What is the impact of microvascular complications of diabetes on severe COVID-19?

Basra, Ruman; Whyte, Martin; Karalliedde, Janaka; Vas, Prashanth

doi:10.1016/j.mvr.2021.104310

Cited by 9 publications

(10 citation statements)

References 78 publications

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“…Similarly, for both oral antiviral agents, HRs in the subgroup with diabetic complications did not reach statistical significance. In fact, the presence of diabetic complications, especially microvascular complications, has been established as a risk factor for severe COVID-19 . It has been postulated that underlying systemic endothelial and microvascular dysfunction may lead to excessive pulmonary endothelial and microvascular injury upon SARS-CoV-2 infection and thus to worse COVID-19 outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the presence of diabetic complications, especially microvascular complications, has been established as a risk factor for severe COVID-19. 29 It has been postulated that underlying systemic endothelial and microvascular dysfunction may lead to excessive pulmonary endothelial and microvascular injury upon SARS-CoV-2 infection and thus to worse COVID-19 outcomes. 29 Whether this may explain the attenuation of effectiveness of oral antiviral medications warrants further evaluation.…”

Section: Discussionmentioning

confidence: 99%

“… 29 It has been postulated that underlying systemic endothelial and microvascular dysfunction may lead to excessive pulmonary endothelial and microvascular injury upon SARS-CoV-2 infection and thus to worse COVID-19 outcomes. 29 Whether this may explain the attenuation of effectiveness of oral antiviral medications warrants further evaluation. The sample size of this subgroup was also relatively small.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of All-Cause Hospitalization and Death Among Nonhospitalized Patients With Type 2 Diabetes and SARS-CoV-2 Infection Treated With Molnupiravir or Nirmatrelvir-Ritonavir During the Omicron Wave in Hong Kong

et al. 2023

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ImportanceDiabetes and COVID-19 are both global pandemics, and type 2 diabetes is a common comorbidity in patients with acute COVID-19 and is proven to be a key determinant of COVID-19 prognosis. Molnupiravir and nirmatrelvir-ritonavir are oral antiviral medications recently approved for nonhospitalized patients with mild to moderate COVID-19, following demonstration of their efficacies in reducing adverse outcomes of the disease; it is crucial to clarify whether both oral antiviral medications are efficacious in a population consisting exclusively of patients with type 2 diabetes.ObjectiveTo evaluate the effectiveness of molnupiravir and nirmatrelvir-ritonavir in a contemporary population-based cohort comprising exclusively nonhospitalized patients with type 2 diabetes and SARS-CoV-2 infection.Design, Setting, and ParticipantsThis retrospective cohort study was performed using population-based electronic medical record data for patients in Hong Kong with type 2 diabetes and confirmed SARS-CoV-2 infection between February 26 and October 23, 2022. Each patient was followed up until death, outcome event, crossover of oral antiviral treatment, or end of the observational period (October 30, 2022), whichever came first. Outpatient oral antiviral users were divided into molnupiravir and nirmatrelvir-ritonavir treatment groups, respectively, and nontreated control participants were matched through 1:1 propensity score matching. Data analysis was performed on March 22, 2023.ExposuresMolnupiravir (800 mg twice daily for 5 days) or nirmatrelvir-ritonavir (300 mg nirmatrelvir and 100 mg ritonavir twice daily for 5 days, or 150 mg nirmatrelvir and 100 mg ritonavir for patients with an estimated glomerular filtration rate of 30-59 mL/min per 1.73 m2).Main Outcomes and MeasuresThe primary outcome was a composite of all-cause mortality and/or hospitalization. The secondary outcome was in-hospital disease progression. Hazard ratios (HRs) were estimated with Cox regression.ResultsThis study identified 22 098 patients with type 2 diabetes and COVID-19. A total of 3390 patients received molnupiravir and 2877 received nirmatrelvir-ritonavir in the community setting. After application of exclusion criteria followed by 1:1 propensity score matching, this study comprised 2 groups. One group included 921 molnupiravir users (487 men [52.9%]), with a mean (SD) age of 76.7 (10.8) years, and 921 control participants (482 men [52.3%]), with a mean (SD) age of 76.6 (11.7) years. The other group included 793 nirmatrelvir-ritonavir users (401 men [50.6%]), with a mean (SD) age of 71.7 (11.5) years, and 793 control participants (395 men [49.8%]), with a mean (SD) age of 71.9 (11.6) years. At a median follow-up of 102 days (IQR, 56-225 days), molnupiravir use was associated with a lower risk of all-cause mortality and/or hospitalization (HR, 0.71 [95% CI, 0.64-0.79]; P &lt; .001) and in-hospital disease progression (HR, 0.49 [95% CI, 0.35-0.69]; P &lt; .001) compared with nonuse. At a median follow-up of 85 days (IQR, 56-216 days), nirmatrelvir-ritonavir use was associated with a lower risk of all-cause mortality and/or hospitalization (HR, 0.71 [95% CI, 0.63-0.80]; P &lt; .001) and a nonsignificantly lower risk of in-hospital disease progression (HR, 0.92 [95% CI, 0.59-1.44]; P = .73) compared with nonuse.Conclusions and RelevanceThese findings suggest that both molnupiravir and nirmatrelvir-ritonavir oral antiviral medications were associated with a lower risk of all-cause mortality and hospitalization among patients with COVID-19 and type 2 diabetes. Further studies in specific populations, such as individuals in residential care homes and individuals with chronic kidney disease, are suggested.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Analysis of All-Cause Hospitalization and Death Among Nonhospitalized Patients With Type 2 Diabetes and SARS-CoV-2 Infection Treated With Molnupiravir or Nirmatrelvir-Ritonavir During the Omicron Wave in Hong Kong

et al. 2023

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“…Durante este período de pandemia, os estudos vêm sugerindo uma relação de risco muito forte entre a COVID-19 e a DM devido à fisiopatologia da infecção pelo SarsCov-2 que envolve alterações microvascular pulmonar e sistêmica com lesão endotelial aguda, hipercoagulação e aumento da permeabilidade capilar está presente. Por outro lado, na DM a hiperglicemia também provoca lesões vasculares sugerindo, portanto, que a disfunção endotelial pré-existente e a doença microvascular na diabetes exacerba as alterações vasculares associados à COVID-19 e, assim, levando a um aumento da gravidade da infecção e mortalidade pelo SarCov-2 17,18 .…”

Section: Discussionunclassified

Diabetes associada a outras comorbidades como fator de risco para a progressão da Covid-19

Mendes¹,

Corrêa²,

Picoli³

et al. 2023

Braz. J. Develop.

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Objetivo: Esse estudo teve como objetivo fazer uma análise do perfil dos casos de SRAG causadas pela COVID-19 em diabéticos durante o período de 15/março/20 a 15/março/21 na cidade de Campinas/SP, a fim de analisar as interações entre a diabetes e as co-comorbidades em relação a gravidade do caso e o desfecho final. Metodologia: Foram utilizadas as informações de pacientes com SRAG do Banco de Dados de Síndrome Respiratória Aguda Grave, incluindo dados da COVID-19 por acesso ao DATASUS, filtradas de acordo com as características alvo, casos confirmados de Covid-19, óbitos confirmados por Covid-19, evolução final do caso, idade, uso de suporte ventilatório, o tipo de suporte ventilatório utilizado e presença de comorbidades em não diabéticos, diabéticos apenas e diabéticos com alguma comorbidade. Resultados: Foi identificado um total de 7318 pacientes com SRAG e classificação final do caso SRAG por COVID-19. Dos casos notificados, 5196 (71%) não apresentavam DM, enquanto 2122 pacientes (29%) apresentavam diabetes como comorbidade, sendo essa porcentagem composta por 4% de pacientes apenas com DM e 25% pacientes com DM associada a alguma(s) comorbidade(s). Conclusão: Pacientes com COVID-19, diabéticos e que possuíam mais de uma comorbidade associada, foram os que mais necessitaram de suporte ventilatório apresentando uma prevalência de 53,2% para o suporte ventilatório invasivo, 39,2% para o não invasivo e 36,4% não necessitaram. Entre os não diabéticos o percentual de óbito foi de 23,96%, enquanto entre os diabéticos esse percentual subiu para 32,85%. A diabetes associada ou não a alguma comorbidade foi responsável por agravar o caso de pacientes com SRAG causada pela COVID-19, contribuindo para o óbito de pacientes.

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“…Diabetes mellitus increases the risk of hospitalization, mortality, and need for critical care in COVID-19. The DM group with pre-existing systemic endothelial and microvascular dysfunction undergoes extra endothelial and microvascular impairment in COVID-19 infection and the “double-killing” results in worse prognosis and multiple organ failure ( 76 ).…”

Section: Comorbiditiesmentioning

confidence: 99%

Mechanisms of Cardiovascular System Injury Induced by COVID-19 in Elderly Patients With Cardiovascular History

Yang

Yan

2022

Front. Cardiovasc. Med.

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The coronavirus disease-2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), represents a great threat to healthcare and socioeconomics worldwide. In addition to respiratory manifestations, COVID-19 promotes cardiac injuries, particularly in elderly patients with cardiovascular history, leading to a higher risk of progression to critical conditions. The SARS-CoV-2 infection is initiated as virus binding to angiotensin-converting enzyme 2 (ACE2), which is highly expressed in the heart, resulting in direct infection and dysregulation of the renin-angiotensin system (RAS). Meanwhile, immune response and hyper-inflammation, as well as endothelial dysfunction and thrombosis implicate in COVID-19 infection. Herein, we provide an overview of the proposed mechanisms of cardiovascular injuries in COVID-19, particularly in elderly patients with pre-existing cardiovascular diseases, aiming to set appropriate management and improve their clinical outcomes.

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What is the impact of microvascular complications of diabetes on severe COVID-19?

Cited by 9 publications

References 78 publications

Analysis of All-Cause Hospitalization and Death Among Nonhospitalized Patients With Type 2 Diabetes and SARS-CoV-2 Infection Treated With Molnupiravir or Nirmatrelvir-Ritonavir During the Omicron Wave in Hong Kong

Analysis of All-Cause Hospitalization and Death Among Nonhospitalized Patients With Type 2 Diabetes and SARS-CoV-2 Infection Treated With Molnupiravir or Nirmatrelvir-Ritonavir During the Omicron Wave in Hong Kong

Diabetes associada a outras comorbidades como fator de risco para a progressão da Covid-19

Mechanisms of Cardiovascular System Injury Induced by COVID-19 in Elderly Patients With Cardiovascular History

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