COVID-19: Diabetes Perspective—Pathophysiology and Management

Dallavalasa, Siva; Tulimilli, SubbaRao V.; Prakash, Jamuna; Ramachandra, Ramya; Madhunapantula, SubbaRao V.; Ravindra, P. V.

doi:10.3390/pathogens12020184

Cited by 18 publications

(16 citation statements)

References 244 publications

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“…Of them, IR seems to be a pivotal factor, adscribed to low-grade inflammation [8]. Nevertheless, the pathophysiological and molecular mechanisms connecting PCS and T2DM are far from completely understood [4] and there is a paucity of studies addressing this relation [8]. Additionally, a previous study by our working group showed that subjects with PCS, along with slight but significant elevations of inflammatory markers, had marked sex differences in the inflammatory response [9].…”

Section: Introductionmentioning

confidence: 99%

“…An important role in this mechanism is attributed to Th17 and Treg cells, along with the secretion of inflammatory factors [3]. In addition to DM-associated low-grade inflammation affecting peripheral insulin sensitivity (IS), other mechanisms driven by hyperglycemia may be involved, such as elevated synthesis of advanced glycation end products (AGEs) [4] or direct stimulation of viral proliferation [1].…”

Section: Introductionmentioning

confidence: 99%

“…Coexistence of other underlying processes, such as stress hyperglycemia or corticosteroid-induced hyperglycemia, is also possible. Hypovitaminosis D may in turn cause IR, which may be aggravated by high viral titres that stimulate the release of cytokines/chemokines, most of them with a negative effect on systemic IS [4].…”

Section: Introductionmentioning

confidence: 99%

“…There is some evidence that PCS is a risk factor for DM [8]. Accumulating results point to several mechanisms that could be implicated: destruction of exocrine and endocrine cells due to SARS-CoV-2 infection, trandifferentiation of pancreatic beta cells through the activation of eIF2 signaling pathway, and induced autoimmunity and low-grade inflammation [4]. Of them, IR seems to be a pivotal factor, adscribed to low-grade inflammation [8].…”

Section: Introductionmentioning

confidence: 99%

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Post-COVID-19 syndrome and insulin resistance 20 months after a mild COVID-19

Fierro

Martin

Rodrigo

et al. 2023

Preprint

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Objective SARS-CoV-2 infection is associated with impaired glucose metabolism. Although the mechanisms are not fully understood, insulin resistance (IR) appears to be a central factor. Patients who had a severe acute phase, but even asymptomatic or with mild COVID-19, have an increased risk of T2DM. After the acute phase, post-COVID-19 syndrome (PCS) also seems to be related to this metabolic disturbance, but there is a paucity of studies. This study aims to evaluate a possible relationship between PCS and IR after mild COVID-19 and, if confirmed, whether there are differences by sex. Subjects and methods Retrospective observational cohort study including subjects who had mild COVID-19 between April and September 2020 in a community setting. None had been vaccinated against SARS-CoV-2 at inclusion, and previous T2DM and liver disease were exclusion criteria. Patients who met NICE criteria were classified as PCS+. Epidemiological and laboratory data were analysed. Three assessments were performed: 1E (pre-COVID-19, considered baseline and reference for comparisons), 2E (approximately 3 months after the acute phase), and 3E (approximately 20 months after the acute phase). A triglyceride-to-glucose (TyG) index ≥8.74 was considered IR. Albumin-to-globulin ratio (AGR) and lactate dehydrogenase (LDH) were assessed as inflammatory markers. Bivariate analyses were performed, using nonparametric and repeated measures tests. A subsample without metabolic disorder or CVD (age< median, BMI<25 kg/m^2, elevated AGR, TyG index=7.80 [0.5]) was generated to reasonably rule out prior baseline IR that could bias the results. The relationships between PCS and TyG in 3E (TyG3) were modeled in 8 multiple regressions, stratifying by sex and BMI combinations. Results A total of 112 subjects (median [IQR] of age= 44 [20] years; 65 women) were analysed. Up to 14.3% was obese and 17% was hypertensive. Significant increases between 1E and 3E were registered regarding (i) basal glycemia (BG), 87 [14] mg/dL vs. 89 [14]; p=0.014, (ii) TyG index (8.25 [0.8] vs. 8.32 [0.7]; p=0.002), and (iii) LDH in 3rd tertile (16.1% vs 32.1%; p=0.007). A total of 8 previously normoglycemic subjects, showed BG2 or BG3 >126 mg/dL. The subgroups with IR highest prevalence at 3E were those of BMI ≥25 kg/m^2 and PCS+. The subgroup without CVD presented a significant increase in the TyG index (TyG1=7.80 [0.1] vs. TyG3= 8.28 [0.1]; p=0.017). LDH1 was significantly correlated with TyG3 in both sexes (rho=0.214 in women, rho=0.298 in men); in contrast, LDH2 and LDH3 did not present such an association. In multivariable analysis, PCS has shown to be an independent and predictive variable of TyG index in women with BMI<25 kg/m^2, after adjustment for age, hypertension, BMI, Charlson comorbidity index, AGR1, AGR2, LDH1, number of symptoms of acute COVID-19, and number of days of the acute episode (beta coefficient=0.350; p=0.039). Conclusions PCS has played a secondary role in predicting IR, showing a modest effect compared to BMI or prior hypertension. A significant increase in IR has been noted 20 months after mild COVID-19, both in cases of previous baseline IR and in those without previous IR. Basal serum LDH has shown to be predictive of current TyG, regardless of elevated LDH after SARS-CoV-2 infection. There were profound differences between women and men, confirming the need for a sex-stratified analysis when addressing the relation between PCS and glycemic alterations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-COVID-19 syndrome and insulin resistance 20 months after a mild COVID-19

Fierro

Martin

Rodrigo

et al. 2023

Preprint

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“…Diabetes and diabetes-related complications in COVID-19 patients are primarily due to the acute illness caused during the SARS-CoV-2 infection followed by the release of glucocorticoids, catecholamines, and pro-inflammatory cytokines, which were shown to drive hyperglycemia positively [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Type 1 Diabetes Mellitus, TNF-α, and IL-10 Gene Expression

et al. 2023

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Type 1 diabetes mellitus (T1DM) is one of the major chronic diseases in children worldwide. This study aimed to investigate interleukin-10 (IL-10) gene expression and tumor necrosis factor-alpha (TNF-α) in T1DM. A total of 107 patients were included, 15 were T1DM in ketoacidosis, 30 patients had T1DM and HbA1c ≥ 8%; 32 patients had T1DM and presented HbA1c < 8%; and 30 were controls. The expression of peripheral blood mononuclear cells was performed using the reverse transcriptase–polymerase chain reaction in real time. The cytokines gene expression was higher in patients with T1DM. The IL-10 gene expression increased substantially in patients with ketoacidosis, and there was a positive correlation with HbA1c. A negative correlation was found for IL-10 expression and the age of patients with diabetes, and the time of diagnosis of the disease. There was a positive correlation between TNF-α expression with age. The expression of IL-10 and TNF-α genes showed a significant increase in DM1 patients. Once current T1DM treatment is based on exogenous insulin, there is a need for other therapies, and inflammatory biomarkers could bring new possibilities to the therapeutic approach of the patients.

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