Glycemia control and choice of antihyperglycemic therapy in patients with type 2 diabetes mellitus and COVID-19: a consensus decision of the board of experts of the Russian association of endocrinologists

Dedov, Ivan I.; Mokrysheva, Natalia; Shestakova, Marina Vladimirovna; Nikonova, Tatiana Vasil'evna; Mayorov, Alexander Yur'evich; Galstyan, Gagik R.; Шамхалова, Минара Шамхаловна; Barysheva, Valeriya O.; Аметов, А.С.; Antsiferov, M. B.; Babenko, A. Yu.; Бардымова, Т. П.; Валеева, Ф. В.; Vachugova, A. A.; Grineva, Elena; Demidova, T. Yu.; Kiseleva, T. P.; Kunicyna, M. A.; Маркова, Т. Н.; Mkrtumyan, А. M.; Петунина, Н. А.; Ruyatkina, L. A.; Saluhov, Vladimir V.; Суплотова, Л. А.; Hadarceva, E. L.; Halimov, Yu. S.

doi:10.14341/dm12873

Cited by 18 publications

(7 citation statements)

References 54 publications

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“…Сахароснижающую терапию в период НКИ получали все пациенты из группы 3 и 87% пациентов из группы 2. В соответствии с существующими подходами большой вклад в управление гипергликемией в период острой инфекции в обеих группах внесла инсулинотерапия [ 12 ], однако существенных различий в проводимой терапии не выявлено при тенденции к более широкому применению пероральных сахароснижающих препаратов (ПССП) в группе больных СД2 (табл. 5).…”

Section: результатыunclassified

The impact of carbohydrate metabolism disorders on the early and long-term clinical outcomes of patients with COVID-19 according to the AKTIV and AKTIV 2 registries

Салухов

Arutyunov

Tarlovskaya

et al. 2023

Probl Endokrinol (Mosk)

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BACKGROUND: Numerous studies indicate a high incidence of various disorders of carbohydrate metabolism against the new coronavirus infection. These disorders aggravate the course of infection and increase mortality. Thereby, analysis of risk factors for unfavorable outcomes and assessment of the long-term consequences of COVID-19 in patients with impaired carbohydrate metabolism is of great importance.AIM: To investigate the association between carbohydrate metabolism disorders in COVID-19 patients and mortality, course of infection, long-term consequences, as well as to identify risk factors for an unfavorable disease course.MATERIALS AND METHODS: A retrospective analysis of data from the combined multicenter non-interventional real-world AKTIV and AKTIV 2 registries was performed. The sample included 9290 patients who had COVID-19 with varying severity from June 29, 2020, to November 29, 2020 (AKTIV) and from October 01, 2020, to March 30, 2021 (AKTIV 2). The patients were divided into 3 groups: Group 1 — patients with intact carbohydrate metabolism, n=6606; Group 2 — patients with newly diagnosed hyperglycemia (NDH), n=1073; Group 3 — patients with a history of type 2 diabetes mellitus (DM2), n=1611. The groups were assessed for clinical and laboratory parameters, comorbidities, mortality, carbohydrate metabolic status, and well-being during the infection and at 12 months.RESULTS: The prevalence of carbohydrate metabolism disorders (CMD) was 28,9%, with DM2 patients accounting for 17,3% and patients with newly diagnosed hyperglycemia (NDH) for 11,6%. The mortality rate of patients with hyperglycemia of any origin was 10.6%, which was significantly higher compared to patients without hyperglycemia (3,9%). The probability of lethal outcome increased 2,48-fold in the group of patients with DM2 and 2,04-fold in the group of patients with NDH. At the same time, the probability of a lethal outcome decreased 2,94-fold in patients without CMD. At 12 months, patients with CMD showed a significantly higher frequency and longer persistence of complaints. This trend was more pronounced in patients with DM2 than in those with NDH. Only 1,7% of patients from the NDH group had type 2 diabetes and were receiving oral hypoglycemic medications one year after the infection. A prognostic model was developed to determine the risk of lethal outcome. The model included such known predictors as concomitant ischemic heart disease, history of myocardial infarction or stroke, blood glucose level, and age.CONCLUSION: Carbohydrate metabolism disorders aggravate the course of COVID-19 and increase mortality. One year after infection, patients with DM2 and NDH were more likely to have symptoms typical for post-COVID syndrome, and NDH resolved in most cases after the infection.

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Section: результатыunclassified

The impact of carbohydrate metabolism disorders on the early and long-term clinical outcomes of patients with COVID-19 according to the AKTIV and AKTIV 2 registries

Салухов

Arutyunov

Tarlovskaya

et al. 2023

Probl Endokrinol (Mosk)

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“…Известно, что гипергликемия является независимым фактором риска тяжелого течения COVID-19 как у пациентов с СД, так и без такового, при этом выявлено как прямое, так и опосредованное влияние вируса SARS-CoV-2 на бета-клетки поджелудочной железы, что усложняет достижение целевых показателей гликемии [8]. Согласно решению совета экспертов Российской Ассоциации Эндокринологов по выбору антигипергликемической терапии в зависимости от тяжести течения COVID-19, при среднетяжелом течении заболевания возможно использование с осторожностью всех гипогликемических препаратов неинсулинового ряда (кроме тиазолидиндионов), а при тяжелом и крайне тяжелом течении рекомендован переход на инсулинотерапию [9].…”

Section: обоснованиеunclassified

Efficacy and safety of glucagon-like peptide-1 receptor agonists therapy initiation in patients with type 2 diabetes hospitalized with coronavirus infection

Markova,

Lysenko,

Stas

et al. 2023

Diabetes mellitus

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BACKGROUND. The search for new effective methods of treatment and prevention of COVID-19 in patients with type 2 diabetes mellitus (T2DM) remains an urgent task for the healthcare system.AIM. To evaluate the efficacy and safety of initiating of glucagon-like peptide-1 receptor agonists (GLP-1RA) therapy in T2DM patients hospitalized with COVID-19.MATERIALS AND METHODS. The inclusion criteria were history of T2DM, BMI> 27 kg/m2, confirmed diagnosis of COVID-19. The intervention group of 53 patients started dulaglutide therapy (1,5 mg once weekly) during the first 24 hours of admission, the control group consisted of 50 patients, who proceeded with glucose-lowering therapy. We evaluated the effect of therapy on carbohydrate metabolism, laboratory and clinical parameters, the outcome of COVID-19 and the safety of therapy (hypoglycemic events, side effects).RESULTS. There were no differences found in the degree of decrease in the level of glycemia in the compared groups: fasting plasma glucose (FPG) on day 7 of hospitalization– 8,2 [6,0;9,8] mmol/L vs 8,1 [6,5;9,8] mmol/L (p=0,935), mean daily glycemia (MDG) — 9,7 [8,3;11,8] mmol/L vs 11,1 [8,7;12,8] mmol/L (p=0,182). Therapy of dulaglutide had a positive effect on inflammatory markers: CRP (15,8 vs 24,4 mg/l, p=0,035), LDH (261,6 vs 326,1 U/l, p=0,016) and the level of lymphocytes (1,2 vs 0,9 x 10*9/L, p=0,049) and on clinical parameters: saturation, the need for oxygen therapy and the risk of severe course according to the NEWS2 scale. The death rate in the group receiving GLP-1RA is 3,5 times lower compared to the control group (5,7% vs 20,0%, p=0,038). The initiation of dulaglutide therapy in patients with T2DM hospitalized with COVID-19 reduced the chance of death and transfer to mechanical ventilation by 4,2 times compared to the control group (OR = 0,24, 95% CI: 0,062–0,931). GLP-1RA therapy in patients with COVID-19 and T2DM is safe in terms of hypoglycemic events and side effects.CONCLUSIONS. The initiation of GLP-1RA therapy leads to a decrease in FPG and MDG, comparable with the control group. The start of GLP-1RA therapy in hospitalized patients with COVID-19 and T2DM reduces the chance of death, favorably affecting on laboratory and clinical parameters.

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“…Лечение СД 2 начинают с метформина и при необходимости назначают ингибиторы ДПП-4 (иДПП-4), ингибиторы натрий-глюкозного котранспортера 2-го типа (иНГТ-2) и агонисты рецепторов глюкагоноподобного пептида-1 (арГПП-1) [6,7].…”

Section: Introductionunclassified

“…По мнению отечественных исследователей, прием данных препаратов, назначенных пациентам до заражения COVID-19, может быть продолжен при контроле гликемии с учетом показаний и противопоказаний. У госпитализированных пациентов в острый период COVID-19 препаратом выбора для коррекции ГГ остается инсулин, при этом больные на инсулинотерапии имеют более высокую летальность [6,13,14].…”

Section: Introductionunclassified

Features of the course of COVID-19 in patients with type 2 diabetes mellitus

Karaseva,

Martynov,

Filatova

et al. 2023

Terapevticheskii arkhiv

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Aim. To identify the features of the course of COVID-19 in patients with type 2 diabetes mellitus (T2DM), depending on the intake of hypoglycemic therapy at the prehospital stage, in conjunction with the functional state of the kidneys.Materials and methods. A retrospective analysis of 291 case histories of patients with COVID-19 and T2DM hospitalized in the infection department of Semashko Regional Clinical Hospital from January to December 2021, including the main clinical and laboratory parameters.Results. Among hospitalized patients with COVID-19, patients with T2DM had a higher mortality rate. An analysis of the case histories of deceased patients with COVID-19 and T2DM showed that at admission, body mass index (BMI), C-reactive protein, and creatinine were higher than those of survivors and amounted to BMI – 33 [30; 39] and 33 [28; 36] kg/m3; p=0.039, C-reactive protein – 77 [47.5; 106.0] and 57 [27.0; 89.0] mg/l; p=0.015, in terms of creatinine level – 89 [70.0; 144.0] and 82 [66.0; 101.0] µmol/l; p=0.039, respectively. It was found that in the second week of hospitalization in the group of deceased patients with COVID-19 and T2DM, the creatinine level was statistically significantly higher than in surviving patients and amounted to 94.5 [71.5; 141.0] and 72.5 [57.0; 88.0] µmol/L; p0.001, respectively. The probability of death in hospitalized patients with type 2 COVID-19 and T2DM depended on BMI and creatinine levels at the second week of hospitalization. Patients with prehospital correction of hyperglycemia dipeptidyl peptidase-4 inhibitors (iDPP-4)/ glucagon-like peptide-1 receptor agonists (agGLP-1)/ sodium-glucose co-transporter 2 inhibitors (iSGLT-2) had significantly lower creatinine levels at week 2 of hospitalization.Conclusion. In patients with moderate to severe COVID-19 with concomitant T2DM, special attention should be paid to the combination of high BMI and creatinine in the second week of hospitalization, which is a prognostically unfavorable predictor of death in such patients.

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Glycemia control and choice of antihyperglycemic therapy in patients with type 2 diabetes mellitus and COVID-19: a consensus decision of the board of experts of the Russian association of endocrinologists

Cited by 18 publications

References 54 publications

The impact of carbohydrate metabolism disorders on the early and long-term clinical outcomes of patients with COVID-19 according to the AKTIV and AKTIV 2 registries

The impact of carbohydrate metabolism disorders on the early and long-term clinical outcomes of patients with COVID-19 according to the AKTIV and AKTIV 2 registries

Efficacy and safety of glucagon-like peptide-1 receptor agonists therapy initiation in patients with type 2 diabetes hospitalized with coronavirus infection

Features of the course of COVID-19 in patients with type 2 diabetes mellitus

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