Diabetes Mellitus and COVID-19: Review Article

Recent advances in the development of multiplexed nanophotonic biosensors

Over the years, the field of nanophotonics has advanced and can be utilized as a method to detect different infectious diseases. The introduction of multiplex nanophotonic diagnostics has enabled the speedy and simultaneous detection of viral infections and specific biomarkers. The quick reaction times, high sensitivity, and specificity of multiplex nanophotonic diagnostics enable real-time identification of viruses without the need for nucleic acid amplification. This review presents an overview of nanophotonic tools used to identify diseases and particular biomarkers. The paper also examines possible research areas for the development of unique, cutting-edge multiplex nanophotonic diagnostics capable of concurrently detecting various diseases or biomarkers/biomolecules. Furthermore, it discusses barriers to further advancement and offers insight into anticipated trends.

Diabetes and Infectious Diseases with a Focus on Melioidosis

Diabetes mellitus (DM) leads to impaired innate and adaptive immune responses. This renders individuals with DM highly susceptible to microbial infections such as COVID-19, tuberculosis and melioidosis. Melioidosis is a tropical disease caused by the bacterial pathogen Burkholderia pseudomallei, where diabetes is consistently reported as the most significant risk factor associated with the disease. Type-2 diabetes is observed in 39% of melioidosis patients where the risk of infection is 13-fold higher than non-diabetic individuals. B. pseudomallei is found in the environment and is an opportunistic pathogen in humans, often exhibiting severe clinical manifestations in immunocompromised patients. The pathophysiology of diabetes significantly affects the host immune responses that play a critical role in fighting the infection, such as leukocyte and neutrophil impairment, macrophage and monocyte inhibition and natural killer cell dysfunction. These defects result in delayed recruitment as well as activation of immune cells to target the invading B. pseudomallei. This provides an advantage for the pathogen to survive and adapt within the immunocompromised diabetic patients. Nevertheless, knowledge gaps on diabetes-infectious disease comorbidity, in particular, melioidosis-diabetes comorbidity, need to be filled to fully understand the dysfunctional host immune responses and adaptation of the pathogen under diabetic conditions to guide therapeutic options.

Risk of Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) Among Patients with Type 2 Diabetes Mellitus on Anti-Hyperglycemic Medications

Background

Observed activity of metformin in reducing the risk of severe COVID-19 suggests a potential use of the anti-hyperglycemic in the prevention of post-acute sequelae of SARS-CoV-2 infection (PASC). We assessed the 3-month and 6-month risk of PASC among patients with type 2 diabetes mellitus (T2DM) comparing metformin users to sulfonylureas (SU) or dipeptidyl peptidase-4 inhibitors (DPP4i) users.

Methods

We used de-identified patient level electronic health record data from the National Covid Cohort Collaborative (N3C) between October 2021 and April 2023. Participants were adults ≥ 18 years with T2DM who had at least one outpatient healthcare encounter in health institutions in the United States prior to COVID-19 diagnosis. The outcome of PASC was defined based on the presence of a diagnosis code for the illness or using a predicted probability based on a machine learning algorithm. We estimated the 3-month and 6-month risk of PASC and calculated crude and weighted risk ratios (RR), risk differences (RD), and differences in mean predicted probability.

Results

We identified 5596 (mean age: 61.1 years; SD: 12.6) and 1451 (mean age: 64.9 years; SD 12.5) eligible prevalent users of metformin and SU/DPP4i respectively. We did not find a significant difference in risk of PASC at 3 months (RR = 0.86 [0.56; 1.32], RD = -3.06 per 1000 [-12.14; 6.01]), or at 6 months (RR = 0.81 [0.55; 1.20], RD = -4.91 per 1000 [-14.75, 4.93]) comparing prevalent users of metformin to prevalent users of SU/ DPP4i. Similar observations were made for the outcome definition using the ML algorithm.

Conclusion

The observed estimates in our study are consistent with a reduced risk of PASC among prevalent users of metformin, however the uncertainty of our confidence intervals warrants cautious interpretations of the results. A standardized clinical definition of PASC is warranted for thorough evaluation of the effectiveness of therapies under assessment for the prevention of PASC.

Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges

Both diabetes mellitus (DM) and tuberculosis (TB) are prevalent all across in India. TB-DM comorbidity has emerged as a syndemic and needs more attention in India considering gaps in screening, clinical care, and research. This paper is intended to review published literature on TB and DM in India to understand the burden of the dual epidemic and its trajectory and to obtain perspectives on the gaps, constraints, and challenges in care and treatment of this dual epidemic. A literature search was carried out on PubMed, Scopus, and Google Scholar, using the key words 'Tuberculosis' OR 'TB' AND 'Diabetes' OR 'Diabetes Mellitus' AND 'India', focusing on the research published between the year 2000 to 2022. The prevalence of DM is high in patients with TB. Quantitative data on the epidemiological situation of TB/DM in India such as incidence, prevalence, mortality, and management are lacking. During the last 2 years convergence of TB-DM syndemic with the COVID-19 pandemic has increased cases with uncontrolled DM but also made coordinated control of TB-DM operationally difficult and of low effectiveness. Research regarding TB-DM comorbidity is required in the context of epidemiology and management. Detection and bidirectional screening are aggressively warranted. Management of DM in those with TB-DM comorbidity needs more efforts, including training and supervision of frontline workers.

Risk factors for intubation and mortality in patients treated with high flow nasal cannula due to COVID-19 infection. Survival Analysis Study in a Northern Mexican Population

BACKGROUND

COVID-19-related acute hypoxic respiratory failure patients often use high-flow nasal cannula (HFNO) oxygen therapy. COVID-19 HFNO intubation and mortality risk factors are understudied in the Mexican population, so the aim was to study them.

METHODS

This retrospective study searched electronic medical records from March 2020 to June 2022 for patients with COVID-19 who required hospitalization and HFNO. Descriptive statistics, a survival curve analysis, and Cox proportional hazard models were used to determine predictor factors for intubation and mortality in patients with HFNO and COVID-19, respectively.

RESULTS

A total of 134 patients received HFNO treatment. Ninety-one (67.9%) were men with a mean (SD) age of 54.5 (17.9) years. Common medical history included obesity (n = 89, 66.4%) with a Body Mass Index (BMI) mean (SD) of 31.8 (5.9), hypertension (n = 67, 50.0%), type 2 diabetes (n = 55, 41.0%), and dyslipidemias (n = 43, 32.1%). The variables associated with a greater risk of requiring intubation after high-flow therapy were age (HR = 1.018, 95% CI 1.003-1.034, p = 0.022) and BMI (HR = 1.071, 95% CI 1.024-1.120, p = 0.003). No variables were associated with lower risk. Increased mortality was associated with increasing age (HR = 1.151, 95% CI 1.102-1.201, p = <0.001), hypertension (HR = 4.092, 95% CI 1.369-12.236, p = 0.012), and dyslipidemia (HR = 3.954, 95% CI 1.395-11.209, p = 0.010). Patients with type 2 diabetes had a lower risk of mortality (HR = 0.235, 95% CI 0.080-0.688, p = 0.008).

CONCLUSIONS

A higher age and BMI were associated with an increased risk of intubation in patients with HFNO and COVID-19. Hypertension and dyslipidemias were associated with a higher risk of mortality.

Research Progress on the Weak Immune Response to the COVID-19 Vaccine in Patients with Type 2 Diabetes

Coronavirus Disease 2019 (COVID-19) is generally susceptible to the population, highly infectious, rapidly transmitted, and highly fatal. There is a lack of specific drugs against the virus at present and vaccination is the most effective strategy to prevent infection. However, studies have found that some groups, particularly patients with diabetes, show varying degrees of weak immune reactivity to various COVID-19 vaccines, resulting in poor preventive efficacy against the novel coronavirus in patients with diabetes. Therefore, in this study, patients with type 2 diabetes mellitus (T2DM) who had weak immune response to the COVID-19 vaccine in recent years were analyzed. This article reviews the phenomenon, preliminary mechanism, and related factors affecting weak vaccine response in patients with T2DM, which is expected to help in the development of new vaccines for high-risk groups for COVID-19.

Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused

Background and Aims

Diabetes is recognized as a significant factor in both mortality and morbidity worldwide, affecting various demographics regardless of geographic location, age group, or gender. This correspondence aims to express concern and draw the attention of leaders and policymakers worldwide to this critical public health issue.

Methods

A thorough literature search was conducted utilizing various databases, including Google Scholar, PubMed, Science Direct, and the International Diabetes Federation (IDF) website, to collect the required data. Keywords were strategically applied to enhance search results, with preference given to English-language articles containing pertinent information.

Results

According to the 2021 report by the IDF, approximately 537 million individuals globally were affected with diabetes, constituting roughly 10.5% of the world's populace. This condition incurred healthcare expenditures totaling $966 billion. Projections indicate a surge in diabetes cases to 783 million by 2045, with associated healthcare costs estimated to surpass $1054 billion. However, almost half of all people with diabetes are unaware of their medical condition, with the highest prevalence of undiagnosed diabetes Mellitus (DM) found in low and middle-income countries (LMICs) of the regions of Africa, the Western Pacific, and Southeast Asia.

Conclusion

Collaborating with the World Health Organization (WHO), LMIC governments should improve healthcare accessibility, including more frequent diabetes screenings for individuals aged ≥ 45 years and younger individuals at elevated risk of having a family history.

Mechanisms of endothelial activation, hypercoagulation and thrombosis in COVID-19: a link with diabetes mellitus

Early since the onset of the COVID-19 pandemic, the medical and scientific community were aware of extra respiratory actions of SARS-CoV-2 infection. Endothelitis, hypercoagulation, and hypofibrinolysis were identified in COVID-19 patients as subsequent responses of endothelial dysfunction. Activation of the endothelial barrier may increase the severity of the disease and contribute to long-COVID syndrome and post-COVID sequelae. Besides, it may cause alterations in primary, secondary, and tertiary hemostasis. Importantly, these responses have been highly decisive in the evolution of infected patients also diagnosed with diabetes mellitus (DM), who showed previous endothelial dysfunction. In this review, we provide an overview of the potential triggers of endothelial activation related to COVID-19 and COVID-19 under diabetic milieu. Several mechanisms are induced by both the viral particle itself and by the subsequent immune-defensive response (i.e., NF-κB/NLRP3 inflammasome pathway, vasoactive peptides, cytokine storm, NETosis, activation of the complement system). Alterations in coagulation mediators such as factor VIII, fibrin, tissue factor, the von Willebrand factor: ADAMST-13 ratio, and the kallikrein-kinin or plasminogen-plasmin systems have been reported. Moreover, an imbalance of thrombotic and thrombolytic (tPA, PAI-I, fibrinogen) factors favors hypercoagulation and hypofibrinolysis. In the context of DM, these mechanisms can be exacerbated leading to higher loss of hemostasis. However, a series of therapeutic strategies targeting the activated endothelium such as specific antibodies or inhibitors against thrombin, key cytokines, factor X, complement system, the kallikrein-kinin system or NETosis, might represent new opportunities to address this hypercoagulable state present in COVID-19 and DM. Antidiabetics may also ameliorate endothelial dysfunction, inflammation, and platelet aggregation. By improving the microvascular pathology in COVID-19 and post-COVID subjects, the associated comorbidities and the risk of mortality could be reduced.

Lower Glycosylated Hemoglobin Is Associated With Lower In-Hospital Mortality in Patients With COVID-19: A Systematic Review of the Literature and Meta-Analysis

OBJECTIVE

Poor glycemic control during COVID-19 hospitalization is associated with higher mortality. However, the association between long-term glycemic control, as reflected by the glycosylated hemoglobin (HbA1c) and outcomes has yet to be clarified, with some studies reporting no association. The aim of this study is to determine the association between HbA1c and in-hospital mortality in patients with COVID-19.

METHODS

Pubmed, Embase, and Web of Science databases were searched for studies examining the association between HbA1c level and in-hospital COVID-19 mortality. Random-effects meta-analysis was performed. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed using funnel plots.

RESULTS

Among 4142 results, 22 studies were included in the final analysis with a total of 11 220 patients. Lower Hba1c was associated with lower in-hospital mortality [odds ratio (OR), 0.53; 95% CI, 0.37-0.76; I2 81%], in using HbA1c as a dichotomous variable. When only patients with diabetes were included in the analysis, the association remained statistically significant (OR, 0.67; 95% CI, 0.47-0.96). In the subgroup analysis, the association remained statistically significant in studies using as cutoff the HbA1c value of 6.5% (OR, 0.34; 95% CI, 0.15-0.77) and 7% (OR, 0.54; 95% CI 0.32-0.90), but not with greater HbA1c cutoff values; 7.5% and ≥8%. In studies using HbA1C as a continuous variable, HbA1c level did not have a statistically significant association with in-hospital mortality, either in univariate or multivariate analyses.

CONCLUSION

A better glycemic control prior to hospitalization, as reflected by lower HbA1c, is associated with lower in-hospital mortality in patients with COVID-19.

The Burden of Cardiovascular Diseases Due to COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that produces respiratory symptoms and has serious consequences for people's cardiovascular systems (CVS). It is a severe issue and a major task not only for health care experts but also for governments to contain this pandemic. SARS-CoV-2 is the seventh member of the human coronavirus family to be implicated in this zoonotic outbreak. COVID-19's CV interactions are comparable to those of SARS-CoV, Middle East respiratory syndrome (MERS-CoV), and influenza. Those who have COVID-19 and underlying cardiovascular diseases (CVDs) are at a higher risk of serious illness and mortality, and disease has been linked to several direct and indirect CV consequences. COVID-19 causes CVDs such as arrhythmias, cardiac arrest, cardiogenic shock, myocarditis, stress-cardiomyopathy, and acute myocardial damage (AMD) as a consequence of acute coronary syndrome. The provision of CV care may expose health care professionals to risk as they become hosts or vectors of viral transmission. It binds to the angiotensin-converting enzyme receptor, causing constitutional and pulmonary signs in the beginning, and then as the infection advances, it affects other organs such as the gastrointestinal tract, CVS, neurological system, and so on. COVID-19 mortality is increased by underlying CVDs comorbidities.

Pediatric diabetes mellitus hospitalizations and COVID-19 pandemic response measures

AIMS

In the United States, evidence suggests that during the COVID-19 pandemic, admissions of patients with diabetes mellitus (DM) have increased. This study assessed hospital admission rates for pediatric type 1 (T1DM) and type 2 (T2DM) diabetes mellitus during 2019-2021, and the potential influence of the timing of various pandemic response measures.

METHODS

Retrospective chart reviews were conducted of 854 T1DM and 135 T2DM hospital admissions between January 2019 and December 2021 in patients < 20 years old to collect demographic data, admission type, body mass index (BMI), and area deprivation index (ADI, a measure of socioeconomic vulnerability). Patients were divided into three cohorts based on their admission year: 2019 (Pre-pandemic), 2020 (Pandemic, Pre-vaccine), and 2021 (Pandemic, Post-vaccine). Admissions were categorized within each cohort by diagnosis (T1DM or T2DM) and clinical presentation (new onset, diabetic ketoacidosis: DKA). Cohorts were compared using an independent samples t-test for continuous variables or a chi-square test for categorical variables.

RESULTS

The incidence of T2DM hospitalizations tripled during the pandemic, increasing from 18 in 2019 (Pre-pandemic), to 55 in 2020 (Pandemic, Pre-vaccine), and 62 in 2021 (Pandemic, Post-vaccine). The rate of patients presenting with DKA was 15.4 % (95 % CI: 4 %-26.9 %) higher in 2020 (Pandemic, Pre-vaccine) among patients with new-onset T1DM (72/139 vs. 52/143), and 22.5 % (95 % CI: 9.6 %-35.4 %) higher in 2020 (Pandemic, Pre-vaccine) among T2DM patients (9/40 vs. 0/14). This increased rate of new onset T2DM significantly correlated with younger age (P = 0.046) and higher ADI score (P = 0.017), but not with BMI.

CONCLUSION

The incidence of T1DM hospitalizations did not increase during the pandemic; however, they tripled for T2DM patients. All new onset DM pediatric patients during the pandemic were more likely to present in DKA. Patients admitted with new onset T2DM were socioeconomically more vulnerable. For T1DM, the peak of local pediatric diabetes admissions in 2020 occurred slightly later coinciding with the reopening of primary care physicians (PCP) offices and schools.

Role of inflammation in determining the severity of COVID-19 infection in patients with diabetes: A comparative study

There is a need to consider the geographical origins when studying the association between COVID-19 and the comorbid conditions. To examine the role of inflammation in determining the severity of COVID-19 among hospitalized patients with diabetes and compare these roles with those who does not have diabetes. A cross sectional comparative design was used with a convenience sample of 352 patients. Samples were collected from hospitalized patients with COVID-19 who were divided into 2 groups (diabetes and non-diabetes). Data regarding results of selected inflammatory markers and sociodemographic were collected. The severity of COVID-19 differed significantly between the diabetes and non-diabetes groups (Chi square = 25.58 P < .05). There was significant difference in the mean scores of neutrophil counts, monocyte count, Basophil count, erythrocyte sedimentation rate, partial thromboplastin time, C-creative protein, platelets, white blood cells, and mean cellular hemoglobin center between those with and those without diabetes. The diabetes were shown more increased in the predictors and severity of the COVID-19 disease. However, neutrophil to lymphocyte ratio, neutrophil count, and age were the significant predictors of the severity level of COVID-19 among patients with diabetes. In conclusion, our study addressed the influence of having diabetes among hospitalized patients with moderate and severe COVID-19 infection. The results showed that severity of COVID-19 infection was affected by diabetes where those with diabetes had more tendency to suffer from the severe form of the disease rather that the moderate level.

Exploration of the common pathogenic link between COVID-19 and diabetic foot ulcers: An in silico approach

Background and Aims

The Coronavirus Disease-19 (COVID-19) is posing an ongoing threat to human health. Patients of diabetic foot ulcer (DFU) are susceptible to COVID-19-induced adverse outcomes. Nevertheless, investigations into their mutual molecular mechanisms have been limited to date. In the present work, we tried to uncover the shared pathogenesis and regulatory gene targets of COVID-19 and DFU.

Methods

In this study, we chose GSE161281 as the COVID-19 data set, which contained severe acute respiratory syndrome coronavirus 2 infected human induced embryonic stem cell-derived peripheral neurons (n = 2) with uninfected controls (n = 2). The GSE134431 designated as the DFU data set, comprising full-thickness DFU (n = 13) and diabetic foot skin (n = 8) samples from diabetic patients. The differential expressed genes (DEGs) were identified from GSE161281 and GSE134431, and the common DEGs between COVID-19 and DFU were extracted. Multifactor regulatory network and co-expression network of the common DEGs were analyzed, along with candidate drug prediction.

Results

Altogether, six common DEGs (dickkopf-related protein 1 [DKK1], serine proteinase inhibitor A3 [SERPINA3], ras homolog family member D [RHOD], myelin protein zero like 3 [MPZL3], Claudin-11 [CLDN11], and epidermal growth factor receptor pathway substrate 8-like 1 [EPS8L1]) were found between COVID-19 and DFU. Functional analyses indicated that pathways of apoptotic and Wnt signaling may contribute to progression of COVID-19. Gene co-expression network implied the shared pathways of immune regulation and cytokine response participated collectively in the development of DFU and COVID-19. A multifactor regulatory network was constructed integrating the corresponding microRNAs (miRNAs) and transcription factors. Additionally, we proposed potential drug objects for the combined therapy.

Conclusion

Our study revealed the shared molecular mechanisms underlying COVID-19 and DFU. The identified pivotal targets and common pathways can provide new perspectives for further research and assist the development of management strategies in patients of DFU complicated with COVID-19.

Risk factors and characteristics of hospitalized COVID-19 patients in Jordan

OBJECTIVES

To investigate the occurrence and identify the factors contributing to hospitalization among individuals diagnosed with COVID-19.

METHODS

From June 15, 2020 to September 30, 2020, a cross-sectional study utilizing an online questionnaire was carried out in Jordan. The study included 657 COVID-19 patients who had recovered and had reached a minimum of 3 months post-illness. Sociodemographic and COVID-19-related data were collected. The questionnaire was distributed to members of the "My Experience with COVID-19 Association" in Jordan.

RESULTS

The prevalence of hospitalization among COVID-19 patients was 3%. Patients with hypertension (p=0.00), diabetes mellitus (p=0.00), and heart disease (p=0.009); using angiotensin-converting enzyme inhibitors (ACE) and angiotensin-receptor blockers (ARBs) (p=0.00); with body mass indexes (BMI) above normal (p=0.005); and aged over 45 years (p=0.00) were at higher risk of hospitalization. Using an odds ratio (OR), hypertension (OR=7.1), diabetes mellitus (OR=11.4), heart disease (OR=6.3), angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers use (OR=10.8), and having a BMI >25 (OR=5) were significant hospitalization risk factors. The seasonal influenza vaccine, smoking, and neuropsychological symptoms showed no significance.

CONCLUSION

Identifying high-risk groups can help them monitor their health and take preventive measures against COVID-19 infection.

Developing a COVID-19 Mortality Prediction (CoMPred) Indicator for ICU Diabetic Patients Treated with Tocilizumab in Saudi Arabia: A Proof-of-Concept Study

Since the beginning of the COVID-19 pandemic, efforts have been made to underline its discourse and identify factors contributing to its severe forms. Clinically, many physicians depended on subjective criteria to determine its severe forms, which varied significantly between practices. However, they did not rely on objective laboratory findings. This study aimed to present a novel and objective laboratory-based indicator to predict mortality among COVID-19 patients. The study included 249 COVID-19 patients who were admitted to the ICU, of which 80 did not survive. The COVID-19 Mortality Prediction (CoMPred) indicator was developed by including the age and the following lab investigations: neutrophil-to-lymphocyte ratio (NLR), D-Dimer, PT, aPTT, ESR, CRP, and urea levels. A CoMPred score of 7.5 or higher carries a sensitivity of 81.10% in predicting mortality, i.e., a patient with a CoMPred score of 7.5 or higher has an 81.10% chance of dying. The CoMPred indicator score directly correlates with mortality, i.e., the higher the score, the higher the possibility of the patient dying. In conclusion, the CoMPred indicator is an objective tool that is affordable and widely available, will assist physicians, and limit the burden on clinical decisions on an unpredicted course of COVID-19 in patients.

Factors contributing to poor COVID-19 outcomes in diabetic patients: Findings from a single-center cohort study

Diabetes Mellitus (DM) is a frequent comorbidity in patients infected with the SARS-CoV-2 virus. The risk of developing severe or critical COVID-19 and higher mortality was observed to be increased in diabetic patients hospitalized due to COVID-19. In this study we aimed to find out the impact of clinical characteristics, comorbidities, laboratory results, and complications on the outcomes of diabetic patients hospitalized due to COVID-19. This article is a retrospective cohort study that include diabetic patients hospitalized with COVID-19 infection. A definition of diabetes was based on the past history of diabetes or if the HbA1c was 6.5% or higher. Demographics, clinical characteristics, comorbidities, laboratory results, and complications were extracted from the electronic medical records. The mortality rate increased with increasing age (from 5.56% in younger patients to 46% in the elderly) and with severity (from 25.71% in moderate cases to 43.77% in critical cases). We found that a critical severity on admission (OR: 5.26, 95% CI: 1.28-21.66, p = 0.0214), a history of stroke (OR: 8.37, 95% CI: 2.2-31.88, p = 0.0018), and low calcium levels on admission (OR: 2.23, 95% CI: 1.01-4.91, p = 0.0475) were significant risk factors predicting higher COVID-19 mortality in diabetic patients. The findings of this study suggest that reduced calcium levels could potentially indicate higher mortality due to COVID-19 in patients with DM. Furthermore, careful monitoring of diabetic patients hospitalized due to COVID-19 infection, especially those with critical disease severity or those with a history of stroke, may improve their outcome and lessen mortality.

Persistence of Symptoms Following Infection With COVID-19 Among Patients With Type 1 and Type 2 Diabetes Mellitus in Saudi Arabia

BACKGROUND

In Saudi Arabia, information on the persistence of COVID-19-related complications in diabetic patients, their associations with the type of diabetes mellitus (DM), and the role of uncontrolled DM in the complications remains elusive. This study aims to fill this gap. This study aimed to examine the persistence of COVID-19 complications in diabetic patients.

METHOD

A simple randomized, cross-sectional, questionnaire-based study among patients with type 1 and 2 DM following infection with COVID-19 in Saudi Arabia.

RESULT

In the present study, a total of 674 participants were included. Among the COVID-19 symptoms, fatigue (65.6%) was reported the most frequently, followed by headache (62.3%) and cough (59.8%). About 44% of patients reported high blood sugar levels, including 25.5% with elevated fasting (>126 mg/dL) and 18.5% with elevated postprandial (>200 mg/dL) glucose levels. We also report that age > 55 years [OR= 1.66 (1.01-2.56), p=0.045], anti-diabetic medications [OR= 2.10 (1.82-3.91), p=0.022], multiple comorbidities [OR= 3.21 (1.98-4.85), p=0.005], chest pain [OR= 2.54 (0.96-3.81), p=0.003], and joint pain [OR= 1.64 (0.73-2.94), p=0.025] were independently associated with COVID-19-related complications in diabetic patients.

CONCLUSION

The most common persistent symptoms in diabetic patients with COVID-19 infection are fatigue, headaches, and cough. Advanced age and use of antidiabetic medications were independently associated with COVID-19-related complications in diabetic patients.

Does COVID-19 Infection Increase the Risk of Diabetes? Current Evidence

PURPOSE OF REVIEW

Multiple studies report an increased incidence of diabetes following SARS-CoV-2 infection. Given the potential increased global burden of diabetes, understanding the effect of SARS-CoV-2 in the epidemiology of diabetes is important. Our aim was to review the evidence pertaining to the risk of incident diabetes after COVID-19 infection.

RECENT FINDINGS

Incident diabetes risk increased by approximately 60% compared to patients without SARS-CoV-2 infection. Risk also increased compared to non-COVID-19 respiratory infections, suggesting SARS-CoV-2-mediated mechanisms rather than general morbidity after respiratory illness. Evidence is mixed regarding the association between SARS-CoV-2 infection and T1D. SARS-CoV-2 infection is associated with an elevated risk of T2D, but it is unclear whether the incident diabetes is persistent over time or differs in severity over time. SARS-CoV-2 infection is associated with an increased risk of incident diabetes. Future studies should evaluate vaccination, viral variant, and patient- and treatment-related factors that influence risk.

Laboratory Findings and Biomarkers in Long COVID: What Do We Know So Far? Insights into Epidemiology, Pathogenesis, Therapeutic Perspectives and Challenges

Long COVID (LC) encompasses a constellation of long-term symptoms experienced by at least 10% of people after the initial SARS-CoV-2 infection, and so far it has affected about 65 million people. The etiology of LC remains unclear; however, many pathophysiological pathways may be involved, including viral persistence; a chronic, low-grade inflammatory response; immune dysregulation and a defective immune response; the reactivation of latent viruses; autoimmunity; persistent endothelial dysfunction and coagulopathy; gut dysbiosis; hormonal and metabolic dysregulation; mitochondrial dysfunction; and autonomic nervous system dysfunction. There are no specific tests for the diagnosis of LC, and clinical features including laboratory findings and biomarkers may not specifically relate to LC. Therefore, it is of paramount importance to develop and validate biomarkers that can be employed for the prediction, diagnosis and prognosis of LC and its therapeutic response, although this effort may be hampered by challenges pertaining to the non-specific nature of the majority of clinical manifestations in the LC spectrum, small sample sizes of relevant studies and other methodological issues. Promising candidate biomarkers that are found in some patients are markers of systemic inflammation, including acute phase proteins, cytokines and chemokines; biomarkers reflecting SARS-CoV-2 persistence, the reactivation of herpesviruses and immune dysregulation; biomarkers of endotheliopathy, coagulation and fibrinolysis; microbiota alterations; diverse proteins and metabolites; hormonal and metabolic biomarkers; and cerebrospinal fluid biomarkers. At present, there are only two reviews summarizing relevant biomarkers; however, they do not cover the entire umbrella of current biomarkers, their link to etiopathogenetic mechanisms or the diagnostic work-up in a comprehensive manner. Herein, we aim to appraise and synopsize the available evidence on the typical laboratory manifestations and candidate biomarkers of LC, their classification based on pathogenetic mechanisms and the main LC symptomatology in the frame of the epidemiological and clinical aspects of the syndrome and furthermore assess limitations and challenges as well as potential implications in candidate therapeutic interventions.

Anti-Viral Surfaces in the Fight against the Spread of Coronaviruses

This review is conducted against the background of nanotechnology, which provides us with a chance to effectively combat the spread of coronaviruses, and which primarily concerns polyelectrolytes and their usability for obtaining protective function against viruses and as carriers for anti-viral agents, vaccine adjuvants, and, in particular, direct anti-viral activity. This review covers nanomembranes in the form of nano-coatings or nanoparticles built of natural or synthetic polyelectrolytes--either alone or else as nanocomposites for creating an interface with viruses. There are not a wide variety of polyelectrolytes with direct activity against SARS-CoV-2, but materials that are effective in virucidal evaluations against HIV, SARS-CoV, and MERS-CoV are taken into account as potentially active against SARS-CoV-2. Developing new approaches to materials as interfaces with viruses will continue to be relevant in the future.

Hospitalized COVID-19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross-sectional cohort study in Mexico in 2020

Background

Diabetes mellitus is a chronic health condition that has been linked with an increased risk of severe illness and mortality from COVID-19. In Mexico, the impact of diabetes on COVID-19 outcomes in hospitalized patients has not been fully quantified. Understanding the increased risk posed by diabetes in this patient population can help healthcare providers better allocate resources and improve patient outcomes.

Objective

The objective of this study was to quantify the extent outcomes (pneumonia, intensive care unit [ICU] stay, intubation, and death) are worsened in diabetic patients with COVID-19.

Methods

Between April 14, 2020 and December 20, 2020 (last accessed), data from the open-source COVID-19 database maintained by the Mexican Federal Government were examined. Utilizing hospitalized COVID-19 patients with complete outcome data, a retrospective cohort study (N = 402,388) was carried out. In relation to COVID-19, both univariate and multivariate logistic regression were used to investigate the effect of diabetes on specific outcomes.

Results

The analysis included 402,388 adults (age >18) with confirmed hospitalized COVID-19 cases with mean age 46.16 (standard deviation = 15.55), 214,161 (53%) male. The outcomes delineated included pneumonia (N = 88,064; 22%), ICU requirement (N = 23,670; 6%), intubation (N = 23,670; 6%), and death (N = 55,356; 14%). After controlling for confounding variables diabetes continued to be an independent risk factor for both pneumonia (odds ratio [OR]: 1.8, confidence interval [CI]: 1.76-1.84, p < 0.01), ICU requirement (OR: 1.09, CI: 1.04-1.14, p < 0.01), intubation (OR: 1.07, CI: 1.04-1.11, p < 0.01), and death (OR: 1.88, CI: 1.84-1.93, p < 0.01) in COVID-19 patients.

Conclusions

According to the study, all outcomes (pneumonia, ICU requirement, intubation, and death) were greater among hospitalized individuals with diabetes and COVID-19. Additional study is required to acquire a better understanding of how diabetes affects COVID-19 outcomes and to develop practical mitigation techniques for the risk of severe sickness and complications in this particular patient population.

Bidirectional Relationship between Glycemic Control and COVID-19 and Perspectives of Islet Organoid Models of SARS-CoV-2 Infection

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to morbidity and mortality, with several clinical manifestations, and has caused a widespread pandemic. It has been found that type 2 diabetes is a risk factor for severe coronavirus disease 2019 (COVID-19) illness. Moreover, accumulating evidence has shown that SARS-CoV-2 infection can increase the risk of hyperglycemia and diabetes, though the underlying mechanism remains unclear because of a lack of authentic disease models to recapitulate the abnormalities involved in the development, regeneration, and function of human pancreatic islets under SARS-CoV-2 infection. Stem-cell-derived islet organoids have been valued as a model to study islets’ development and function, and thus provide a promising model for unraveling the mechanisms underlying the onset of diabetes under SARS-CoV-2 infection. This review summarized the latest results from clinical and basic research on SARS-CoV-2-induced pancreatic islet damage and impaired glycemic control. Furthermore, we discuss the potential and perspectives of using human ES/iPS cell-derived islet organoids to unravel the bidirectional relationship between glycemic control and SARS-CoV-2 infection.

Effect of Protective Measures Adopted in the COVID-19 Pandemic on Hemodialysis Patients

Introduction The use of masks and other preventive measures is nowadays an essential measure to prevent COVID-19 infections, particularly in hemodialysis patients. The aim of this study was to understand whether these protective measures adopted during the COVID-19 pandemic reduced or somehow contained the number of respiratory infections in a population of hemodialysis patients. Methods This was a longitudinal retrospective single-center study of hemodialysis patients with at least six months of follow-up in a central hospital. A total of 103 patients were evaluated for the study. Two groups were defined: a control group that was followed in the year before the beginning of the pandemic and a group that followed in the year after its beginning. Results Patients in the pandemic group had a higher prevalence of previous major cardiovascular events (48.9% vs 8.6%) and heart failure (31.3% vs 12.1%) than those in the control group. Vaccination rates for influenza and pneumococcus as well as the monthly analytical results were similar in both groups. There were no significant differences in lower respiratory infections, hospitalizations caused by lower respiratory infections, and mortality between both groups. However, not accounting for aspiration pneumonias, the pandemic group had half the mortality due to respiratory infections (2.2% vs 5.2%). Conclusion Despite patients in the pandemic group having a similar prevalence of respiratory infections and hospitalizations motivated by lower respiratory infections, they presented about half the mortality of the control group. This suggests that although there was no decrease in the number of infections, protective measures may have contributed to a decreased mortality.

Noninsulin-based antihyperglycemic medications in patients with diabetes and COVID-19: A systematic review and meta-analysis

BACKGROUND

Patients with diabetes are more likely to suffer COVID-19 complications. Using noninsulin antihyperglycemic medications (AGMs) during COVID-19 infection has proved challenging. In this study, we evaluate different noninsulin AGMs in patients with COVID-19.

METHODS

We searched Medline, Embase, Web of Science, and Cochrane on 24 January 2022. We used the following keywords (COVID-19) AND (diabetes mellitus) AND (antihyperglycemic agent). The inclusion criteria were studies reporting one or more of the outcomes. We excluded non-English articles, case reports, and literature reviews. Study outcomes were mortality, hospitalization, and intensive care unit (ICU) admission.

RESULTS

The use of metformin rather than other glucose-lowering medications was associated with statistically significant lower mortality (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.47, 0.77, p < .001). Dipeptidyl peptidase-4 inhibitor (DPP-4i) use was associated with statistically significantly higher hospitalization risk (RR: 1.44, 95% CI: 1.23, 1.68, p < .001) and higher risk of ICU admissions and/or mechanical ventilation vs nonusers (RR: 1.24, 95% CI: 1.04, 1.48, p < .02). There was a statistically significant decrease in hospitalization for SGLT-2i users vs nonusers (RR: 0.89, 95% CI: 0.84-0.95, p < .001). Glucagon-like peptide-1 receptor agonist (GLP-1RA) use was associated with a statistically significant decrease in mortality (RR: 0.56, 95% CI: 0.42, 073, p < 0.001), ICU admission, and/or mechanical ventilation (RR: 0.79, 95% CI: 0.69-0.89, p < .001), and hospitalization (RR: 0.73, 95% CI: 0.54, 0.98, p = .04).

CONCLUSIONS

AGM use was not associated with increased mortality. However, metformin and GLP-1RA use reduced mortality risk statistically significantly. DPP-4i use was associated with a statistically significant increase in the risk of hospitalization and admission to the ICU.

d-Alanine as a biomarker and a therapeutic option for severe influenza virus infection and COVID-19

Since the outbreak of coronavirus disease 2019 (COVID-19), biomarkers for evaluating severity, as well as supportive care to improve clinical course, remain insufficient. We explored the potential of d-amino acids, rare enantiomers of amino acids, as biomarkers for assessing disease severity and as protective nutrients against severe viral infections. In mice infected with influenza A virus (IAV) and in patients with severe COVID-19 requiring artificial ventilation or extracorporeal membrane oxygenation, blood levels of d-amino acids, including d-alanine, were reduced significantly compared with those of uninfected mice or healthy controls. In mice models of IAV infection or COVID-19, supplementation with d-alanine alleviated severity of clinical course, and mice with sustained blood levels of d-alanine showed favorable prognoses. In severe viral infections, blood levels of d-amino acids, including d-alanine, decrease, and supplementation with d-alanine improves prognosis. d-Alanine has great potentials as a biomarker and a therapeutic option for severe viral infections.

The α-Amylase and α-Glucosidase Inhibition Capacity of Grape Pomace: A Review

The concept of functional foods is gaining more importance due to its role in maintaining a healthy status and preventing some metabolic diseases. The control of diabetes, in particular type-2 (T2DM), could be considered a big challenge since it involves other factors such as eating habits. From the pharmacological point of view, inhibiting digestive enzymes, such as α-amylase and α-glucosidase, is one of the mechanisms mainly used by synthetic drugs to control this disease; however, several side effects are described. For that reason, using bioactive compounds may appear as an alternative without presenting the complications synthetic drugs available on the market have. The winemaking industry generates tons of waste annually, and grape pomace (GP) is the most important. GP is recognized for its nutritional value and as a source of bioactive compounds that are helpful for human health. This review highlights the importance of GP as a possible source of α-amylase and α-glucosidase inhibitors. Also, it is emphasized the components involved in this bioactivity and the possible interactions among them. Especially, some phenolic compounds and fiber of GP are the main ones responsible for interfering with the human digestive enzymes. Preliminary studies in vitro confirmed this bioactivity; however, further information is required to allow the specific use of GP as a functional ingredient inside the market of products recommended for people with diabetes.

Graphical abstract

Spatiotemporal heterogeneity of SARS-CoV-2 diffusion at the city level using geographically weighted Poisson regression model: The case of Bologna, Italy

This paper aimed to analyse the spatio-temporal patterns of the diffusion of SARS-CoV-2, the virus causing coronavirus 2019 (COVID-19, in the city of Bologna, the capital and largest city of the Emilia-Romagna Region in northern Italy. The study took place from February 1st, 2020 to November 20th, 2021 and accounted for space, sociodemographic characteristics and health conditions of the resident population. A second goal was to derive a model for the level of risk of being infected by SARS-CoV-2 and to identify and measure the place-specific factors associated with the disease and its determinants. Spatial heterogeneity was tested by comparing global Poisson regression (GPR) and local geographically weighted Poisson regression (GWPR) models. The key findings were that different city areas were impacted differently during the first three epidemic waves. The area-to-area influence was estimated to exert its effect over an area with 4.7 km radius. Spatio-temporal heterogeneity patterns were found to be independent of the sociodemographic and the clinical characteristics of the resident population. Significant single-individual risk factors for detected SARS-CoV-2 infection cases were old age, hypertension, diabetes and co-morbidities. More specifically, in the global model, the average SARS-CoV-2 infection rate decreased 0.93-fold in the 21-65 years age group compared to the >65 years age group, whereas hypertension, diabetes, and any other co-morbidities (present vs absent), increased 1.28-, 1.39- and 1.15-fold, respectively. The local GWPR model had a better fit better than GPR. Due to the global geographical distribution of the pandemic, local estimates are essential for mitigating or strengthening security measures.

Retrospective assessment of the association between co-morbid disease burden and biochemical parameters in hospitalized hypertensive COVID-19 patients

Background/Aim: Hypertension (HT) was examined as a risk factor affecting the progression of the 2019 novel coronavirus disease (COVID-19). In COVID-19 patients, it can be found in many co-morbid diseases, along with hypertension. It is not clear whether the co-morbid burden of the disease affects the prognosis in hypertensive COVID-19 patients and which biochemical parameters may be indicative of this. Therefore, this study was designed to determine the effect of co-morbid disease burden on biochemical parameters in hospitalized hypertensive COVID-19 patients. Methods: After receiving approval from the University Ethics Committee, demographic, clinical, radiological, and laboratory data of 250 hospitalized hypertensive COVID-19 patients between May 2020 and Sept 2020 were screened. Patients with missing records and unclear history of hypertension drug use were excluded from the study. A total of 215 patients were included in the study. Patients were divided into four groups according to the co-morbidity status: (1) HT alone (Group HT0), (2) HT+ Diabetes Mellitus (DM) (Group HTDM1), (3) HT+one co-morbidity exclude DM (Group HT2), and (4) HT+at least two co-morbidities (Group HT3). Results: We analyzed the data of 105 female and 110 male patients. Of the 215 patients whose data were evaluated in this study, 15 patients died. Two hundred people were discharged with recovery. The mortality rate was 7%. Of the hypertension patients, 34.9% had DM, 32.6% had coronary artery disease (CAD), 30.2% had chronic obstructive pulmonary disease (COPD), 16.3% had heart failure (HF), 23.3% had chronic kidney failure (CKD), and 9.3% had cerebrovascular disease (CVD). Twenty-five percent were smokers. Urea, creatinine, direct bilirubin (DBil), and Troponin-I values were significantly higher in the Group HT3 compared to the Group HT0, Group HTDM1, and Group HT2 (P < 0.001, P < 0.001, P < 0.001, P = 0.002 respectively). Glomerular filtration rate (GFR) and albümin levels were significantly lower in Group HT3 than in Group HT0, Group HTDM1, and Group HT2 (P < 0.001 and P < 0.001, respectively). The logistic regression model was statistically significant (χ2(7) = 69.088 and P < 0.001); advanced age, decrease in GFR and plateletcrit (PCT) levels, and increase in D-dimer and DBil levels were observed as predictive parameters of mortality in all hospitalized COVID-19 HT patients. Conclusion: We determined that SARS-CoV-2 pneumonia patients with HT plus at least two co-morbidities were more serious than other patient groups in terms of organ damage and biochemical variables. In our study, we observed an increase in urea, creatinine, D-dimer, Dbil, and Troponin-I values and a decrease in GFR and albumin values as the co-morbidity burden increased in hypertensive COVID-19 patients. However, a decrease in GFR and hemogram PCT levels and an increase in D-dimer and DBil levels could be risk factors for mortality.

Mortality Predictors in Severe SARS-CoV-2 Infection

Background and Objectives: The severe forms of SARS-CoV-2 pneumonia are associated with acute hypoxic respiratory failure and high mortality rates, raising significant challenges for the medical community. The objective of this paper is to present the importance of early quantitative evaluation of radiological changes in SARS-CoV-2 pneumonia, including an alternative way to evaluate lung involvement using normal density clusters. Based on these elements we have developed a more accurate new predictive score which includes quantitative radiological parameters. The current evolution models used in the evaluation of severe cases of COVID-19 only include qualitative or semi-quantitative evaluations of pulmonary lesions which lead to a less accurate prognosis and assessment of pulmonary involvement. Materials and Methods: We performed a retrospective observational cohort study that included 100 adult patients admitted with confirmed severe COVID-19. The patients were divided into two groups: group A (76 survivors) and group B (24 non-survivors). All patients were evaluated by CT scan upon admission in to the hospital. Results: We found a low percentage of normal lung densities, PaO2/FiO2 ratio, lymphocytes, platelets, hemoglobin and serum albumin associated with higher mortality; a high percentage of interstitial lesions, oxygen flow, FiO2, Neutrophils/lymphocytes ratio, lactate dehydrogenase, creatine kinase MB, myoglobin, and serum creatinine were also associated with higher mortality. The most accurate regression model included the predictors of age, lymphocytes, PaO2/FiO2 ratio, percent of lung involvement, lactate dehydrogenase, serum albumin, D-dimers, oxygen flow, and myoglobin. Based on these parameters we developed a new score (COV-Score). Conclusions: Quantitative assessment of lung lesions improves the prediction algorithms compared to the semi-quantitative parameters. The cluster evaluation algorithm increases the non-survivor and overall prediction accuracy.COV-Score represents a viable alternative to current prediction scores, demonstrating improved sensitivity and specificity in predicting mortality at the time of admission.

Alternative protein sources of plant, algal, fungal and insect origins for dietary diversification in search of nutrition and health

This review aimed to compare alternative protein sources in terms of nutritional composition and health benefits with the purpose of disseminating up-to-date knowledge and contribute for diversification of the food marked and consumers decision-making. Plant-based is the most well-established category of alternative proteins, but there is still room for diversification. Less conventional species such as chia seeds are prominent sources of ω-3 (∼60% total lipids), while hempseed and quinoa are notable sources of ω-6 (up to 58% and 61%, respectively). Edible insects and microalgae are alternative foods rich in protein (up to 70%), fibers (∼30%), as well as peptides and polysaccharides with antimicrobial, antioxidant, anti-hypertensive, antidiabetic, antidepressant, antitumor, and immunomodulatory activities. Additionally, lipid contents in insect larvae can be as high as 50%, on a dry weight basis, containing fatty acids with anti-inflammatory and antitumor properties. In contrast, edible fungi have low lipid contents (∼2%), but are rich in carbohydrates (up to 79%) and have balanced amino acid profiles. The results suggest that food formulations combining different alternative protein sources can meet dietary requirements. Further studies on flavoring and texturing processes will help to create meat and dairy analogs, thus helping to broaden acceptance and applicability of alternative protein sources.