Clinical Characteristics of Diabetic Patients with COVID-19

Background. Since December 2019, novel coronavirus- (SARS-CoV-2) infected pneumonia (COVID-19) has rapidly spread throughout China. This study is aimed at describing the characteristics of COVID-19 patients in Wuhan. Methods. 199 COVID-19 patients were admitted to Wuhan Red Cross Hospital in China from January 24th to March 15th. The cases were divided into diabetic and nondiabetic groups according to the history of taking antidiabetic drugs or by plasma fasting blood glucose level at admission, and the difference between groups were compared. Results. Among 199 COVID-19 patients, 76 were diabetic and 123 were nondiabetic. Compared with nondiabetics, patients with diabetes had an older age, high levels of fasting plasma glucose (FPG), D-dimer, white blood cell, blood urea nitrogen (BUN) and total bilirubin (TBIL), lower levels of lymphocyte, albumin and oxygen saturation (SaO2), and higher mortality (P<0.05). The two groups showed no difference in clinical symptoms. Diabetes, higher level of D-dimer at admission, and lymphocyte count less than 0.6×109/L at admission were associated with increasing odds of death. Antidiabetic drugs were associated with decreasing odds of death. Treatment with low molecular weight heparin was not related to odds of death. Conclusion. The mortality rate of COVID-19 patients with diabetes was significantly higher than those without diabetes. Diabetes, higher level of D-dimer, and lymphocyte count less than 0.6×109/L at admission were the risk factors associated with in-hospital death.

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Stress hyperglycemia is associated with in-hospital mortality in patients with diabetes and acute ischemic stroke

10.21203/rs.3.rs-54844/v1 ◽

2020 ◽

Author(s):

Donghua Mi ◽

Zixiao Li ◽

Hongqiu Gu ◽

Yin Yang ◽

Chunjuan Wang ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Acute Ischemic Stroke ◽

Cardiovascular Risk Factors ◽

Fasting Blood Glucose ◽

Hospital Death ◽

Diabetic Patients ◽

Stress Hyperglycemia ◽

Patients With Diabetes

Abstract Background and Objective: Stress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting.Our study aimed to examine the association between stress-induced hyperglycemia and the occurrence of in-hospital death in patients with diabetes and acute ischemic stroke. Research Design and Methods: All data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from > 300 centers across China. Patients’ demographics, clinical presentation, and laboratory data were extracted from the database. The primary endpoint was in-hospital death. The ratio of fasting blood glucose (FBG) to HbA1c was calculated, i.e., the stress-induced hyperglycemia ratio (SHR), to determine stress hyperglycemia following acute ischemic stroke. Results A total of 168,381 patients were included. The mean age was 66.2 ± 10.7, and 77,688 (43.0%) patients were female. The patients were divided into two groups: survivors (n = 167,499) and non-survivors (n = 882), as well as into four groups according to their SHR quartiles (n = 42,090 − 42,099/quartile). The frequencies of traditional cardiovascular risk factors increased with the SHR quartiles. There were 109 (0.26%), 142 (0.34%), 196 (0.47%), and 435 (1.03%) patients who died in the Q1, Q2, Q3, and Q4 quartiles, respectively. Compared with Q1 patients, the death risk was higher in Q4 patients (odds ratio (OR) = 4.02) (adjusted OR = 1.89, 95% confidence interval [CI] = 1.14–3.12, P = 0.026 after adjustment for traditional cardiovascular risk factors). Conclusions The SHR may serve as an accessory parameter for the prognosis of patients with diabetes after acute ischemic stroke.Hyperglycemia in stroke patients with diabetes mellitus is associated with a higher risk of in-hospital death.

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Effect of ranolazine on HbA1c and blood glucose levels in diabetic patients with chronic angina

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20190647 ◽

2019 ◽

Vol 8 (3) ◽

pp. 377

Author(s):

Shilpa B. N. ◽

Shashikala G. H. ◽

Siddesh . ◽

Mallesh P.

Keyword(s):

Blood Glucose ◽

Fasting Blood Glucose ◽

Preventive Therapy ◽

Antidiabetic Drugs ◽

Diabetic Patients ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Patients With Diabetes ◽

Chronic Angina ◽

Group 2

Background: Diabetes mellitus is the fifth leading cause of death worldwide and is one of the common co-morbid conditions associated with coronary artery disease (CAD). The overall prevalence of CAD is 7.4% but the prevalence of CAD in diabetics is 9%. Hence treatment of hyperglycemia is a key goal of secondary preventive therapy with a target of reducing HbA1c to <7%. The risk of CAD has been reported to occur 2 to3 decades prior in diabetics compared to non-diabetics. Hence discovery of drugs with potential role in both diabetes and CAD seems to be necessary. Ranolazine is a novel oral anti anginal drug known to reduce HbA1c and fasting blood glucose levels in angina patients with diabetes. The objective of this study is to show the effect of ranolazine (antianginal drug) on HbA1c and fasting blood glucose levels in diabetic patients with chronic angina.Methods: Patients were divided into: Group 1 continued with previous antidiabetic drugs and antianginal drugs. Group 2 were prescribed Tab ranolazine 1000mg b.d (orally) as add on therapy along with previous antidiabetic drugs and antianginal drugs.Results: There was a significant reduction in HbA1c and FBS levels in Group 2 patients who were on ranolazine. Reduction of HbA1c in group1 and Group 2 was 0.21±0.65% and 1.30±1.16% respectively. Reduction of FBS in group1 and group2 was 10.66±27.80mg/dl and 29.97±31.49mg/dl respectively.Conclusions: From the present study we can conclude that ranolazine, an antianginal drug when given at a dose of 1000mg bd in diabetic patients with chronic angina reduces HbA1c and FBS levels.

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Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

Journal of the American Podiatric Medical Association ◽

10.7547/1010049 ◽

2011 ◽

Vol 101 (1) ◽

pp. 49-54 ◽

Cited By ~ 12

Author(s):

Aynur Gulcan ◽

Erim Gulcan ◽

Sukru Oksuz ◽

Idris Sahin ◽

Demet Kaya

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Fasting Blood Glucose ◽

Diabetic Patients ◽

Essential Components ◽

Patients With Diabetes ◽

Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

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Clinical Characteristics and CT Manifestations of 143 Patients With 2019 Novel Coronavirus Disease (COVID-19) in Taizhou City, Zhejiang, China

10.21203/rs.3.rs-32895/v1 ◽

2020 ◽

Author(s):

Yani Kuang ◽

Susu He ◽

Shuangxiang Lin ◽

Rui Zhu ◽

Rongzhen Zhou ◽

...

Keyword(s):

Clinical Symptoms ◽

Protein A ◽

Clinical Manifestations ◽

Imaging Features ◽

First Case ◽

Severe Group ◽

Laboratory Examinations ◽

The Difference ◽

Severity Of The Disease ◽

Novel Coronavirus

Abstract Background: In December 2019, the first case of pneumonia associated with the SARS-CoV-2 was found in Wuhan and rapidly spread throughout China, so data are needed on the affected patients. The purpose of our study was to find the clinical manifestations and CT features of COVID-19.Methods: All patients with COVID-19 in Taizhou city were retrospectively included and divided into non-severe group and severe group according to the severity of the disease. The clinical manifestations, laboratory examinations and imaging features of COVID-19 patients were analyzed, and the differences between the two groups were compared.Results: A total of 143 laboratory-confirmed cases were included in the study, including 110 non-severe patients and 33 severe patients. The median age of patients was 47 (range 4–86 years). Fever (73.4%) and cough (63.6%) were the most common initial clinical symptoms. Between two groups of cases, the results of aspartate transaminase, creatine kinase and lactate dehydrogenase, serum albumin, CR, glomerular filtration rate, amyloid protein A, fibrinogen, calcitonin level and oxygen partial pressure, IL – 10, absolute value of CD3, CD4, CD8 were different, and the difference was statistically significant (P < 0.05). Therefore, these quantitative indicators can be used to help assess the severity. On admission, the CT showed that the lesions were mostly distributed in the periphery of the lung or subpleural (135 cases (98%)), and most of lesions presented as patchy (81%), mixed density (63%) shadow. Consolidation (68% vs 41%), bronchial inflation signs (59% vs 41%), and bronchiectasis (71% vs 39%) were more common in the severe group.Conclusions: Most of the cases of COVID-19 in Taizhou have mild symptoms and no death. In addition to clinical symptoms, some laboratory tests (such as absolute values of CD4 and CD8) and CT findings can be used to assess the severity of the disease.

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Screening for microalbuminuria in patients with diabetes mellitus: frozen storage of urine samples decreases their albumin content.

Clinical Chemistry ◽

10.1093/clinchem/35.2.308 ◽

1989 ◽

Vol 35 (2) ◽

pp. 308-310 ◽

Cited By ~ 64

Author(s):

L D Elving ◽

J A Bakkeren ◽

M J Jansen ◽

C M de Kat Angelino ◽

E de Nobel ◽

...

Keyword(s):

Frozen Storage ◽

Urine Samples ◽

Diabetic Patients ◽

Albumin Concentration ◽

Low Concentrations ◽

Albumin Content ◽

Patients With Diabetes ◽

The Difference ◽

Urinary Albumin Concentration

Abstract The influence of storage on urinary albumin concentration was prospectively studied with use of overnight urine specimens (Albustix negative) from 73 diabetic patients. From each urine sample four aliquots were taken. One was stored at 4 degrees C and assayed within two weeks, the other three were stored at -20 degrees C and assayed within two weeks and after two and six months. Albumin concentration was measured with laser immunonephelometry. The detection limit, 1 mg/L, suffices for the screening of diabetic patients for microalbuminuria. After storage for two and six months at -20 degrees C, significantly lower albumin concentrations were found. The difference was mainly caused by lower concentrations found in urine samples in which a precipitate had formed, which was the case in 22 and 25 samples, respectively. Thus, freezing of urine samples for determination of low concentrations of albumin may yield falsely low results. Urine samples are best stored at 4 degrees C and assayed within two weeks.

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Investigation of the Protective Effects of Phlorizin on Diabetic Cardiomyopathy indb/dbMice by Quantitative Proteomics

Journal of Diabetes Research ◽

10.1155/2013/263845 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 24

Author(s):

Qian Cai ◽

Baoying Li ◽

Fei Yu ◽

Weida Lu ◽

Zhen Zhang ◽

...

Keyword(s):

Diabetic Cardiomyopathy ◽

Body Weight Gain ◽

Fasting Blood Glucose ◽

Interaction Network ◽

Diabetic Patients ◽

Protective Effects ◽

Absolute Quantitation ◽

Patients With Diabetes ◽

Itraq Proteomics ◽

Isobaric Tag

Patients with diabetes often develop hypertension and atherosclerosis leading to cardiovascular disease. However, some diabetic patients develop heart failure without hypertension and coronary artery disease, a process termed diabetic cardiomyopathy. Phlorizin has been reported to be effective as an antioxidant in treating diabetes mellitus, but little is known about its cardioprotective effects on diabetic cardiomyopathy. In this study, we investigated the role of phlorizin in preventing diabetic cardiomyopathy indb/dbmice. We found that phlorizin significantly decreased body weight gain and the levels of serum fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), and advanced glycation end products (AGEs). Morphologic observations showed that normal myocardial structure was better preserved after phlorizin treatment. Using isobaric tag for relative and absolute quantitation (iTRAQ) proteomics, we identified differentially expressed proteins involved in cardiac lipid metabolism, mitochondrial function, and cardiomyopathy, suggesting that phlorizin may prevent the development of diabetic cardiomyopathy by regulating the expression of key proteins in these processes. We used ingenuity pathway analysis (IPA) to generate an interaction network to map the pathways containing these proteins. Our findings provide important information about the mechanism of diabetic cardiomyopathy and also suggest that phlorizin may be a novel therapeutic approach for the treatment of diabetic cardiomyopathy.

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Molecular Insights of Immune Responses Variability in COVID-19 Patients: A Review

Letters in Applied NanoBioScience ◽

10.33263/lianbs103.24022413 ◽

2021 ◽

Vol 10 (3) ◽

pp. 2402-2413

Keyword(s):

Immune Response ◽

Immune System ◽

Inflammatory Response ◽

Clinical Symptoms ◽

Multiorgan Failure ◽

Innate Immune ◽

Immune Memory ◽

System Response ◽

The Difference ◽

Novel Coronavirus

Currently, a novel coronavirus disease 2019 (COVID 19) caused by SARS-CoV-2 has emerged worldwide. This chronic viral infection causes an acute respiratory distress syndrome (ARDS) which its pathophysiology is not yet well elucidated. However, ARDS has shown that ARDS causes diffuse alveolar damages induced by an excessive inflammatory response and a lack of anti-inflammatory response to the virus. Furthermore, these pathophysiological characteristics are associated with multiorgan failure and can increase the mortality rate. The difference in immune system response against COVID-19 is not well known. However, variability in innate immune system receptors between patients infected with SARS-CoV-2 as a function of aging and sex can explain this difference. Thus, innate immune memory or trained immunity mediated by epigenetic mechanisms is also involved in the variability response against COVID-19. The action of an adaptative immune response, in particular, antigen presentation via HLA is also a key element in this variability. Finally, each viral strain's capacity in evading the action of the immune response has also been suggested as an important mechanism by which certain patients infected with SARS-CoV-2 develop severity and others did not develop any clinical symptoms.

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Diabetes With Osteomyelitis in Rare Sites With Sepsis as the First Diagnosis: Three Case Reports and Literature Review

10.21203/rs.3.rs-44918/v1 ◽

2020 ◽

Author(s):

Jiayan Zhou ◽

Xiaohong Jiang

Keyword(s):

Lumbar Spine ◽

Bacterial Infections ◽

Clinical Symptoms ◽

Histopathological Examination ◽

Case Reports ◽

Diabetic Patients ◽

Limb Pain ◽

The Third ◽

Spine Pain ◽

Patients With Diabetes

Abstract Background: Osteomyelitis is an infectious bone disease. Common clinical symptoms are fever, local limb pain and redness. Anti-infective treatment is commonly used, but the efficacy varies in different patients. Sometimes surgery is needed to relieve patients' symptoms. Diabetic patients have a high risk of osteomyelitis due to long-term hyperglycemia, activated inflammatory response and immune deficiency.Patient Concerns: In our study, the three patients were men who were admitted to the hospital due to fever and pain. Two patients had upper limb pain, and the third had lumbar spine pain. All of them had blood cultures that suggested bacterial infections and increased levels of C-reactive protein.Diagnosis: Two patients in our study had osteomyelitis that was verified by magnetic resonance imaging; osteomyelitis was confirmed by postoperative histopathological examination in the third patient.Interventions: All patients received intravenous infusion of antibiotics to treat osteomyelitis. The third patient underwent debridement of the lumbar spine.Outcomes: Among the three patients, two recovered after adjustment of the antibiotic therapy, and one recovered after a surgical operation.Conclusion: Our study reports three patients with diabetes with osteomyelitis in rare sites. We should be aware that diabetes is one of the risk factors for osteomyelitis. When diabetic patients present with fever and pain, healthcare professionals should be alert to the possibility of osteomyelitis. Blood tests are helpful for clarifying the degree of inflammation, and imaging tests are helpful for locating the infection site. However, for some atypical cases, we cannot rely too much on auxiliary examinations, and we need to pay attention to the clinical symptoms and signs. Glycemic control and anti-infective therapy are common methods for the treatment of osteomyelitis, and surgical intervention should be considered if necessary to relieve local symptoms.

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Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease

10.21203/rs.3.rs-27357/v1 ◽

2020 ◽

Author(s):

Hadith Rastad ◽

Hossein Karim ◽

Hanieh-Sadat Ejtahed ◽

Ramin Tajbakhsh ◽

Mohammad Noorisepehr ◽

...

Keyword(s):

Cardiovascular Disease ◽

Hospital Mortality ◽

Lymphocyte Count ◽

Mortality Data ◽

Diabetic Patients ◽

Logistic Regression Models ◽

Risk Of Death ◽

Number Of Patients ◽

Increased Risk ◽

Novel Coronavirus

Abstract Background: Diabetes mellitus (DM) and cardiovascular disease (CVD) are present in a large number of patients with novel Coronavirus disease 2019 (COVID-19). We aimed to determine the risk and predictors of in-hospital mortality from COVID-19 in patients with DM and CVD.Methods: This retrospective cohort study included hospitalized patients aged ≥ 18 years with confirmed COVID-19 in Alborz province, Iran, from 20 February 2020 to 25 March 2020. Data on demographic, clinical and outcome (in-hospital mortality) data were obtained from electronic medical records. Self-reported comorbidities were classified into the following groups: “DM” (having DM with or without other comorbidities), “only DM” (having DM without other comorbidities), “CVD” (having CVD with or without other comorbidities), “only CVD” (having CVD without other comorbidities), and “having any comorbidity”. Multivariate logistic regression models were fitted to quantify the risk and predictors of in-hospital mortality from COVID-19 in patients with these comorbidities.Results: Among 2957 patients with COVID-19, 2656 were discharged as cured, and 301 died. In multivariate model, DM (OR: 1.62 (95%CI: 1.14-2.30)) and only DM (1.69 (1.05-2.74)) increased the risk of death from COVID-19; but, both CVD and only CVD showed non-significant associations (p>0.05). Moreover, “having any comorbidities” increased the risk of in-hospital mortality from COVID-19 (OR: 2.66 (95%CI: 2.09 -3.40)). Significant predictors of mortality from COVID-19 in patients with DM were lymphocyte count, creatinine and C-reactive protein (CRP) level (all P- values < 0.05).Conclusions: Our findings suggest that diabetic patients have an increased risk of in-hospital mortality following COVID-19; also, lymphocyte count, creatinine and CRP concentrations could be considered as significant predictors for the death of COVID-19 in these patients.

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Associated risk factors with disease severity and antiviral drug therapy in patients with COVID-19

10.21203/rs.3.rs-70914/v2 ◽

2020 ◽

Author(s):

Xiaowei Gong ◽

Xianfeng Guo ◽

Shiwei Kang ◽

Yan Li ◽

Haixiang Gao ◽

...

Keyword(s):

Risk Factors ◽

Clinical Symptoms ◽

Discharge Rate ◽

Antiviral Drug ◽

Oxygenation Index ◽

Multivariable Logistic Regression Analysis ◽

Common Symptom ◽

Clinical Benefits ◽

Novel Coronavirus ◽

D Dimer

Abstract Background: Due to the latent onset of novel coronavirus disease 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies. This study aimed to identify the factors associated with increased COVID-19 severity and evaluate the current antiviral drugs, especially in severe patients. Methods: This was a retrospective observational study performed at the No. 7 Hospital of Wuhan (Wuhan, China) with hospitalized patients confirmed with COVID-19 from January 11 to March 13, 2020. Multivariable logistic regression analysis was used to identify the associated factors of severe COVID. Treatments of antivirus drugs were collected and evaluated.Results: Of the 550 patients, 292 (53.1%) were female and 277 (50.4%) were >60 years old. The most common symptom was fever (n=372, 67.7%), followed by dry cough (n=257, 46.7%), and dyspnea (n=237, 43.1%), and fatigue (n=224, 40.7%). Among the severe patients, 20.2% required invasive ventilator support and 18.0% required non-invasive ventilator. The identified risk factors for severe cases were: age ≥60 years (odds ratio (OR) =3.02, 95% confidence interval (CI): 1.13-8.08, P=0.028), D-dimer >0.243 μg/ml (OR=2.734, 95%CI: 1.012-7.387, P=0.047), and low oxygenation index (OR=0.984, 95%CI: 0.980-0.989, P<0.001). In severe cases, the benefits (relief of clinical symptoms, clinical outcome, and discharge rate) of arbidol alone was 73.3%, which was better than ribavirin (7/17, 41.2%, P=0.029).Conclusions: Age >60 years, D-dimer >0.243 µg/ml, and lower oxygenation index were associated with severe COVID-19. Arbidol might provide more clinical benefits in treating patients with severe COVID-19 compared with ribavirin.

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