Sunday, June 23

COVID19 effect on People With Diabetes

The history of the pandemic offers an informative overview of the entire section. In doing so, the importance of learning more about the risks COVID-19 poses to people living with diabetes.

Diabetes has not yet been shown to increase the likelihood of infection, but progression to severe illness is more likely in people with diabetes. Neither the mechanisms underlying the increased risk nor the best interventions to limit it have yet been defined, but the studies in this issue offer important clues.

Clinical characteristics and outcomes of patients with diabetes and COVID-19 in association with glucose-lowering medication

The study showed in ADA’s Diabetes Care journal, researchers analyzed data of 904 COVID-19 patients, of whom 136 had diabetes, to evaluate whether the type of prior glucose-lowering therapies used by those with diabetes was associated with outcomes. Results showed mortality rates in the patients with diabetes were two to three times higher than in those without diabetes, and within the diabetes subgroup, older age and higher C-reactive protein levels (a measurement that increases when there is inflammation in the body) were independent predictors of death. Further analyses suggested that the use of insulin was associated with worse outcomes; however, it was unclear if this was due to the effects of insulin itself or to the characteristics of the patients for whom it was prescribed. 

Clinical characteristics and risk factors for mortality of COVID-19 patients with diabetes in Wuhan, China: A two-center, retrospective study

Researchers compared the characteristics and outcomes of 153 patients with diabetes with an equal number of patients without diabetes of the same age and sex. Both groups had a similar duration of COVID-19 symptoms, but PaO2 (a measurement of how well oxygen moves from the lungs to the blood) was lower in the diabetes group upon admission. The death rate was higher in the patients with diabetes, with models suggesting older age and hypertension independently contributed to the higher mortality number.

Obesity and COVID-19 severity in a designated hospital in Shenzhen, China

This analysis studied 383 hospitalized patients and divided them into groups by weight according to BMI measurements. After adjusting for diabetes, hypertension, liver disease, and other clinical features, results indicated the patients in the obese group had increased odds of progression to severe illness compared to the patients in the normal-weight group.

Obesity is a risk factor for greater COVID-19 severity

Researchers in this study warn of the impact of obesity on the severity of COVID-19. When they compared 75 Chinese patients with COVID-19 who were obese to 75 Chinese patients with COVID-19 who were non-obese but within the same sex and age group, they determined obesity increases the risk of severe illness approximately threefold after adjustment for clinical characteristics including the presence of diabetes. Results showed a nearly linear relationship between higher BMI and severe/critical illness in all the patients.

Remote glucose monitoring of hospitalized, quarantined patients with diabetes and COVID-19

A team in a hospital in Israel successfully converted a continuous glucose-monitoring system from a personal tool to a team-based, real-time remote glucose-monitoring system utilized by intensive care unit staff. Their efforts, including staff training and visualization of several patients on one control screen, led to improvements in average glucose levels in the facility’s first COVID-19 patients with diabetes upon whom the system was used. The initiative was implemented to maintain the standard of care for patients with diabetes, which includes monitoring glucose levels regularly, while also striving to prevent patient-staff transmission of COVID-19. 

Two additional research articles will be online and included in the special section in the coming days. One study offers further insight into glycemic control via insulin and its potential impact on COVID-19 patient outcomes. Another article evaluates the possible association between diabetes and the expression of a molecule that researchers think may be a site of attachment for the virus responsible for COVID-19 to explore if people with diabetes are more prone to COVID-19 infection.