A.I. Burnasyan Scientific journal FMBC

Clinical Bulletin

ISSN 2782-6430 (print)

State Research Center −Burnasyan Federal Medical Biophysical
Center of Federal Medical Biological Agency

The journal is published in Russian.
Format – A4.
The periodicity of the journal is 4 times a year.

Issue №1 2024 год

more

A.I. Burnasyan  FMBC clinical bulletin. 2022 № 2

Diabetes Mellitus and Obesity in Covid-19: Epidemiology, Pathogenesis, Approach to the Treatment
I.V. Trigolosova1, E.A.Praskurnichiy1, T.U. Hodeeva2, N.N. Hizniak2

1A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia
2FGBU FKC VMT FMBA Russia, Moscow
Contact person: Praskurnichiy Evgeniy Arkad’evich: praskurnichey@mail.ru

Abstract
Obesity and Diabetes mellitus (DM) along with cardiovascular, respiratory and cancer disease are main risk factors of high morbidity and severe coronavirus disease of 2019 (COVID-19). Mortality rate in obesity patients depends on BMI and increasing in 1,5-4 times in case of morbidity obesity. Type 2 Diabetes mellitus (T2DM) and arterial hypertension increase the risk of severe COVID-19 and that risk increasing in combination obesity and DM and/or arterial hypertension. The severe COVID-19 depends on degree of glycosylated hemoglobin (HbA1c). The mortality risk in COVID-19 patients with HbA1c >10% greatly increase in T2DM as well as in T1DM. In a systematic review of 3,711 COVID-19 patients from 8 studies (492 patients with new-onset diabetes), the pooled prevalence of new-onset diabetes was 14.4% (95% CI 5.9–25.8%) from a random-effect meta-analysis. The pathogenesis of hyperglycemia in COVID-19 – multifactorial process, including direct injure β-cells by SARS CoV2, inflammation in pancreatic ducts, stress hyperglycemia, increase insulin resistance due to cytokine storm and steroid-induced diabetes. Given the presence of several mechanisms involved in the development of hyperglycemia with COVID-19, the approach to therapy DM in Covid-19 may be differ from current guidelines. Development of new algorithms of hyperglycemia therapy for Covid-19 and their introduction into clinical practice is the most important task of modern endocrinological science, as it will prevent serious consequences and ensure a decrease in mortality in Covid-19

Keywords: diabetes mellitus , Covid-19 obesity,, hyperglycemia, insulin therapy

For citation: Trigolosova I.V.,.Praskurnichiy E.A,. Hodeeva T.U, Hizniak N.N. Diabetes mellitus and obesity in Covid-19: epidemiology, pathogenesis, approach to the treatment. A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2022.2:54-59. (In Russian) DOI: 10.33266/2782-6430-2022-2-54-59

REFERENCES

  1. World Health Organization. Weekly epidemiological update on COVID-19 – 1 March 2022. URL: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—1-march-2022.
  2. Williamson E.J., Walker A.J., Bhaskaran K., Bacon S., Bates C., Morton C.E., Curtis H.J., Mehrkar A., Evans D., Inglesby P., Cockburn J., McDonald H.I., MacKenna B., Tomlinson L., Douglas I.J., Rentsch C.T., Mathur R., Wong A.Y.S., Grieve R., Harrison D., Forbes H., Schultze A., Croker R., Parry J., Hester F., Harper S., Perera R., Evans S.J.W., Smeeth L., Goldacre B. Factors Associated with COVID-19-Related Death Using OpenSAFELY. Nature. 2020;584;7821:430-436. doi: 10.1038/s41586-020-2521-4.
  3. Wu Z., McGoogan J.M. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323;13:1239-1242. doi: 10.1001/jama.2020.2648.
  4. Guo W., Li M., Dong Y., Zhou H., Zhang Z., Tian C., et al. Diabetes is a Risk Factor for the Progression and Prognosis of COVID‐19. Diabetes Metab Res Rev [Internet]. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228407 (Accessed date: 02.07.2020).
  5. Hippisley-Cox J., Young D., Coupland C., Channon K.M., Tan P.S., Harrison D.A., Rowan K., Aveyard P., Pavord I.D., Watkinson P.J. Risk of Severe COVID-19 Disease with ACE Inhibitors and Angiotensin Receptor Blockers: Cohort Study Including 8.3 Million People. Heart. 2020;106;19:1503-1511. doi: 10.1136/heartjnl-2020-317393.
  6. Petrilli C.M., Jones S.A., Yang J., Rajagopalan H., O’Donnell L., Chernyak Y., Tobin K.A., Cerfolio R.J., Francois F., Horwitz L.I. Factors Associated with Hospital Admission and Critical Illness among 5279 People with Coronavirus Disease 2019 in New York City: Prospective Cohort Study. BMJ. 2020;369:m1966. doi: 10.1136/bmj.m1966.
  7. Klang E., Kassim G., Soffer S., Freeman R., Levin M.A., Reich D.L. Severe Obesity as an Independent Risk Factor for COVID-19 Mortality in Hospitalized Patients Younger than 50. Obesity (Silver Spring). 2020;28;9:1595-1599. doi: 10.1002/oby.22913.
  8. Kim T.S., Roslin M., Wang J.J., Kane J., Hirsch J.S., Kim E.J. Northwell Health COVID-19 Research Consortium. BMI as a Risk Factor for Clinical Outcomes in Patients Hospitalized with COVID-19 in New York. Obesity (Silver Spring). 2021;29;2:279-284. doi: 10.1002/oby.23076. Epub 2020 Dec 23.
  9. Al Heialy S., Hachim M.Y., Senok A., Gaudet M., Abou Tayoun A., Hamoudi R., Alsheikh-Ali A., Hamid Q. Regulation of Angiotensin- Converting Enzyme 2 in Obesity: Implications for COVID-19. Front Physiol. 2020;11:555039. doi: 10.3389/fphys.2020.555039.
  10. Bailly L., Fabre R., Courjon J., Carles M., Dellamonica J., Pradier C. Obesity, Diabetes, Hypertension and Severe Outcomes among Inpatients with Coronavirus Disease 2019: a Nationwide Study. Clin Microbiol Infect. 2022;28;1:114-123. doi: 10.1016/j.cmi.2021.09.010.
  11. Ko J.Y., Danielson M.L., Town M., Derado G., Greenlund K.J., Kirley P.D., Alden N.B., Yousey-Hindes K., Anderson E.J., Ryan P.A., Kim S., Lynfield R., Torres S.M., Barney G.R., Bennett N.M., Sutton M., Talbot H.K., Hill M., Hall A.J., Fry A.M., Garg S., Kim L. COVID-NET Surveillance Team. Risk Factors for Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. Clin Infect Dis. 2021;72;11:e695-e703. doi: 10.1093/cid/ciaa1419.
  12. Schiffrin E.L., Flack J.M., Ito S., Muntner P., Webb R.C. Hypertension and COVID-19. Am J Hypertens. 2020;33;5:373-374. doi: 10.1093/ajh/hpaa057.
  13. Bode B., Garrett V., Messler J., McFarland R., Crowe J., Booth R., Klonoff D.C. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol. 2020;14;4:813-821. doi: 10.1177/1932296820924469.
  14. Targher G., Mantovani A., Wang X.B., Yan H.D., Sun Q.F., Pan K.H., Byrne C.D., Zheng K.I., Chen Y.P., Eslam M., George J., Zheng M.H. Patients with Diabetes are at Higher Risk for Severe Illness from COVID-19. Diabetes Metab. 2020;46;4:335-337. doi: 10.1016/j.diabet.2020.05.001.
  15. Barron E., Bakhai C., Kar P., Weaver A., Bradley D., Ismail H., Knighton P., Holman N., Khunti K., Sattar N., Wareham N.J., Young B., Valabhji J. Associations of Type 1 and Type 2 Diabetes with COVID-19-Related Mortality in England: a Whole-Population Study. Lancet Diabetes Endocrinol. 2020;8;10:813-822. doi: 10.1016/S2213-8587(20)30272-2.
  16. Stefan N., Fritsche A., Schick F., Häring H.U. Phenotypes of Prediabetes and Stratification of Cardiometabolic Risk. Lancet Diabetes Endocrinol. 2016;4;9:789-798. doi: 10.1016/S2213-8587(16)00082-6.
  17. Wang S., Ma P., Zhang S., Song S., Wang Z., Ma Y., Xu J., Wu F., Duan L., Yin Z., Luo H., Xiong N., Xu M., Zeng T., Jin Y. Fasting Blood Glucose at Admission is an Independent Predictor for 28-Day Mortality in Patients with COVID-19 Without Previous Diagnosis of Diabetes: a Multi-Centre Retrospective Study. Diabetologia. 2020;63;10:2102-2111. doi: 10.1007/s00125-020-05209-1.
  18. Li H., Tian S., Chen T., Cui Z., Shi N., Zhong X., Qiu K., Zhang J., Zeng T., Chen L., Zheng J. Newly Diagnosed Diabetes Is Associated with a Higher Risk of Mortality than Known Diabetes in Hospitalized Patients with COVID-19. Diabetes Obes Metab. 2020;22;10:1897-1906. doi: 10.1111/dom.14099.
  19. Fadini G.P., Morieri M.L., Boscari F., Fioretto P., Maran A., Busetto L., Bonora B.M., Selmin E., Arcidiacono G., Pinelli S., Farnia F., Falaguasta D., Russo L., Voltan G., Mazzocut S., Costantini G., Ghirardini F., Tresso S., Cattelan A.M., Vianello A., Avogaro A., Vettor R. Newly-Diagnosed Diabetes and Admission Hyperglycemia Predict COVID-19 Severity by Aggravating Respiratory Deterioration. Diabetes Res Clin Pract. 2020;168:108374. doi: 10.1016/j.diabres.2020.108374.
  20. Unsworth R., Wallace S., Oliver N.S., Yeung S., Kshirsagar A., Naidu H., Kwong R.M.W., Kumar P., Logan K.M. New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter Regional Findings in the U.K. Diabetes Care. 2020;43;11:e170-e171. doi: 10.2337/dc20-1551.
  21. McGlacken-Byrne SM, Drew SEV, Turner K, Peters C, Amin R. The SARS-CoV-2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi-centre study of the first COVID-19 wave. Diabet Med. 2021 Sep;38(9):e14640. doi: 10.1111/dme.14640. PMID: 34245598; PMCID: PMC8420510.
  22. Sathish T., Kapoor N., Cao Y., Tapp R.J., Zimmet P. Proportion of Newly Diagnosed Diabetes in COVID-19 Patients: A Systematic Review and Meta-Analysis. Diabetes Obes Metab. 2021;23;3:870-874. doi: 10.1111/dom.14269. PMCID: PMC7753574.
  23. Armeni E., Aziz U., Qamar S., Nasir S., Nethaji C., Negus R., Murch N., Beynon H.C., Bouloux P., Rosenthal M., Khan S., Yousseif A., Menon R., Karra E. Protracted Ketonaemia in Hyperglycaemic Emergencies in COVID-19: a Retrospective Case Series. Lancet Diabetes Endocrinol. 2020;8;8:660-663. doi: 10.1016/S2213-8587(20)30221-7.
  24. Muniangi-Muhitu H., Akalestou E., Salem V., Misra S., Oliver N.S., Rutter G.A. Covid-19 and Diabetes: A Complex Bidirectional Relationship. Front Endocrinol (Lausanne). 2020;11:582936. doi: 10.3389/fendo.2020.582936.
  25. Chang X., Li Y., Nguyen K., Qu H., Liu Y., Glessner J., Sleiman P.M.A., Hakonarson H. Genetic Correlations between COVID-19 and a Variety of Traits and Diseases. Innovation (N Y). 2021;2;2:100112. doi: 10.1016/j.xinn.2021.100112.
  26. Blokhin I.O., Lentz S.R. Mechanisms of Thrombosis in Obesity. Curr Opin Hematol. 2013;20;5:437-44. doi: 10.1097/MOH.0b013e3283634443.
  27. Ackermann M., Verleden S.E., Kuehnel M., Haverich A., Welte T., Laenger F., Vanstapel A., Werlein C., Stark H., Tzankov A., Li W.W., Li V.W., Mentzer S.J., Jonigk D. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N. Engl. J. Med. 2020;383;2:120-128. doi: 10.1056/NEJMoa2015432.
  28. Zhang Z., Han N., Shen Y. S100A12 Promotes Inflammation and Cell Apoptosis in Sepsis-Induced ARDS Via Activation of NLRP3 Inflammasome Signaling. Mol Immunol. 2020;122:38-48. doi: 10.1016/j.molimm.2020.03.022.
  29. Yang J.K., Feng Y., Yuan M.Y., Yuan S.Y., Fu H.J., Wu B.Y., Sun G.Z., Yang G.R., Zhang X.L., Wang L., Xu X., Xu X.P., Chan J.C. Plasma Glucose Levels and Diabetes Are Independent Predictors for Mortality and Morbidity in Patients with SARS. Diabet Med. 2006;23;6:623-628. doi: 10.1111/j.1464-5491.2006.01861.x.
  30. Capes S.E., Hunt D., Malmberg K., Gerstein H.C. Stress Hyperglycaemia and Increased Risk of Death after Myocardial Infarction in Patients with and Without Diabetes: a Systematic Overview. Lancet. 2000;355;9206:773-8. doi: 10.1016/S0140-6736(99)08415-9.
  31. Liu F., Long X., Zhang B., Zhang W., Chen X., Zhang Z. ACE2 Expression in Pancreas May Cause Pancreatic Damage After SARS-CoV-2 Infection. Clin Gastroenterol Hepatol. 2020;18;9:2128-2130.e2. doi: 10.1016/j.cgh.2020.04.040.
  32. Donnelly N., Gorman A.M., Gupta S., Samali A. The eIF2α Kinases: their Structures and Functions. Cell Mol Life Sci. 2013;70;19:3493-511. doi: 10.1007/s00018-012-1252-6.
  33. Xu H., Barnes G.T., Yang Q., Tan G., Yang D., Chou C.J., Sole J., Nichols A., Ross J.S., Tartaglia L.A., Chen H. Chronic Inflammation in Fat Plays a Crucial Role in the Development of Obesity-Related Insulin Resistance. J. Clin. Invest. 2003;112;12:1821-30. doi: 10.1172/JCI19451.
  34. RECOVERY Collaborative Group, Horby P., Lim W.S., Emberson J.R., Mafham M., Bell J.L., Linsell L., Staplin N., Brightling C., Ustianowski A., Elmahi E., Prudon B., Green C., Felton T., Chadwick D., Rege K., Fegan C., Chappell L.C., Faust S.N., Jaki T., Jeffery K., Montgomery A., Rowan K., Juszczak E., Baillie J.K., Haynes R., Landray M.J. Dexamethasone in Hospitalized Patients with Covid-19. N. Engl. J. Med. 2021;384;8:693-704. doi: 10.1056/NEJMoa2021436.
  35. Liu X.X., Zhu X.M., Miao Q., Ye H.Y., Zhang Z.Y., Li Y.M. Hyperglycemia Induced by Glucocorticoids in Nondiabetic Patients: a Meta-Analysis. Ann. Nutr. Metab. 2014;65;4:324-32. doi: 10.1159/000365892.
  36. Gulliford MC, Charlton J, Latinovic R. Risk of diabetes associated with prescribed glucocorticoids in a large population. Diabetes Care. 2006 Dec;29(12):2728-9. doi: 10.2337/dc06-1499. PMID: 17130214.
  37. Gurwitz J.H., Bohn R.L., Glynn R.J., Monane M., Mogun H., Avorn J.. Glucocorticoids and the Risk for Initiation of Hypoglycemic Therapy. Arch. Intern. Med. 1994;154;1:97-101.
  38. Rayman G., Lumb A.N., Kennon B., Cottrell C., Nagi D., Page E., Voigt D., Courtney H.C., Atkins H., Higgins K., Platts J., Dhatariya K., Patel M., Newland-Jones P., Narendran P., Kar P., Burr O., Thomas S., Stewart R. Dexamethasone Therapy in COVID-19 Patients: Implications and Guidance for the Management of Blood Glucose in People with and Without Diabetes. Diabet Med. 2021;38;1:e14378. doi: 10.1111/dme.14378.
  39. Antsiferov M.B., Andreyeva N.V., Markova T.N. Organizatsiya Spetsializirovannoy Meditsinskoy Pomoshchi Vzroslomu Naseleniyu s Sakharnym Diabetom v Usloviyakh Novoy Koronavirusnoy Infektsii COVID-19 = Organization of Specialized Medical Care for Adults with Diabetes Mellitus in the Context of a New Coronavirus Infection COVID-19. Guidelines No. 87. Moscow Publ., 2020. 50 p. (In Russ.). [Анциферов М.Б., Андреева Н.В., Маркова Т.Н. Организация специализированной медицинской помощи взрослому населению с сахарным диабетом в условиях новой коронавирусной инфекции COVID-19: Методические рекомендации №87. М., 2020. 50 с.].
  40. Dashora U.K., Taylor R. Maintaining Glycaemic Control During High-Dose Prednisolone Administration for Hyperemesis Gravidarum in Type 1 Diabetes. Diabet Med. 2004;21;3:298-9. doi: 10.1046/j.1464-5491.2003.01026_21_3.x-i1.

Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship. 
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.01.2022. Accepted for publication: 01.02.2022

© 2024 Scientific journal - "Clinical Bulletin of the FMBС im. A.I. Burnasyan"
Scroll to Top