Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
A Prospective 1-Year Follow-up of Glycemic Status and C-Peptide Levels of COVID-19 Survivors with Dysglycemia in Acute COVID-19 Infection: David Tak Wai Lui, Chi Ho Lee, Ying Wong, Carol Ho Yi Fong, Kimberly Hang Tsoi, Yu Cho Woo, Kathryn Choon Beng Tan; Diabetes Metab J. 2024;48(4):763-770. Published online March 11, 2024; DOI: https://doi.org/10.4093/dmj.2023.0175

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Abstract PDF PubReader ePub: Background
We evaluated changes in glycemic status, over 1 year, of coronavirus disease 2019 (COVID-19) survivors with dysglycemia in acute COVID-19.
Methods
COVID-19 survivors who had dysglycemia (defined by glycosylated hemoglobin [HbA1c] 5.7% to 6.4% or random glucose ≥10.0 mmol/L) in acute COVID-19 were recruited from a major COVID-19 treatment center from September to October 2020. Matched non-COVID controls were recruited from community. The 75-g oral glucose tolerance test (OGTT) were performed at baseline (6 weeks after acute COVID-19) and 1 year after acute COVID-19, with HbA1c, insulin and C-peptide measurements. Progression in glycemic status was defined by progression from normoglycemia to prediabetes/diabetes, or prediabetes to diabetes.
Results
Fifty-two COVID-19 survivors were recruited. Compared with non-COVID controls, they had higher C-peptide (P< 0.001) and trend towards higher homeostasis model assessment of insulin resistance (P=0.065). Forty-three COVID-19 survivors attended 1-year reassessment. HbA1c increased from 5.5%±0.3% to 5.7%±0.2% (P<0.001), with increases in glucose on OGTT at fasting (P=0.089), 30-minute (P=0.126), 1-hour (P=0.014), and 2-hour (P=0.165). At baseline, 19 subjects had normoglycemia, 23 had prediabetes, and one had diabetes. Over 1 year, 10 subjects (23.8%; of 42 non-diabetes subjects at baseline) had progression in glycemic status. C-peptide levels remained unchanged (P=0.835). Matsuda index decreased (P=0.007) and there was a trend of body mass index increase from 24.4±2.7 kg/m² to 25.6±5.2 (P=0.083). Subjects with progression in glycemic status had more severe COVID-19 illness than non-progressors (P=0.030). Reassessment was not performed in the control group.
Conclusion
Subjects who had dysglycemia in acute COVID-19 were characterized by insulin resistance. Over 1 year, a quarter had progression in glycemic status, especially those with more severe COVID-19. Importantly, there was no significant deterioration in insulin secretory capacity.

COVID-19
Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus: Real-World Data Analysis: Hye Jun Kim, Sang Jun Lee, Soonok Sa, Jung Ho Bae, Gyuseon Song, Chae Won Lee, Ju Hee Kim, Sung Ryul Shim, Myunghee Hong, Hyun Wook Han; Diabetes Metab J. 2023;47(3):356-365. Published online March 6, 2023; DOI: https://doi.org/10.4093/dmj.2022.0129

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Background
Little is known about the adverse events (AEs) associated with coronavirus disease 2019 (COVID-19) vaccination in patients with type 2 diabetes mellitus (T2DM).
Methods
This study used vaccine AE reporting system data to investigate severe AEs among vaccinated patients with T2DM. A natural language processing algorithm was applied to identify people with and without diabetes. After 1:3 matching, we collected data for 6,829 patients with T2DM and 20,487 healthy controls. Multiple logistic regression analysis was used to calculate the odds ratio for severe AEs.
Results
After COVID-19 vaccination, patients with T2DM were more likely to experience eight severe AEs than controls: cerebral venous sinus thrombosis, encephalitis myelitis encephalomyelitis, Bell’s palsy, lymphadenopathy, ischemic stroke, deep vein thrombosis (DVT), thrombocytopenia (TP), and pulmonary embolism (PE). Moreover, patients with T2DM vaccinated with BNT162b2 and mRNA-1273 were more vulnerable to DVT and TP than those vaccinated with JNJ-78436735. Among patients with T2DM administered mRNA vaccines, mRNA-1273 was safer than BNT162b2 in terms of the risk of DVT and PE.
Conclusion
Careful monitoring of severe AEs in patients with T2DM may be necessary, especially for those related to thrombotic events and neurological dysfunctions after COVID-19 vaccination.

Citations

Citations to this article as recorded by

Herbal-based therapeutics for diabetic patients with SARS-Cov-2 infection
Yousef Rasmi, Ighli di Bari, Shah Faisal, Munima Haque, Pornanong Aramwit, Aline da Silva, Elmira Roshani Asl
Molecular Biology Reports.2024;[Epub] CrossRef
Tuberculosis vaccines update: Is an RNA-based vaccine feasible for tuberculosis?
Sasha E. Larsen, Susan L. Baldwin, Rhea N. Coler
International Journal of Infectious Diseases.2023; 130: S47. CrossRef
Neurological Disorders following COVID-19 Vaccination
Ying Yang, Lisu Huang
Vaccines.2023; 11(6): 1114. CrossRef
Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus: Real-World Data Analysis (Diabetes Metab J 2023;47:356-65)
Hye Jun Kim, Sung Ryul Shim, Myunghee Hong, Hyun Wook Han
Diabetes & Metabolism Journal.2023; 47(5): 717. CrossRef
Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus: Real-World Data Analysis (Diabetes Metab J 2023;47:356-65)
Jung Hun Ohn
Diabetes & Metabolism Journal.2023; 47(5): 715. CrossRef

COVID-19
Impact of COVID-19 Lockdown on the Metabolic Control Parameters in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis: Ifan Ali Wafa, Nando Reza Pratama, Nurizzah Farahiyah Sofia, Elsha Stephanie Anastasia, Tiffany Konstantin, Maharani Ayuputeri Wijaya, M. Rifqi Wiyono, Lilik Djuari, Hermina Novida; Diabetes Metab J. 2022;46(2):260-272. Published online March 8, 2022; DOI: https://doi.org/10.4093/dmj.2021.0125

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Background
Abrupt implementation of lockdowns during the coronavirus disease 2019 (COVID-19) pandemic affected the management of diabetes mellitus in patients worldwide. Limited access to health facilities and lifestyle changes potentially affected metabolic parameters in patients at risk. We conducted a meta-analysis to determine any differences in the control of metabolic parameters in patients with diabetes, before and during lockdown.
Methods
We performed searches of five databases. Meta-analyses were carried out using random- or fixed-effect approaches to glycaemic control parameters as the primary outcome: glycosylated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), time-in-range (TIR), time-above-range (TAR), time-below-range (TBR). Mean difference (MD), confidence interval (CI), and P value were calculated. Lipid profile was a secondary outcome and is presented as a descriptive analysis.
Results
Twenty-one studies enrolling a total of 3,992 patients with type 1 or type 2 diabetes mellitus (T1DM or T2DM) were included in the study. Patients with T1DM showed a significant improvement of TIR and TAR (MD=3.52% [95% CI, 0.29 to 6.74], I²=76%, P=0.03; MD=–3.36% [95% CI, –6.48 to –0.25], I²=75%, P=0.03), while FBG among patients with T2DM significantly worsened (MD=3.47 mg/dL [95% CI, 1.22 to 5.73], I²=0%, P<0.01). No significant difference was found in HbA1c, RBG, and TBR. Use of continuous glucose monitoring in T1DM facilitated good glycaemic control. Significant deterioration of lipid parameters during lockdown, particularly triglyceride, was observed.
Conclusion
Implementation of lockdowns during the COVID-19 pandemic did not worsen glycaemic control in patients with diabetes. Other metabolic parameters improved during lockdown, though lipid parameters, particularly triglyceride, worsened.

Citations

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Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol
Samira Barbara Jabakhanji, Oluwabunmi Ogungbe, Sonia Y Angell, Lawrence Appel, David Byrne, Roopa Mehta, John McCaffrey, Lori Rosman, Edward W Gregg, Kunihiro Matsushita
BMJ Open.2024; 14(1): e074443. CrossRef
Influence of the COVID-19 pandemic on the achievement of guideline targets for HbA1c, blood pressure, and LDL cholesterol in people with diabetes in Japan
Shingo Kuwajima, Takahito Itoh, Tatsuya Sato, Shoya Ino, Satoru Shibata, Kouhei Ohno, Hiroyuki Hotta, Tomoaki Matsumoto, Hitoshi Ooiwa, Hirofumi Kubo, Takayuki Miki
Diabetology International.2024; 15(3): 507. CrossRef
Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico
Devany Paola Morales-Rodriguez, Arnulfo González-Cantú, Arnulfo Garza-Silva, Andrea Rivera-Cavazos, Iván Francisco Fernández-Chau, Andrea Belinda Cepeda-Medina, Miguel Angel Sanz-Sánchez, Gerardo Francisco del Rio-Parra, María Angelina Torres-Fuentes, Mig
Diabetology & Metabolic Syndrome.2024;[Epub] CrossRef
Excellence in the management of Advanced Hybrid Closed-Loop Systems: Lessons from the Polish cohort
Bartłomiej Matejko, Tim van den Heuvel, Javier Castaneda, Arcelia Arrieta, Katarzyna Cyranka, Ohad Cohen, Maciej Małecki, Tomasz Klupa
Diabetes Research and Clinical Practice.2024; 216: 111832. CrossRef
Glycemic Control in Type 1 Diabetes Mellitus and COVID-19: What We Learned From the Lockdown Experience
Catarina Almeida, André Ferreira, Daniela Duarte, Ana Filipa Viegas, André Santos, Alexandra Vaz, Edite Nascimento
Cureus.2023;[Epub] CrossRef
Changes in body weight and glycemic control in association with COVID-19 Shutdown among 23,000 adults with type 2 diabetes
Emily Panza, Kevin E. Kip, Kripa Venkatakrishnan, Oscar C. Marroquin, Rena R. Wing
Acta Diabetologica.2023; 60(6): 787. CrossRef
The Impact of a Lockdown for the COVID-19 Pandemic on Seasonal HbA1c Variation in Patients with Type 2 Diabetes
Yu-Cheng Cheng, Yu-Hsuan Li, Hsiu-Chen Liu, Chiann-Yi Hsu, Wan-Jen Chang, I-Te Lee, Chin-Li Lu
Life.2023; 13(3): 763. CrossRef
The Impact of Partial Lockdown During COVID-19 Pandemic on Metabolic Control in People with Type 2 Diabetes Mellitus
Ayşe Zülal TOKAÇ, Tuğde Buse UĞUR, Buse Ecem KURUGÖL, Sevilay ALİGÜLÜ, Osman HAYRAN
Journal of Biotechnology and Strategic Health Research.2023; 7(1): 67. CrossRef
Retrospective Study on the Impact of COVID-19 Lockdown on Patients with Type 2 Diabetes in Northern Taiwan
Hsuan Huang, Hsiao-Ling Su, Chih-Hsung Huang, Yi-Hsin Lin
Diabetes, Metabolic Syndrome and Obesity.2023; Volume 16: 2539. CrossRef
RIPK1 and RIPK3 inhibitors: potential weapons against inflammation to treat diabetic complications
Dan Ke, Zhen Zhang, Jieting Liu, Peijian Chen, Yucen Dai, Xinhai Sun, Yanhui Chu, Luxin Li
Frontiers in Immunology.2023;[Epub] CrossRef
“Does Physical Exercise Promote Health Benefits for Diabetic Patients during the COVID-19 Pandemic?”: A Systematic Review
Erivaldo de Souza, Daniela Meneses-Santos, Josué Cruz Santos, Felipe J. Aidar, Carla Roberta de Oliveira Carvalho, Jymmys Lopes dos Santos, Anderson Carlos Marçal
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Impact of National Lockdown From COVID-19 Pandemic in Patients With Type 2 Diabetes: An Observational Study
Nuntakorn Thongtang, Niracha Chanwimol, Lukana Preechasuk, Varisara Boonyuang, Pinyo Rattanaumpawan, Supawadee Likitmaskul, Apiradee Sriwijitkamol
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COVID-19
Association of Metabolic Syndrome with COVID-19 in the Republic of Korea: Woo-Hwi Jeon, Jeong-Yeon Seon, So-Youn Park, In-Hwan Oh; Diabetes Metab J. 2022;46(3):427-438. Published online November 26, 2021; DOI: https://doi.org/10.4093/dmj.2021.0105

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Background
Metabolic syndrome (MetS) is reportedly a crucial risk factor for coronavirus disease 2019 (COVID-19). Since the epidemiological studies that examine this association are few and include small samples, we investigated the relationship between MetS and COVID-19 severity and death using a larger sample in the Republic of Korea.
Methods
We analyzed 66,321 patients, 4,066 of whom had COVID-19. We used chi-square tests to examine patients’ characteristics. We performed logistic regression analysis to analyze differences in COVID-19 infection and clinical outcomes according to the presence of MetS.
Results
Although MetS was not significantly associated with COVID-19 risk, acquiring MetS was significantly associated with the risk of severe COVID-19 outcomes (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.34 to 2.91; P=0.001). The mortality risk was significantly higher in COVID-19 patients with MetS (OR, 1.74; 95% CI, 1.17 to 2.59; P=0.006). Patients with abnormal waist circumference were approximately 2.07 times more likely to develop severe COVID-19 (P<0.001), and high-density lipoprotein cholesterol (HDL-C) levels were significantly associated with COVID-19; the mortality risk due to COVID-19 was 1.74 times higher in men with an HDL-C level of <40 mg/dL and in women with an HDL-C level of <50 mg/dL (P=0.012).
Conclusion
COVID-19 is likely associated with severity and death in patients with MetS or in patients with MetS risk factors. Therefore, patients with MetS or those with abnormal waist circumference and HDL-C levels need to be treated with caution.

Citations

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Heterogeneity in familial clustering of metabolic syndrome components in the multiethnic GENNID study
Jia Y. Wan, Deborah Goodman, Sukh Makhnoon, Trina M. Norden‐Krichmar, Baolin Wu, Karen L. Edwards
Obesity.2024; 32(1): 176. CrossRef
Identification of shared genetic risks underlying metabolic syndrome and its related traits in the Korean population
Jun Young Kim, Yoon Shin Cho
Frontiers in Genetics.2024;[Epub] CrossRef
Metabolic health is more strongly associated with the severity and mortality of coronavirus disease 2019 than obesity
Hye Yeon Koo, Jae-Ryun Lee, Jin Yong Lee, Hyejin Lee
Archives of Public Health.2024;[Epub] CrossRef
Associated Factors with Changes of Metabolic Abnormalities among General Population in COVID-19 Pandemic
Eunjoo Kwon, Eun-Hee Nah, Suyoung Kim, Seon Cho, Hyeran Park
Korean Journal of Health Promotion.2023; 23(2): 55. CrossRef
Association between metabolic syndrome and mortality in patients with COVID-19: A nationwide cohort study
Hyo Jin Park, Jin-Hyung Jung, Kyungdo Han, Jean Shin, Yoojeong Lee, Yujin Chang, Kyeyeung Park, Yoon Jeong Cho, Youn Seon Choi, Seon Mee Kim, Ga Eun Nam
Obesity Research & Clinical Practice.2022; 16(6): 484. CrossRef

COVID-19
Effects of Social Distancing on Diabetes Management in Older Adults during COVID-19 Pandemic: Soo Myoung Shin, Tae Jung Oh, Sung Hee Choi, Hak Chul Jang; Diabetes Metab J. 2021;45(5):765-772. Published online August 30, 2021; DOI: https://doi.org/10.4093/dmj.2021.0096

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Background
On March 22, 2020, intense social distancing (SD) was implemented in Korea to prevent the spread of coronavirus disease 19 (COVID-19). This study examined the impact of SD on diabetes control in older adults with diabetes.
Methods
Adults aged 60 to 90 years with type 2 diabetes mellitus who were physically and mentally independent were recruited. Participants who had complete blood chemistry data from April to July 2019 (pre-SD era) and April to July 2020 (SD era) were enrolled. Data were obtained about physical activity, nutrition, sarcopenia, and psychological and mental health from questionnaires in April to July 2020. Calf circumference was measured.
Results
In total, 246 people (100 men, 146 women; mean age, 73.8±5.7 years) participated in this study. The levels of glycated hemoglobin (HbA1c, 7.4%±1.0% vs. 7.1%±0.8%, P<0.001), fasting glucose (142.2±16.7 mg/dL vs. 132.0±27.7 mg/dL, P<0.001), and body weight (62.6±9.4 kg vs. 61.8±10.1 kg, P<0.01) were higher in the SD era than in the pre-SD era. Total physical activity was lower in the SD era (2,584.6±2,624.1 MET-min/week^–1 vs. 1,987.3±2,295.0 MET-min/week^–1, P<0.001). A larger increase in HbA1c level was associated with increased body weight and decreased physical activity.
Conclusion
SD had negative effects on diabetes management in older adults with diabetes. Fasting glucose and HbA1c levels and body weight increased during the SD era. Participants with reduced physical activity gained more weight and had higher blood glucose levels. Given that the COVID-19 pandemic is ongoing, health professionals and diabetes educators should monitor changes in lifestyle factors in older adults with diabetes.

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Kirrilee Jane Barlow, Paul P Fahey, Evan Atlantis
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Social isolation, loneliness and subsequent risk of major adverse cardiovascular events among individuals with type 2 diabetes mellitus
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Stress, Depression, and Unhealthy Behavior Changes among Patients with Diabetes during COVID-19 in Korea
Hae Ran Kim, Jeong-Soon Kim
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Reply to comment on “Unexpected decline in glycated hemoglobin level after emergency COVID‐19 measures in three robust older Japanese women with prediabetes/mild type 2 diabetes”
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Geriatrics & Gerontology International.2022; 22(7): 541. CrossRef
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Rubén A. García-Lara, José L. Gómez-Urquiza, María José Membrive-Jiménez, Almudena Velando-Soriano, Monserrat E. Granados-Bolivar, José L. Romero-Béjar, Nora Suleiman-Martos
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COVID-19
Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19: Sang Youl Rhee, Jeongwoo Lee, Hyewon Nam, Dae-Sung Kyoung, Dong Wook Shin, Dae Jung Kim; Diabetes Metab J. 2021;45(2):251-259. Published online March 5, 2021; DOI: https://doi.org/10.4093/dmj.2020.0206

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Background
Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM).
Methods
As of May 2020, analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Insurance Review and Assessment Service (HIRA) database in Korea. Using this dataset, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Additionally, we validated the results using the National Health Insurance Service (NHIS) of Korea dataset.
Results
Totally, data of 67,850 subjects were accessible in the HIRA dataset. Of these, 5,080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 (95% confidence interval [CI], 0.135 to 0.971), and that for RAS blockade users was 0.599 (95% CI, 0.251 to 1.431). These findings were consistent with the analysis based on the NHIS data using 704 final subjects. The adjusted odds ratio for severe treatment among DPP-4i users was 0.303 (95% CI, 0.135 to 0.682), and that for RAS blockade users was 0.811 (95% CI, 0.391 to 1.682).
Conclusion
This study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19.

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COVID-19
Use of Renin-Angiotensin-Aldosterone System Inhibitors and Severe COVID-19 Outcomes in Patients with Hypertension: A Nationwide Cohort Study: Jae Hyun Bae, Sun Kyu Choi, Nam Hoon Kim, Juneyoung Lee, Sin Gon Kim; Diabetes Metab J. 2021;45(3):430-438. Published online February 22, 2021; DOI: https://doi.org/10.4093/dmj.2020.0279

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Background
Angiotensin-converting enzyme 2 facilitates the entry of severe acute respiratory syndrome coronavirus 2 into the human body. We investigated the association of renin-angiotensin-aldosterone system (RAAS) inhibitor use with severe coronavirus disease 2019 (COVID-19) outcomes in hypertensive patients.
Methods
We identified hypertensive patients with confirmed COVID-19 from the Korean Health Insurance Review and Assessment Service from inception to May 15, 2020. The primary outcome was the composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and death from COVID-19. The individual components were evaluated as secondary outcomes.
Results
Of 1,374 hypertensive patients with COVID-19, 1,076 (78.3%) and 298 (21.7%) were users and never-users of RAAS inhibitors, respectively. The RAAS inhibitor users were not associated with the risk of the primary outcome (adjusted odds ratio [aOR], 0.72; 95% confidence interval [CI], 0.46 to 1.10). The risk of ICU admission was significantly lower in the users than the never-users (aOR, 0.44; 95% CI, 0.24 to 0.84). The RAAS inhibitors were beneficial only in ICU admissions that did not require IMV (aOR, 0.28; 95% CI, 0.14 to 0.58). The risk of death from COVID-19 was comparable between the groups (aOR, 1.09; 95% CI, 0.64 to 1.85). We could not evaluate the risks of CRRT and ECMO owing to the small number of events.
Conclusion
RAAS inhibitor use was not associated with the composite of severe outcomes in the hypertensive patients with COVID-19 but significantly lowered the risk of ICU admission, particularly in patients who did not require IMV.

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Systematic review and meta-analysis of the clinical outcomes of ACEI/ARB in East-Asian patients with COVID-19
Nancy Xurui Huang, Qi Yuan, Fang Fang, Bryan P. Yan, John E. Sanderson, Masaki Mogi
PLOS ONE.2023; 18(1): e0280280. CrossRef
Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research
Jordan Loader, Frances C. Taylor, Erik Lampa, Johan Sundström
Journal of the American Heart Association.2022;[Epub] CrossRef
Renin-angiotensin-aldosterone system blockers in Bulgarian COVID-19 patients with or without chronic kidney disease
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Medicine.2022; 101(48): e31988. CrossRef

COVID-19
Does Diabetes Increase the Risk of Contracting COVID-19? A Population-Based Study in Korea: Sung-Youn Chun, Dong Wook Kim, Sang Ah Lee, Su Jung Lee, Jung Hyun Chang, Yoon Jung Choi, Seong Woo Kim, Sun Ok Song; Diabetes Metab J. 2020;44(6):897-907. Published online December 23, 2020; DOI: https://doi.org/10.4093/dmj.2020.0199

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Background
This study aimed to determine the infection risk of coronavirus disease 2019 (COVID-19) in patients with diabetes (according to treatment method).
Methods
Claimed subjects to the Korean National Health Insurance claims database diagnosed with COVID-19 were included. Ten thousand sixty-nine patients with COVID-19 between January 28 and April 5, 2020, were included. Stratified random sampling of 1:5 was used to select the control group of COVID-19 patients. In total 50,587 subjects were selected as the control group. After deleting the missing values, 60,656 subjects were included.
Results
Adjusted odds ratio (OR) indicated that diabetic insulin users had a higher risk of COVID-19 than subjects without diabetes (OR, 1.25; 95% confidence interval [CI], 1.03 to 1.53; P=0.0278). In the subgroup analysis, infection risk was higher among diabetes male insulin users (OR, 1.42; 95% CI, 1.07 to 1.89), those between 40 and 59 years (OR, 1.66; 95% CI, 1.13 to 2.44). The infection risk was higher in diabetic insulin users with 2 to 4 years of morbidity (OR, 1.744; 95% CI, 1.003 to 3.044).
Conclusion
Some diabetic patients with certain conditions would be associated with a higher risk of acquiring COVID-19, highlighting their need for special attention. Efforts are warranted to ensure that diabetic patients have minimal exposure to the virus. It is important to establish proactive care and screening tests for diabetic patients suspected with COVID-19 for timely disease diagnosis and management.

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Short Communication

COVID-19
Impact of Social Distancing Due to Coronavirus Disease 2019 on the Changes in Glycosylated Hemoglobin Level in People with Type 2 Diabetes Mellitus: Sung-Don Park, Sung-Woo Kim, Jun Sung Moon, Yin Young Lee, Nan Hee Cho, Ji-Hyun Lee, Jae-Han Jeon, Yeon-Kyung Choi, Mi Kyung Kim, Keun-Gyu Park; Diabetes Metab J. 2021;45(1):109-114. Published online December 4, 2020; DOI: https://doi.org/10.4093/dmj.2020.0226

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This study investigated the impact of social distancing due to coronavirus disease 2019 (COVID-19) on glycemic control in people with type 2 diabetes mellitus (T2DM). We retrospectively analyzed the change in glycosylated hemoglobin level (ΔHbA1c) in people with T2DM who undertook social distancing because of COVID-19. We compared the ΔHbA1c between COVID-19 and non-COVID-19 cohorts that were enrolled at the same time of year. The ΔHbA1c of the COVID-19 cohort was significantly higher than that of two non-COVID-19 cohorts. Subgroup analysis according to age and baseline HbA1c level showed that social distancing significantly increased the mean HbA1c level of participants of <50 years. The ΔHbA1c of participants of <50 years and with HbA1c <7.0% in the COVID-19 cohort showed larger changes than other subgroups. In adjusted model, adjusted ΔHbA1c levels in the COVID-19 cohort remained significantly higher than those in the two other cohorts. Social distancing negatively impacts blood glucose control in people with T2DM, especially those who are younger and have good blood glucose control.

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Original Articles

COVID-19
Independent Impact of Diabetes on the Severity of Coronavirus Disease 2019 in 5,307 Patients in South Korea: A Nationwide Cohort Study: Sun Joon Moon, Eun-Jung Rhee, Jin-Hyung Jung, Kyung-Do Han, Sung-Rae Kim, Won-Young Lee, Kun-Ho Yoon; Diabetes Metab J. 2020;44(5):737-746. Published online October 21, 2020; DOI: https://doi.org/10.4093/dmj.2020.0141

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Background
Inconsistent results have been observed regarding the independent effect of diabetes on the severity of coronavirus disease 2019 (COVID-19). We conducted a nationwide population-based cohort study to evaluate the relationship between diabetes and COVID-19 severity in South Korea.
Methods
Patients with laboratory-confirmed COVID-19 aged ≥30 years were enrolled and medical claims data were obtained from the Korean Health Insurance Review and Assessment Service. Hospitalization, oxygen treatment, ventilator application, and mortality were assessed as severity outcomes. Multivariate logistic regression analyses were performed after adjusting for age, sex, and comorbidities.
Results
Of 5,307 COVID-19 patients, the mean age was 56.0±14.4 years, 2,043 (38.5%) were male, and 770 (14.5%) had diabetes. The number of patients who were hospitalized, who received oxygen, who required ventilator support, and who died was 4,986 (94.0%), 884 (16.7%), 121 (2.3%), and 211 (4.0%), respectively. The proportion of patients with diabetes in the abovementioned outcome groups was 14.7%, 28.1%, 41.3%, 44.6%, showing an increasing trend according to outcome severity. In multivariate analyses, diabetes was associated with worse outcomes, with an adjusted odds ratio (aOR) of 1.349 (95% confidence interval [CI], 1.099 to 1.656; P=0.004) for oxygen treatment, an aOR of 1.930 (95% CI, 1.276 to 2.915; P<0.001) for ventilator use, and an aOR of 2.659 (95% CI, 1.896 to 3.729; P<0.001) for mortality.
Conclusion
Diabetes was associated with worse clinical outcomes in Korean patients with COVID-19, independent of other comorbidities. Therefore, patients with diabetes and COVID-19 should be treated with caution.

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Covid-19
The Clinical Characteristics and Outcomes of Patients with Moderate-to-Severe Coronavirus Disease 2019 Infection and Diabetes in Daegu, South Korea: Mi Kyung Kim, Jae-Han Jeon, Sung-Woo Kim, Jun Sung Moon, Nan Hee Cho, Eugene Han, Ji Hong You, Ji Yeon Lee, Miri Hyun, Jae Seok Park, Yong Shik Kwon, Yeon-Kyung Choi, Ki Tae Kwon, Shin Yup Lee, Eon Ju Jeon, Jin-Woo Kim, Hyo-Lim Hong, Hyun Hee Kwon, Chi Young Jung, Yin Young Lee, Eunyeoung Ha, Seung Min Chung, Jian Hur, June Hong Ahn, Na-young Kim, Shin-Woo Kim, Hyun Ha Chang, Yong Hoon Lee, Jaehee Lee, Keun-Gyu Park, Hyun Ah Kim, Ji-Hyun Lee; Diabetes Metab J. 2020;44(4):602-613. Published online August 12, 2020; DOI: https://doi.org/10.4093/dmj.2020.0146

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Background

Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes.

Methods

We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group.

Results

Compared with the non-DM group (n=847), patients with DM (n=235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease.

Conclusion

DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.

Citations

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Review

Complications
Coronavirus Disease 2019 and Diabetes: The Epidemic and the Korean Diabetes Association Perspective: Junghyun Noh, Hyun-Ha Chang, In-Kyung Jeong, Kun Ho Yoon; Diabetes Metab J. 2020;44(3):372-381. Published online June 29, 2020; DOI: https://doi.org/10.4093/dmj.2020.0138

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Abstract PDF PubReader

Diabetes has been associated with more severe outcomes and higher mortality in coronavirus disease 2019 (COVID-19) patients compare to morbidity and mortality in patients without diabetes. Several mechanisms may play a role in this greater morbidity and mortality, especially uncontrolled hyperglycemia, an impaired immune system, pre-existing proinflammatory states, multiple comorbidities, and dysregulated angiotensin-converting enzyme 2 signaling. Thus, the diabetes medical community emergently needs to know about COVID-19 and its effects on patients with diabetes, as they must take precautions to carefully manage these patients during the COVID-19 pandemic. The Korean Diabetes Association provides some guidance and practical recommendations for the management of diabetes during the pandemic. This report provides insight into the association between diabetes and COVID-19, proper management of diabetes in patients with COVID-19 and an official suggestion by the Korean Diabetes Association for managing the COVID-19 outbreak.

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Original Article

Complications
The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study: Seung Min Chung, Yin Young Lee, Eunyeong Ha, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee, Jian Hur, Kyung Soo Hong, Jong Geol Jang, Hyun Jung Jin, Eun Young Choi, Kyeong-Cheol Shin, Jin Hong Chung, Kwan Ho Lee, June Hong Ahn, Jun Sung Moon; Diabetes Metab J. 2020;44(3):405-413. Published online May 21, 2020; DOI: https://doi.org/10.4093/dmj.2020.0105

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Background

To determine the role of diabetes mellitus (DM) in the coronavirus disease 2019 (COVID-19), we explored the clinical characteristics of patients with DM and compared risk factors such as age, glycemic control, and medications to those without DM.

Methods

This was a retrospective cohort study of 117 confirmed patients with COVID-19 which conducted at a tertiary hospital in Daegu, South Korea. The primary outcome was defined as the severe and critical outcome (SCO), of which the composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality. We analyzed what clinical features and glycemic control-related factors affect the prognosis of COVID-19 in the DM group.

Results

After exclusion, 110 participants were finally included. DM patients (n=29) was older, and showed higher blood pressure compared to non-DM patients. DM group showed higher levels of inflammation-related biomarkers and severity score, and highly progressed to SCO. After adjustment with other risk factors, DM increased the risk of SCO (odds ratio [OR], 10.771; P<0.001). Among the DM patients, SCO was more prevalent in elderly patients of ≥70 years old and age was an independent risk factor for SCO in patients with DM (OR, 1.175; P=0.014), while glycemic control was not. The use of medication did not affect the SCO, but the renin-angiotensin system inhibitors showed protective effects against acute cardiac injury (OR, 0.048; P=0.045).

Conclusion

The COVID-19 patients with DM had higher severity and resulted in SCO. Intensive and aggressive monitoring of COVID-19 clinical outcomes in DM group, especially in elderly patients is warranted.

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Brief Report

Complications
Acute Hyperglycemic Crises with Coronavirus Disease-19: Case Reports: Na-young Kim, Eunyeong Ha, Jun Sung Moon, Yong-Hoon Lee, Eun Young Choi; Diabetes Metab J. 2020;44(2):349-353. Published online April 23, 2020; DOI: https://doi.org/10.4093/dmj.2020.0091

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Abstract PDF PubReader

Since the first case was contracted by coronavirus disease-19 (COVID-19) in Daegu, Korea in February 2020, about 6,800 cases and 130 deaths have been reported on April 9, 2020. Recent studies have reported that patients with diabetes showed higher mortality and they had a worse prognosis than the group without diabetes. In poorly controlled patients with diabetes, acute hyperglycemic crises such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) also might be precipitated by COVID-19. Thus, intensive monitoring and aggressive supportive care should be needed to inadequately controlled patients with diabetes and COVID-19 infection. Here, we report two cases of severe COVID-19 patients with acute hyperglycemic crises in Korea.

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Diabetes, Obesity and Metabolism.2023; 25(7): 1785. CrossRef
Risks associated with acute pancreatitis (AP) with diabetic ketoacidosis (DKA) in COVID-19 patients: a literature review
Sundru Manjulata Devi, Annapurna Pamreddy, Venkata Ramana Narendra
Journal of Diabetes & Metabolic Disorders.2023; 22(1): 135. CrossRef
A Review of Hyperglycemia in COVID-19
Maryam Zahedi, Saba Kordrostami, Mohammadreza Kalantarhormozi, Marziyeh Bagheri
Cureus.2023;[Epub] CrossRef
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Diabetic Ketoacidosis in COVID-19 Patients: Clinical Characteristics and Outcomes – A Retrospective Study in a Single Tertiary Care Hospital, Dubai, United Arab Emirates
Hana AL Sughaiyer, Abeer AL Haj, Samia Murad Ibrahim Abdulrahman
Dubai Diabetes and Endocrinology Journal.2023; 29(2): 107. CrossRef
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Artur Furga
Probacja.2023; 3: 235. CrossRef
COVID-19 SALGININDA DİYABET YÖNETİMİ VE HEMŞİRENİN ROLÜ
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American Journal of Physiology-Endocrinology and Metabolism.2022; 322(1): E44. CrossRef
COVID-19 and hyperglycaemic emergencies: perspectives from a developing country
Raisa Bhikoo, Marli Conradie-Smit, Gerhard Van Wyk, Sa’ad Lahri, Elizabeth Du Plessis, Jaco Cilliers, Susan Hugo, Ankia Coetzee
Journal of Endocrinology, Metabolism and Diabetes of South Africa.2022; 27(1): 42. CrossRef
Potential impact of combined influenza and pneumococcal vaccines on the severity of respiratory illness in COVID-19 infection among type 2 diabetic patients
Amr Shaaban Hanafy, Waseem M. Seleem, Hany A. Elkattawy
Clinical and Experimental Medicine.2022;[Epub] CrossRef
The COVID-19-diabetes mellitus molecular tetrahedron
Mehdi Mahmudpour, Katayoun Vahdat, Mohsen Keshavarz, Iraj Nabipour
Molecular Biology Reports.2022; 49(5): 4013. CrossRef
Diabetes and COVID-19; A Bidirectional Interplay
Paraskevi Kazakou, Vaia Lambadiari, Ignatios Ikonomidis, Aikaterini Kountouri, Georgios Panagopoulos, Stavros Athanasopoulos, Eleni Korompoki, Ioannis Kalomenidis, Meletios A. Dimopoulos, Asimina Mitrakou
Frontiers in Endocrinology.2022;[Epub] CrossRef
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Signal Transduction and Targeted Therapy.2022;[Epub] CrossRef
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Rajesh Kethireddy, Darshan Gandhi, Asim Kichloo, Love Patel
World Journal of Critical Care Medicine.2022; 11(4): 219. CrossRef
New-Onset and Persistent Insulin-Dependent Diabetes in Patients With COVID-19: A Peruvian Experience
Anthony Ramos-Yataco, Emanuel A Salcedo Davila, Kelly Meza, Inga Harbuz-Miller
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Type 2 Diabetes Mellitus and COVID-19: A Narrative Review
Cristina Rey-Reñones, Sara Martinez-Torres, Francisco M. Martín-Luján, Carles Pericas, Ana Redondo, Carles Vilaplana-Carnerero, Angela Dominguez, María Grau
Biomedicines.2022; 10(9): 2089. CrossRef
SARS-CoV-2 Infections, Impaired Tissue, and Metabolic Health: Pathophysiology and Potential Therapeutics
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Tropical Doctor.2021; 51(1): 126. CrossRef
Diabetic emergencies during the COVID‐19 pandemic: A case–control study
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Diabetic ketoacidosis presented with COVID-19 infection: A rare case report
Deniz Çekiç, Selçuk Yaylacı, Sümeyye Çekiç, Kubilay İşsever, Hamad Dheir, Havva Kocayiğit, Mehmet Halil Öztürk, Oğuz Karabay
Journal of Clinical Medicine of Kazakhstan.2021; 18(1): 79. CrossRef
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BMC Infectious Diseases.2021;[Epub] CrossRef
Increased Incidence of Pediatric Diabetic Ketoacidosis After COVID-19: A Two-Center Retrospective Study in Korea
Min Jeong Han, Jun Ho Heo
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 783. CrossRef
Diabetes, obesity, and insulin resistance in COVID-19: molecular interrelationship and therapeutic implications
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Diabetology & Metabolic Syndrome.2021;[Epub] CrossRef
Neuropsychiatric Symptoms of COVID-19 Explained by SARS-CoV-2 Proteins’ Mimicry of Human Protein Interactions
Hale Yapici-Eser, Yunus Emre Koroglu, Ozgur Oztop-Cakmak, Ozlem Keskin, Attila Gursoy, Yasemin Gursoy-Ozdemir
Frontiers in Human Neuroscience.2021;[Epub] CrossRef
COVID-19 and Diabetic Ketoacidosis: Report of Eight Cases
Balraj Singh, Prem Patel , Parminder Kaur , Nicole Majachani, Michael Maroules
Cureus.2021;[Epub] CrossRef
Machine Learning Applied to Clinical Laboratory Data in Spain for COVID-19 Outcome Prediction: Model Development and Validation
Juan L Domínguez-Olmedo, Álvaro Gragera-Martínez, Jacinto Mata, Victoria Pachón Álvarez
Journal of Medical Internet Research.2021; 23(4): e26211. CrossRef
Effect of COVID-19 on management of type 1 diabetes: Pushing the boundaries of telemedical healthcare
Ines Bilic Curcic, Maja Cigrovski Berkovic, Tomislav Kizivat, Silvija Canecki Varzic, Robert Smolic, Martina Smolic
World Journal of Diabetes.2021; 12(6): 780. CrossRef
COVID-19 and Diabetes: Understanding the Interrelationship and Risks for a Severe Course
Cyril P. Landstra, Eelco J. P. de Koning
Frontiers in Endocrinology.2021;[Epub] CrossRef
Real-World Studies Support Use of Continuous Glucose Monitoring in Type 1 and Type 2 Diabetes Independently of Treatment Regimen
James R. Gavin, Clifford J. Bailey
Diabetes Technology & Therapeutics.2021; 23(S3): S-19. CrossRef
Evaluation of Characteristics and Outcomes for Patients with Diabetic Ketoacidosis (DKA) With and Without COVID-19 in Elmhurst Queens During Similar Three-Month Periods in 2019 and 2020
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Cureus.2021;[Epub] CrossRef
Temporal trends in emergency admissions for diabetic ketoacidosis in people with diabetes in England before and during the COVID-19 pandemic: a population-based study
Shivani Misra, Emma Barron, Eszter Vamos, Stephen Thomas, Ketan Dhatariya, Partha Kar, Bob Young, Kamlesh Khunti, Jonathan Valabhji
The Lancet Diabetes & Endocrinology.2021; 9(10): 671. CrossRef
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World Journal of Clinical Cases.2021; 9(28): 8327. CrossRef
Follow-Up Study of the Cardiopulmonary and Psychological Outcomes of COVID-19 Survivors Six Months After Discharge in Sichuan, China
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International Journal of General Medicine.2021; Volume 14: 7207. CrossRef
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Saad Alhumaid, Abbas Al Mutair, Zainab Al Alawi, Ali A. Rabaan, Mohammed A. Alomari, Sadiq A. Al Salman, Ahmed S. Al-Alawi, Mohammed H. Al Hassan, Hesham Alhamad, Mustafa A. Al-kamees, Fawzi M. Almousa, Hani N. Mufti, Ali M. Alwesabai, Kuldeep Dhama, Jaff
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Toddler With New Onset Diabetes and Atypical Hemolytic-Uremic Syndrome in the Setting of COVID-19
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The Journal of Clinical Endocrinology & Metabolism.2020; 105(8): 2819. CrossRef
A Case of Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State in a Patient With COVID-19
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Maureen Czick, Christine Shapter, Robert Shapter
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2020; Volume 13: 3169. CrossRef
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The Lancet Diabetes & Endocrinology.2020; 8(9): 782. CrossRef
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Diabetes Research and Clinical Practice.2020; 166: 108303. CrossRef
Hyperglycemia, Hypertriglyceridemia, and Acute Pancreatitis in COVID-19 Infection
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The Journal of Korean Diabetes.2020; 21(3): 120. CrossRef
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Katie C. Coate, Jeeyeon Cha, Shristi Shrestha, Wenliang Wang, Luciana Mateus Gonçalves, Joana Almaça, Meghan E. Kapp, Maria Fasolino, Ashleigh Morgan, Chunhua Dai, Diane C. Saunders, Rita Bottino, Radhika Aramandla, Regina Jenkins, Roland Stein, Klaus H.
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