Aims Diabetes is an independent risk factor for severe SARS-CoV-2 infections. The goal of this study is to elucidate risk factors predictive of more severe outcomes in these individuals by comparing clinical characteristics of those requiring inpatient admission to those who remain outpatient. Methods A retrospective review identified 832 patients — 631 inpatients and 201 outpatients—with diabetes and a positive SARS-CoV-2 test between March 1 and June 15, 2020. Comparisons between the outpatient and inpatient cohorts was conducted to identify risk factors associated with severity of disease determined by admission rate and mortality. Previous DPP-4 inhibitor use and disease outcomes were analyzed. Results Risk factors for increased admission included older age (OR 1.04 (95% CI 1.01 – 1.06), p = 0.003) presence of chronic kidney disease (OR 2.32 (1.26 – 4.28), p = 0.007), and a higher A1C at time of admission (OR 1.25 (1.12 – 1.39), p <0.001). Lower admission rates were seen in those with commercial insurance. Increased mortality was seen in individuals with older age (OR 1.09 (1.07 – 1.11), p <0.001), BMI (OR 1.04 (1.01- 1.07), p = 0.003), and A1C at time of diagnosis of COVID (OR 1.12 (1.01 – 1.24), p = 0.028) and patients requiring hospitalization. Lower mortality was seen in those with hyperlipidemia. DPP-4 inhibitor use prior to COVID-19 infection was not associated with decreased hospitalization rate. Conclusions/Interpretation This retrospective review offers the first analysis of outpatient predictors for admission rate and mortality of COVID-19 illness in patients with diabetes.

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Although diabetes remains the number one cause of renal failure nationwide, spontaneous hypoglycemia in patients with CKD has also been described in the absence of exogenous insulin or any other diabetes treatment. Decreased renal gluconeogenesis and impaired renal insulin clearance are underlying mechanisms of hypoglycemia in individuals with ESRD. Diazoxide was originally approved as an anti-hypertensive medication, but also is known to bind ATP-sensitive K channels in the beta cells of the pancreas, ultimately leading to inhibition of insulin release. We detail six cases of ESRD-associated hypoglycemia which responded to treatment with diazoxide therapy.

BackgroundImmunotherapy has revolutionized the treatment of solid malignancies, but is associated with endocrine-related adverse events. This study aims to dissect the natural course of immunotherapy-induced hypothyroidism and provide guidance regarding diagnosis and management in patients with and without pre-existing hypothyroidism.MethodsA retrospective analysis was conducted using patients who received immunotherapy between 2010‐2019 within a multicenter hospital system. Participants were separated in three groups—those with pre-existing hypothyroidism, those who developed primary hypothyroidism and those with hypophysitis within a year of their first immunotherapy. Serial effects of immunotherapy on thyroid function tests (TFTs) and levothyroxine dosing were evaluated.Results822 patients were screened, with 85 determined to have pre-existing hypothyroidism, 48 de-novo primary hypothyroidism and 12 de-novo hypophysitis. All groups displayed fluctuations in TFTs around weeks 6‐8 of treatment. In the pre-existing hypothyroidism group, the levothyroxine dose was higher at 54 weeks than at baseline with the difference showing a trend towards statistical significance (p=0.06). The observed mean levothyroxine dose was significantly lower than the mean calculated weight-based dose for all groups. This finding was most clinically significant for the de-novo hypophysitis group (mean difference: -58.3 mcg, p&lt;0.0001). The mean 0.9 mcg/kg levothyroxine dose at week 54 for the de-novo hypophysitis group was statistically lower than the other groups (p=0.009).ConclusionIt is reasonable to screen with TFTs every 4 weeks, and space out TFTs surveillance to every 12 weeks after week 20. Our findings suggest a more conservative approach for levothyroxine dosing in those developing de-novo hypothyroidism, especially hypophysitis, such as initiating at 0.9-1.2 mcg/kg.

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