Challenging Issues in the Management of Cardiovascular Risk Factors in Diabetes During the COVID-19 Pandemic: A Review of Current Literature

Rahimi, Leili; Malek, Mojtaba; Ismail‐Beigi, Faramarz; Khamseh, Mohammad E.

doi:10.1007/s12325-020-01417-8

Cited by 8 publications

(10 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The available data do show no increased or even lower maternal mortality rate after infection [25], but it does not mean that pregnancy is a protective factor for severe infection. It was reported that severe infection mostly occurred in the elderly (> 60 years old), patients with basic diseases, such as diabetes, obesity, hypertension, coronary heart disease, cerebrovascular diseases, and other chronic diseases [26][27][28][29][30], as well as those who did not receive timely treatment or delay treatment [31]. Pregnant women are usually younger without primary diseases.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Gao

Zhang

et al. 2020

BMC Infect Dis

View full text Add to dashboard Cite

Background: The recent COVID-19 outbreak in Wuhan, China, has quickly spread throughout the world. In this study, we systematically reviewed the clinical features and outcomes of pregnant women with COVID-19. Methods: PubMed, Web of Science, EMBASE and MEDLINE were searched from January 1, 2020, to April 16, 2020. Case reports and case series of pregnant women infected with SARS-CoV-2 were included. Two reviewers screened 366 studies and 14 studies were included. Four reviewers independently extracted the features from the studies. We used a random-effects model to analyse the incidence (P) and 95% confidence interval (95% CI). Heterogeneity was assessed using the I 2 statistic. Results: The meta-analysis included 236 pregnant women with COVID-19. The results were as follows: positive CT findings (71%; 95% CI, 0.49-0.93), caesarean section (65%; 95% CI, 0.42-0.87), fever (51%; 95% CI, 0.35-0.67), lymphopenia (49%; 95% CI, 0.29-0.70), coexisting disorders (33%; 95% CI, 0.21-0.44), cough (31%; 95% CI, 0.23-0.39), fetal distress (29%; 95% CI, 0.08-0.49), preterm labor (23%; 95% CI, 0.14-0.32), and severe case or death (12%; 95% CI, 0.03-0.20). The subgroup analysis showed that compared with non-pregnant patients, pregnant women with COVID-19 had significantly lower incidences of fever (pregnant women, 51%; non-pregnant patients, 91%; P < 0.00001) and cough (pregnant women, 31%; non-pregnant patients, 67%; P < 0.0001). Conclusions: The incidences of fever, cough and positive CT findings in pregnant women with COVID-19 are less than those in the normal population with COVID-19, but the rate of preterm labor is higher among pregnant with COVID-19 than among normal pregnant women. There is currently no evidence that COVID-19 can spread through vertical transmission.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Gao

Zhang

et al. 2020

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…150,151 GLP-1 receptor agonists can also potentially decrease inflammatory response in patients with COVID-19 by activation of AMPK and blockade of NF-KB. 152,153 ACE inhibitors and ARBs have also been reported to increase ACE2 expression, 37,38 and it was suggested that perhaps their use should be discontinued in patients with diabetes and the medications be changed to other agents, if possible. However, detailed reports have not shown any negative effects of these agents in patients with diabetes who acquire COVID-19.…”

Section: Medical Management Of Diabetes and Covid-19mentioning

confidence: 99%

“…GLP‐1 receptor agonists can also potentially decrease inflammatory response in patients with COVID‐19 by activation of AMPK and blockade of NF‐KB 152,153 …”

Section: Medical Management Of Diabetes and Covid‐19mentioning

confidence: 99%

Factors leading to high morbidity and mortality of COVID‐19 in patients with type 2 diabetes

Rajpal

Rahimi

Ismail‐Beigi

2020

Journal of Diabetes

Self Cite

157

123

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) is a recent pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. Diabetes (mostly type 2 diabetes mellitus, T2DM) and hyperglycemia are among the major comorbidities in patients with COVID-19 leading to poor outcomes. Reports show that patients with diabetes and COVID-19 are at an increased risk for developing severe complications including acute respiratory distress syndrome, multi-organ failure, and death. Here we explore potential mechanistic links that could explain the observed higher morbidity and mortality in this patient population. Patients with T2DM have an underlying increased level of inflammation associated with obesity and insulin resistance in addition to other comorbidities including hypertension, obesity, cardiovascular disease, dyslipidemia, and being older. We review evidence that T2DM with hyperglycemia are among factors that lead to elevated expression of angiotensin-converting enzyme 2 (ACE2) in lungs and other tissues; ACE2 is the cellular "receptor" and port of viral entry. The preexisting chronic inflammation with augmented inflammatory response to the infection and the increasing viral load leads to extreme systemic immune response ("cytokine storm") that is strongly associated with increased severity of COVID-19. Based on the available evidence, it is recommended by a panel of experts that safe but stringent control of blood glucose, blood pressure, and lipids be carried out in patients with T2DM, measures that could potentially serve to decrease the severity of COVID-19 should these patients contract the viral infection. Once the infection occurs, then attention should be directed to proper glycemic control with use of insulin and frequent monitoring of blood glucose levels.

show abstract

“…According to the last reports, 20%–50% of patients with progressive disease reported with comorbid diseases including diabetes, hypertension, other cardiovascular system diseases, immunological disease, asthma, and chronic obstructive pulmonary disease (COPD) 11 . Other studies indicated a high mortality rate in patients with more than one comorbidity status; moreover, ARDS developed more than threefold in a patient without comorbidity 12–15 …”

Section: Introductionmentioning

confidence: 99%

“…11 Other studies indicated a high mortality rate in patients with more than one comorbidity status; moreover, ARDS developed more than threefold in a patient without comorbidity. [12][13][14][15] Our objective was to compare the serious adverse risk of smoking versus diabetes comorbidities and outcomes of patients with COVID-19.…”

mentioning

confidence: 99%

Presenting the characteristics, smoking versus diabetes, and outcome among patients hospitalized with COVID‐19

Abbas

Nassir

Aga

et al. 2020

Journal of Medical Virology

View full text Add to dashboard Cite

Methods We designed a cross‐sectional, observational follow‐up for 284 COVID‐19 patients involving healthy patients, smokers, diabetics, and diabetic plus smokers recruited from May 1, 2020 to June 25, 2020. The clinical features, severity, duration, and outcome of the disease were analyzed. Results Of 284 COVID‐19 patients, the median age was 48 years (range, 18–80), and 33.80% were female. Common symptoms included fever (85.56%), shortness of breath (49.65%), cough (45.42%), and headache (40.86%). Patients with more than one comorbidity (diabetes and smoking) presented as severe‐critical cases compared to healthy patients, diabetics, and smokers. Smokers presented with a lower rate of death in comparison to diabetic patients and diabetic + smoking, furthermore, smoking was less risky than diabetes. Although the mortality rate was high in patients with smokers compared to healthy patients (4.22%, the hazard ratio [HR], 1.358; 95% confidence interval [CI], 1.542–1.100; p = .014), it was less than in diabetics (7.04%, HR 1.531, 95% CI: 1.668–1.337, p = .000), and diabetic plus smoker (10.00%, HR, 1.659; 95% CI, 1.763–1.510; p = .000). Conclusion Multiple comorbidities are closely related to the severity of COVID‐19 disease progression and the higher mortality rate. Smokers presented as mild cases compared to diabetic and diabetic + smoking patients, who presented as severe to critical cases. Although a higher death rate in smokers was seen compared with healthy patients, this was smaller when compared to diabetic and diabetic + smoking patients.

show abstract

Challenging Issues in the Management of Cardiovascular Risk Factors in Diabetes During the COVID-19 Pandemic: A Review of Current Literature

Cited by 8 publications

References 73 publications

Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Factors leading to high morbidity and mortality of COVID‐19 in patients with type 2 diabetes

Presenting the characteristics, smoking versus diabetes, and outcome among patients hospitalized with COVID‐19

Contact Info

Product

Resources

About