before the pandemic: NOD COVID India Study

Cited by 54 publications

References 19 publications

Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management

Post COVID-19 Syndrome (“Long COVID”) and Diabetes: Challenges in Diagnosis and Management

Effect of plasma glucose at admission on COVID-19 mortality: experience from a tertiary hospital

Diabetes and COVID19: a bidirectional relationship

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