Evaluation and management of COVID-19-related severity in people with type 2 diabetes

IntroductionPeople with type 2 diabetes (T2D) have an increased rate of hospitalization and mortality related to COVID-19. To identify ahead of time those who are at risk of developing severe diseases and potentially in need of intensive care, we investigated the independent associations between longitudinal glycated hemoglobin (HbA1c), the impact of common medications (metformin, insulin, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and corticosteroids) and COVID-19 severity in people with T2D.Research design and methodsRetrospective cohort study was conducted using deidentified claims and electronic health record data from the OptumLabs Data Warehouse across the USA between January 2017 and November 2020, including 16 504 individuals with T2D and COVID-19. A univariate model and a multivariate model were applied to evaluate the association between 2 and 3-year HbA1c average, medication use between COVID-19 diagnosis and intensive care unit admission (if applicable), and risk of intensive care related to COVID-19.ResultsWith covariates adjusted, the HR of longitudinal HbA1c for risk of intensive care was 1.12 (per 1% increase, p<0.001) and 1.48 (comparing group with poor (HbA1c ≥9%) and adequate glycemic control (HbA1c 6%–9%), p<0.001). The use of corticosteroids and the combined use of insulin and metformin were associated with significant reduction of intensive care risk, while ACEIs and ARBs were not associated with reduced risk of intensive care.ConclusionsTwo to three-year longitudinal glycemic level is independently associated with COVID-19-related severity in people with T2D. Here, we present a potential method to use HbA1c history, which presented a stronger association with COVID-19 severity than single-point HbA1c, to identify in advance those more at risk of intensive care due to COVID-19 in the T2D population. The combined use of metformin and insulin and the use of corticosteroids might be significant to prevent patients with T2D from becoming critically ill from COVID-19.

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Characteristics and Outcomes of Patients With and Without Type 2 Diabetes Mellitus and Pulmonary Sepsis

Journal of Intensive Care Medicine ◽

10.1177/0885066619833910 ◽

2019 ◽

Vol 35 (9) ◽

pp. 836-843 ◽

Cited By ~ 1

Author(s):

Matheni Sathananthan ◽

Airani Sathananthan ◽

Niranjan Jeganathan

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Intensive Care ◽

Hospital Stay ◽

Bacterial Pneumonia ◽

Type 2 Dm ◽

Mean Glucose ◽

The Impact

Purpose: To date, studies have provided conflicting results regarding the impact of type 2 diabetes mellitus (DM) on sepsis-related outcomes. Our objective is to understand the impact of type 2 DM in bacterial pneumonia and sepsis-related intensive care unit (ICU) outcomes. Methods: Retrospective study using Multiparameter Intelligent Monitoring in Intensive Care III database. We included 1698 unique patients admitted with sepsis secondary to bacterial pneumonia to the ICU within the time period of 2001 to 2012. Results: The type 2 DM group had an increased incidence of acute kidney injury (67.9% vs 58.1%, P < .01) and need for dialysis compared to the non-DM group. There was no difference in mortality, microbiology, other organ failure, or hospital length of stay between the type 2 DM and non-DM group. Lower admission blood glucose was associated with increased mortality in patients with type 2 DM (49% at ≤120 mg/dL, 35.1% at 121-180 mg/dL, and 32.1% at >180 mg/dL) but not in non-DM patients. Conversely, higher mean glucose during the hospital stay was associated with increased mortality in non-DM patients (24.7% at ≤120 mg/dL, 45.1% at 121-180 mg/dL, and 73.0% at >180 mg/dL) but not in patients with type 2 DM. Conclusions: Our findings demonstrated that type 2 DM does not increase the overall mortality. Our findings of increased mortality in both type 2 DM patients with lower admission glucose, and non-DM patients with higher mean glucose during the hospital stay needs to be further evaluated. Future studies in regards to this could lead to personalized glucose treatment goals for patients.

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Acute effects of sedentary breaks on vascular health in adults at risk for type 2 diabetes: A systematic review

Vascular Medicine ◽

10.1177/1358863x211009307 ◽

2021 ◽

pp. 1358863X2110093

Author(s):

Mary O Whipple ◽

Kevin S Masters ◽

Amy G Huebschmann ◽

Rebecca L Scalzo ◽

Jane EB Reusch ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

At Risk ◽

Elevated Risk ◽

Moderate Intensity ◽

Cochrane Library ◽

Vascular Health ◽

Acute Effects ◽

The Impact

The aim of this systematic review was to evaluate the available evidence regarding the acute effects of interrupting/breaking up prolonged sedentary behavior (SB) on vascular health among individuals at elevated risk for type 2 diabetes (T2D). Searches of MEDLINE, Embase, Web of Science, and Cochrane Library databases were conducted on April 7, 2020. Included studies: (1) examined the effect of breaking up prolonged SB in adults with or at elevated risk for T2D and (2) assessed a vascular health outcome, such as blood pressure (BP), flow-mediated dilation (FMD), pulse-wave velocity, or endothelin-1. A total of 20 articles (17 unique studies) were included. Only three studies reported adequate statistical power for the specified vascular outcome. The available evidence suggests that light and moderate intensity activity breaks are effective in acutely lowering BP when compared to prolonged sitting. The small number of studies that included FMD or other vascular outcomes prohibits conclusions regarding the impact of SB breaks on these outcomes. Few studies evaluating the impact of breaking up SB among adults at risk for T2D have included and been adequately powered to examine vascular outcomes, but our preliminary finding, that certain SB breaks improve BP, provides proof-of-concept for this line of inquiry. Future studies should examine both the acute and chronic vascular effects of breaking up SB among individuals most vulnerable to the effects of SB (e.g. older adults, those with T2D), as these individuals are both highly sedentary and at greatest risk of poor health outcomes. PROSPERO ID: CRD42020183423.

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The impact of an insulin sensitizer, troglitazone, on glucose metabolism in African Americans at risk for type 2 diabetes mellitus: a placebo-controlled, 24-month randomized study

Metabolism ◽

10.1016/s0026-0495(03)00160-4 ◽

2003 ◽

Vol 52 (9) ◽

pp. 1211-1217 ◽

Cited By ~ 4

Author(s):

D Schuster ◽

T Gaillard ◽

S Rhinesmith ◽

D Habash ◽

K Osei

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

At Risk ◽

Type 2 Diabetes Mellitus ◽

African Americans ◽

Glucose Metabolism ◽

Randomized Study ◽

Insulin Sensitizer ◽

The Impact

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Impact of COVID-19 on Children and Young Adults With Type 2 Diabetes: A Narrative Review With Emphasis on the Potential of Intermittent Fasting as a Preventive Strategy

Frontiers in Nutrition ◽

10.3389/fnut.2021.756413 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hala K. Elmajnoun ◽

MoezAlIslam E. Faris ◽

Suma Uday ◽

Shaun Gorman ◽

James E. Greening ◽

...

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Young Adults ◽

Narrative Review ◽

Cochrane Library ◽

Intermittent Fasting ◽

Ramadan Fasting ◽

Children And Young Adults ◽

The Impact

Background: The world is still struggling to control the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The level of uncertainty regarding the virus is still significantly high. The virus behaves differently in children and young adults. Most children and adolescents are either asymptomatic or have mild symptoms. They generally have a very good prognosis. However, it is not well-known whether children and young adults with type 2 diabetes are at risk of getting a severe infection of COVID-19. Many Muslim children with type 2 diabetes have been performing dawn to dusk fasting during the month of Ramadan, before and during the COVID-19 pandemic, and the impact of this on their health has not been well investigated. Previous studies in adults have suggested that intermittent fasting may be beneficial in different ways including reversal of type 2 diabetes and prevention of COVID-19 infection.Objective: The primary aim of this narrative review is to summarise the impacts of the COVID-19 pandemic on children and young adults with type 2 diabetes, and to identify the knowledge gaps in the literature. It also explores the potential of intermittent fasting in reversing the pathogenesis of diabetes and highlighting how this approach could prevent these patients from developing chronic complications.Methods: This narrative review has been produced by examining several databases, including Google Scholar, Research Gate, PubMed, Cochrane Library, MEDLINE (EBSCO), and Web of Science. The most common search terms used were “COVID-19 AND Children”, “SARS-CoV-2 AND/OR Children”, “COVID-19 AND Diabetes” “COVID-19 Epidemiology”, “COVID-19 AND Ramadan fasting”, “COVID-19 and Intermittent fasting.” All the resources used are either peer-reviewed articles/reports and/or official websites of various media, governmental and educational organisations.Results: Having reviewed the currently limited evidence, it has been found that the incidence of COVID-19 among children with type 2 diabetes seems to be not much different from children without diabetes. However, these patients are still vulnerable to any infection. Several studies have reported that prevention programmes such as intermittent fasting are effective to protect these groups of patients from developing any complications. Moreover, observing Ramadan fasting as a type of intermittent fasting could be beneficial for some children with established diabetes, prediabetes and people at risk.Conclusion: Children and young adults with type 2 diabetes are not at risk of severe COVID-19 infection as the case in adults with diabetes. More research is needed to identify the impact of COVID-19 and to investigate the efficacy and safety of intermittent fasting, including Ramadan fasting, among these age groups. Implementing these cost-effective programmes may have a great impact in minimising the incidence of diabetes. Moreover, this could be effective particularly at prediabetes stage by preventing these people from going onto develop type 2 diabetes and taking medications for the rest of their life and protecting people from complications linked to disease and infection.

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Dietary Effects of Replacing Carbohydrate-based Breakfast Foods with Eggs in Adults at Risk for Type 2 Diabetes (P08-044-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz044.p08-044-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Orsolya Palacios ◽

Kevin Maki ◽

Mary Buggia ◽

Mary Dicklin ◽

Marjorie Bell ◽

...

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Energy Intake ◽

Dietary Intervention ◽

Saturated Fat ◽

Daily Energy Intake ◽

Diet Records ◽

Daily Energy ◽

The Impact

Abstract Objectives To assess the effect of breakfast egg intake, vs. energy-matched carbohydrate (CHO)-based foods, on daily energy and select nutrient intakes in free-living adults at-risk for type 2 diabetes. Methods Overweight or obese adults with prediabetes and/or metabolic syndrome were included in this randomized crossover study consisting of two 4-wk dietary intervention periods, separated by a ≥4 wk washout. During each intervention, subjects consumed study products containing either 2 eggs/d, 6 d/wk (12 eggs/wk) at breakfast, or energy-matched CHO-based foods. Means for energy and macronutrient contents of the study breakfast meals for both interventions were approximately 550 kcal, 31–32% energy from fat and 10.5% energy from saturated fat; protein energy was 25.9% and 12.1% for the egg and CHO meals, respectively. Subjects were instructed to incorporate the study breakfast meals into their habitual diets and maintain other lifestyle habits. Daily energy, macronutrients, fiber, cholesterol, sodium and calcium intakes were assessed by 3-d diet records at baseline and at the end of each condition. Dietary data was analyzed using the Food Processor software (v11.4). Results Overall, 30 subjects (11 male; 19 female) with mean age of 53.5 ± 1.9 y and body mass index (BMI) of 31.9 ± 0.7 kg/m2 provided evaluable data. Reported median daily energy intake during the egg condition was 2145 kcal, which was significantly (P = 0.008) higher than the 1996 kcal reported during the CHO condition (see Table). Dietary analyses indicate the 149 kcal/d difference was due to intake of foods other than the study products. Despite the higher reported energy intake during the egg condition, weight change from baseline did not differ between the interventions (–0.1 and 0.2 kg, for egg and CHO conditions, respectively). Median % energy intake from CHO was significantly lower and daily sodium and cholesterol intakes significantly higher during the egg condition. Conclusions Intake of 12 eggs/wk at breakfast, vs. energy-matched CHO foods, resulted in greater reported daily energy intake and no change in body weight. Further investigation is needed to assess the impact of egg-based breakfast meals on appetite and energy expenditure. Funding Sources American Egg Board/Egg Nutrition Center, Park Ridge, IL. Supporting Tables, Images and/or Graphs

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