Consequences of the COVID-19 pandemic for patients with metabolic diseases

Bornstein, Stefan R.; Rubino, Francesco; Ludwig, Barbara; Rietzsch, Hannes; Schwarz, Peter E. H.; Rodionov, Roman N.; Khunti, Kamlesh; Hopkins, David; Birkenfeld, Andreas L.; Boehm, Bernhard O.; Amiel, Stephanie A.; Holt, Richard; Skyler, Jay S.; DeVries, J. Hans; Renard, Éric; Eckel, Robert H.; Zimmet, Paul; Alberti, K. G. M. M.; Geloneze, Bruno; Chan, Juliana C.N.; Mbanya, Jean Claude; Onyegbutulem, H C; Ramachandran, Ambady; Basit, Abdul; Hassanein, Mohamed; Spinas, Giatgen A.; Beuschlein, Felix; Mingrone, Geltrude

doi:10.1038/s42255-021-00358-y

Cited by 38 publications

(40 citation statements)

References 20 publications

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“… 151 During the pandemic, we have learned how to optimise pharmacological management, including ICU treatment, for patients with diabetes with or without COVID-19. 12 , 113 The pandemic has also presented people with diabetes and their health-care teams with an opportunity to innovate and transition towards increasingly digitalised care, to continue supporting patients from their own homes. 102 Preventative measures, including increased physical activity and enhanced health nutrition, are important in reversing insulin resistance and could be effective in reducing mortality related to COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…Synergy between COVID-19 and type 2 diabetes and obesity might further amplify the inflammatory response and downregulate interferon responses, contributing to increased disease severity in patients with diabetes and obesity. 12 Dysregulation of the RAAS and downregulation of ACE2 expression, in conjunction with stress signalling, can increase insulin resistance. 77 Thus, insulin resistance, by triggering airway hyper-reactivity, increases the risk of respiratory failure and cardiopulmonary collapse in patients with diabetes and COVID-19.…”

Section: Predisposition To Severe Covid-19 Outcomes In Patients With Metabolic and Endocrine Diseasesmentioning

confidence: 99%

“… 106 Despite the expected negative impact of lockdown, retrospective analyses have not reported a worsening of glucose control due to lifestyle changes. 107

Current recommendations of metabolic disease management in a pandemic situation Encourage patients to restrict social contact to reduce risk of infection 97 Prioritise patients for vaccination 98 , 99 Encourage patients to incorporate a healthy lifestyle during lockdown and quarantine 22 Individual management: help patients to establish an individual set of self-management goals (eg, measurement rate, bodyweight, steps per day, waist circumference, blood pressure) and to adhere to these goals consistently 100 Digital support: help patients to make use of online education, virtual consultation, and digital health (eg, measurements of temperature, physical activity, bodyweight, waist circumference, and blood pressure, which will be digitally transferred to the physician) 101 Behavioural support: help patients to use digital stress management tools to increase resilience and stress resistance 102 Intensify foot care 103 Check for new diabetes 90 Manage cardiac risk 9 Encourage patients to adhere to lipid-lowering drugs 40 , 77 Monitor urinary excretion and oedema in patients with chronic kidney disease 12 Optimise metabolic and blood pressure control 101 Perform intensified glucose monitoring (eg, self-monitoring of blood glucose five times per day, flash and continuous glucose monitoring) to identify early deterioration of glycaemic condition and monitor blood pressure if hypertensive 101 Avoid grade 2 hypoglycaemia (2·2–3·0 mmol/L [40·0–55·0 mg/dL]) and grade 3 hypoglycaemia (1·7–2·2 mmol/L [30·0–40·0 mg/dL]) 104 Target ranges: 22 Fasting plasma glucose concentration: 4·0–8·0 mmol/L (72·0–144·0 mg/dL) Fasting plasma glucose concentration of patients in intensive care: 6·7–11·1 mmol/L (120·0–200·0 mg/dL) HbA 1c : <53·0 mmol/mol (7%) …”

Section: Implications For Medications and Therapymentioning

confidence: 99%

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COVID-19 and metabolic disease: mechanisms and clinical management

Steenblock

Schwarz

Ludwig

et al. 2021

The Lancet Diabetes & Endocrinology

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191

160

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Up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders. Notably, there are many direct links between COVID-19 and the metabolic and endocrine systems. Thus, not only are patients with metabolic dysfunction (eg, obesity, hypertension, non-alcoholic fatty liver disease, and diabetes) at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders. In this Review, we provide an update on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Additionally, we update the practical recommendations and management of patients with COVID-19 and post-pandemic. Furthermore, we summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Predisposition To Severe Covid-19 Outcomes In Patients With Metabolic and Endocrine Diseasesmentioning

confidence: 99%

“… 106 Despite the expected negative impact of lockdown, retrospective analyses have not reported a worsening of glucose control due to lifestyle changes. 107

Section: Implications For Medications and Therapymentioning

confidence: 99%

See 1 more Smart Citation

COVID-19 and metabolic disease: mechanisms and clinical management

Steenblock

Schwarz

Ludwig

et al. 2021

The Lancet Diabetes & Endocrinology

Self Cite

191

160

View full text Add to dashboard Cite

show abstract

“…Most patients with severe Covid-19 disease have been receiving dexamethasone and may have an adrenal pre-damaged by the inflammatory process [ 18 ]. Therefore, there may be a predisposition for adrenal insufficiency [ 19 ] explaining some of the symptoms of the ME/CFS in post-COVID-19 patients.…”

Section: Me/cfs In Post-covid-19 Patients and Therapeutic Optionsmentioning

confidence: 99%

Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis?

Bornstein

Voit-Bak²,

Donate³

et al. 2021

Mol Psychiatry

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As millions of patients have been infected by SARS-CoV-2 virus a vast number of individuals complain about continuing breathlessness and fatigue even months after the onset of the disease. This overwhelming phenomenon has not been well defined and has been called “post-COVID syndrome” or “long-COVID” [1]. There are striking similarities to myalgic encephalomyelitis also called chronic fatigue syndrome linked to a viral and autoimmune pathogenesis. In both disorders neurotransmitter receptor antibodies against ß-adrenergic and muscarinic receptors may play a key role. We found similar elevation of these autoantibodies in both patient groups. Extracorporeal apheresis using a special filter seems to be effective in reducing these antibodies in a significant way clearly improving the debilitating symptoms of patients with chronic fatigue syndrome. Therefore, such a form of neuropheresis may provide a promising therapeutic option for patients with post-COVID-19 syndrome. This method will also be effective when other hitherto unknown antibodies and inflammatory mediators are involved.

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“…It has generally been accepted that diabetes increases significantly morbidity and mortality but during the current pandemic diabetes has attracted particular attention since its presence has been associated with the most severe forms of COVID-19 and related mortality [1,2]. It's therefore of crucial importance to keep diabetic patients under proper management not only to control short term complications and to prevent liver and cardio-renal-metabolic complications, but also to reduce the risk of a potentially severe course and limit adverse outcomes due to COVID-19 [3][4][5][6][7]. Several authors have emphasized the importance of novel anti-diabetic agents during this pandemic, such as incretin-based therapies, for patients with type-2 diabetes (T2DM) [8][9][10].…”

mentioning

confidence: 99%