Coping and risk perception during the COVID-19 pandemic in type 2 diabetes: Does it influence metabolic control?

Diabetes and poor glycemic control are significant predictors of severity and death in the COVID-19 disease. The perception of this risk in individuals with type 2 diabetes (T2D) could modify coping styles, leading to behaviors associated with better self-care and metabolic control. Theoretically, active coping is associated with better glycemic control in patients with T2D. Nonetheless, information during extreme risk like the COVID-19 pandemic is still limited. Our objective was to evaluate the association between coping styles and risk perception in the COVID-19 pandemic and the change in metabolic parameters. This is a prospective study that included individuals with T2D treated in a tertiary care center during the COVID-19 outbreak who returned to follow-up one year later. We assessed coping styles and risk perception with the Extreme Risk Coping Scale and the risk perception questionnaire. Clinical characteristics and metabolic parameters were registered in both visits. Groups were compared using Kruskal Wallis tests, and changes in metabolic parameters were assessed with Wilcoxon rank sum tests. Our sample included 177 participants at baseline, and 118 concluded the study. Passive coping was more frequent in women. Low-risk perception was associated with higher age, lower psychiatric comorbidities, and lower frequency of psychiatric treatment compared with other risk perception groups. Patients with active coping plus high-risk perception did not have a change in metabolic parameters at follow-up, whereas patients with other coping styles and lower risk perception had an increase in total cholesterol, LDL-cholesterol, and triglycerides. There were no differences by coping group or by risk perception in glycemic control.

De-escalating treatment indications for patients who achieve metabolic goals.

INTRODUCTION: Robust evidence exists regarding initiation, intensification or modification of treatments. Recommendations to de-escalate therapy are lacking, specifically in diabetes. A successful treatment de-intensification reduces overtreatment, polypharmacy, and risk of adverse effects. OBJECTIVE: To encompass current recommendations for deprescribing common drugs and create a consensus among health professionals. METHODS: We reviewed four databases for deprescribing approaches published between 2010 and 2022. Articles were divided into different groups of drugs (for uric-acid, hypoglycemic, lipid-lowering, and psychotropic drugs). RESULTS: Hypoglycemic agents: strategies were limited to newer agents and insulin regimens for elderly individuals. Reducing insulin was associated with 1.1% reduction of A1c over time. SGLT2i and GLP-1RAs dose reduction depends on adverse events. Lipid-lowering agents: studies show that patients with very low cholesterol have fewer cardiovascular events without associated increased risk. Antihypertensive agents: Younger patients, lower systolic blood pressure, and few comorbidities are ideal characteristics for discontinuation. Uric acid therapy: we found no recommendation for dose de-escalation. Poor treatment adherence is associated with episodes of gout and deforming arthritis in the long term. CONCLUSION: Deprescribing hypoglycemic, statins, antihypertensives, and urate-lowering agents may be feasible in selected patients, but periodic surveillance is important. More evidence is necessary to support this decision entirely.

Comparison of Metabolic, Lifestyle and Mental Health Parameters in People with Diabetes and Relatives with and without Family Support.

Purpose: To analyze and compare metabolic, lifestyle and mental health parameters in relatives and people-with-T2DM (PDM) with and without support. Patients and Methods: We included 160 patients with <5 years of diagnosis of T2DM, without disabling complications, and non-smokers, attending a multidisciplinary program for diabetes control, and their accompanying relatives. If the patients or relatives abandoned the program, we contacted them and asked to take laboratory tests and answer surveys regarding anxiety, depression, and perception of their family support. Variables distribution was assessed with the Kolmogorov-Smirnov test. We used ANOVA or Kruskal Wallis Tests, according to variable distribution. Frequencies and percentages are used for categorical values and analyzed with a chi-square test. We separated the participants in four groups: relatives with and without support and PDM with and without support. Results: We included 160 participants, age 51±10, and 54.3% women. Total cholesterol (188±36 vs 204±43 vs 170±34 vs 181±35 mg/dL, p=0.001), LDL-cholesterol (113±35 vs 125±27 vs 101 ±30 vs 109±29, p=0.008), and non-HDL cholesterol (143±32 vs 154 ±30 vs 129±33 vs 135±35 mg/dL, p=0.010) were higher in the group without support. Although patients without family support had lower values, they did not achieve metabolic goals. Weight (75±17 vs 77±19 vs 74.2±10.5 vs 90.2±17.3 kg) and body mass index (28.9±4.8 vs 30.1±4.7 vs 27.4±3.3 vs 33±4.3 kg/m2) were higher in PDM without family support (p<0.001 for both). Conclusion: Support in PDM and their families is important in metabolic control. However, raising awareness among family members to screen for diabetes and changes in lifestyle are points to improve. Including the evaluation of social and family support will allow a more complete assessment to identify barriers to achieving goals.

Risk Factors Associated with Diabetic Retinopathy with and without Macular Edema in Recently Diagnosed Patients with Type 2 Diabetes.

Purpose: To evaluate the risk factors associated with diabetic macular edema (DME) in patients with a recent type 2 diabetes mellitus (T2DM) diagnosis. Patients and Methods: We conducted a case-control study at a third-level hospital in Mexico City. We enrolled patients ≥18 years old, with T2DM less than five years of diagnosis, without disabling complications, and non-smokers. The control group was patients with diabetic retinopathy and without macular edema (DR-DME). Cases were patients with DR+DME. We measured fasting glucose, creatinine, lipid profile, urinary albumin/creatinine ratio (ACR), and HbA1c. An ophthalmological examination consisted of visual acuity measurement, digital three-field fundus photography with an automatic non-mydriatic camera, slit lamp, and Optical coherence tomography (OCT) examination. Results: 183 and 61 patients with DR-DME and DR+DME, respectively, were included in the analysis. The prevalence of mild DR was higher in the DR-DME group, but the frequencies of moderate and severe retinopathy were higher in the DR+DME group. Patients in the DR-DME group had better vision than those in the DR+DME group. Logistic regression analysis revealed that age (OR, 1.07), HbA1c (OR, 1.19), and Albumin-to-Creatinine Ratio (ACR) > 30 mg/g (OR, 3.37) were associated with an increased possibility of DME compared to DR-DME. Conclusion: Our study provides insights into the association between risk factors and DME. We found a statistically strong association between HbA1c levels, age, and ACR. Patients with poor metabolic control should undergo an extensive medical examination to screen for DME, which may be related to the chronicity of DM and renal damage.

Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study.

BACKGROUND: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. OBJECTIVE: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. MATERIAL AND METHODS: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. RESULTS: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30%. DR was found in 62% of patients (30% had sight-threatening DR [STDR]), 17% had referable DME, and 3%, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). CONCLUSION: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

ANTECEDENTES: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. OBJETIVO: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. MATERIAL Y MÉTODOS: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. RESULTADOS: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). CONCLUSIÓN: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.

Discapacidad visual asociada a retinopatía diabética y edema macular: un estudio de base hospitalaria / Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study

Resumen Antecedentes: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. Objetivo: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. Material y métodos: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. Resultados: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). Conclusión: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.

Abstract Background: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. Objective: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. Material and methods: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. Results: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30 %. DR was found in 62 % of patients (30 % had sight-threatening DR [STDR]), 17 % had referable DME, and 3 %, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). Conclusion: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes: Psychological treatment in type 2 diabetes.

Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures. Objective: We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program. Method: 1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up. Results: Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test. Conclusion: This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.

Long-Term Effects of Anxiety on the Metabolic Control of Recently Diagnosed Type 2 Diabetes Patients: Results from the CAIPaDi Cohort Study.

Introduction: Anxiety disorders (AXD) are among the most prevalent mental health conditions in patients with type 2 diabetes (T2D). Previous data have established an association of other psychiatric conditions with poor metabolic control and increased odds of diabetes-related complications. Nonetheless, follow-up information about the effects of AXD on the metabolic control of patients with TD2 is still limited. Objective: Evaluate the effects of AXD on the metabolic parameters of patients with T2D over 12 months of follow-up in a multidisciplinary comprehensive care model. Methods: Prospective study of T2D subjects enrolled in a comprehensive care program with follow-up at 3 and 12 months of treatment. Patients were assessed using the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale (HADS). We registered clinical and metabolic characteristics from each visit. Metabolic parameters over time were analyzed with a mixed model of repeated measures using AXD and time as interaction variables. Results: Our sample included 2703 patients at baseline, and 1161 (43%) subjects continued the follow-up at 12 months. The AXD group had more females, lower age, and fewer years of formal education compared with subjects without AXD at baseline, 3 and 12 months. Patients with AXD also reported higher mean fasting glucose at three months, and higher HbA1c at three and 12 months. Our MMRM for HbA1c reported significant differences over time in subjects with and without AXD. The differences in means between groups increased from 0.17% at three months to 0.31% at 12 months. The variables from the HADS anxiety score, sex, age, years of diagnosis, and insulin treatment were also associated with HbA1c parameters over time. Conclusion: Patients with AXD had the worst glycemic control at 3 and 12 months of follow-up. HbA1c differences in patients with AXD compared with non-AXD subjects increases over time in association with anxiety symptoms.

Detection of sudomotor alterations evaluated by Sudoscan in patients with recently diagnosed type 2 diabetes.

INTRODUCTION: Diabetic peripheral neuropathy (DPN) causes morbidity and affects the quality of life. Before diabetes diagnosis, neuropathic damage may be present. Sudoscan provides accurate measurement of the sudomotor function. This study aimed to assess the abnormalities detected by Sudoscan, offered estimates of DPN prevalence, and investigated the relationship between metabolic and clinical parameters. Additionally, we evaluated the diagnostic accuracy of the Sudoscan compared with monofilament and tuning fork tests for detecting DPN. RESEARCH DESIGN AND METHODS: Cross-sectional descriptive study including patients with type 2 diabetes for <5 years since diagnosis. We investigated the presence of DPN using a 128 Hz tuning fork test, the 10 g monofilament, and the sudomotor dysfunction in feet using Sudoscan. We compared patients with and without alterations in the Sudoscan. A logistic regression model analyzed variables independently associated with sudomotor dysfunction. RESULTS: From 2013 to 2020, 2243 patients were included, 55.1% women, age 51.8 years, and 17.1% with normal weight. Monofilament tests and/or tuning fork examination were abnormal in 29% (95% CI 0.23% to 0.27%) and 619 patients (27.6%, 0.25% to 0.29%) had sudomotor alterations. In logistic regression analysis, age (ß=1.01, 0.005-1.02), diastolic blood pressure (ß=0.98, 0.96-0.99), heart rate (ß=1.01, 1.00-1.02), glucose (ß=1.00, 1.00-1.03), albuminuria (ß=1.001, 1.000-1.001), beta-blockers=1.98, 1.21-3.24) and fibrate use=0.61, 0.43-0.87) were associated with sudomotor dysfunction. The AUC (area under the curve) for Sudoscan was 0.495 (0.469-0.522), with sensitivity and specificity of 24% and 71%, respectively. CONCLUSION: The Sudoscan identified an important proportion of patients with dysfunction, allowing prompt intervention to decrease the risk for complications. TRIAL REGISTRATION NUMBER: NCT02836808.

The beneficial effect of a comprehensive diabetes care model on high-risk relatives accompanying patients with type 2 diabetes.

AIMS: Assess the effect of a diabetes program on lifestyle, metabolic, and mental health parameters in relatives of patients with T2D, and correlate changes between relatives and patients. METHODS: Relatives were included in a structured program for patients with T2D. They received individualized interventions or were asked to follow lifestyle modifications indicated to their patient with diabetes. Outcomes were change in BMI, fat loss, patients achieving LDL-c and triglycerides goals, exercise, and mental health indicators at three and twelve months. RESULTS: We included 200 relatives. Obesity was present in 42 %, hypertension in 8.5 %, hypercholesterolemia in 29.5 %, and hypertriglyceridemia in 46 % of relatives. Relatives lost - 3.7 kg and - 3.0 kg of body fat at three months and one-year evaluations. At least 60 % achieved normal triglycerides and LDL-c, and 40 % exercised at least 150 min/week. Anxiety symptoms dropped from 37 % to 22 % (p = 0.001), and depressive symptoms from 22 % to 12.9 % (p = 0.01) at three months. Correlations were found between the changes in relatives and patients in weight at three months (r = 0.22, p = 0.001), one year (r = 0.3, p < 0.001), and the number of goals achieved at one year. CONCLUSION: Relatives of patients with diabetes attending a multidisciplinary program for T2D benefit in metabolic, lifestyle, and mental health indicators.

Maintenance of Self-Care Activities During COVID-19 Lockdown in Patients with Type 2 Diabetes That Received a Comprehensive Care Program Training.

Introduction: In 2020, several countries established a global emergency state. Lockdowns restricted people's lifestyles and daily activities to prevent coronavirus spread. These measures hindered diabetes mellitus control and lifestyle changes. This study aims to evaluate if attending a multidisciplinary program before the pandemic helped maintain a good metabolic state, lifestyle modifications, and mental health in patients with diabetes mellitus during the COVID-19 lockdown. Methods: Patients included in this study attended a multidisciplinary program, with <5 years of diagnosis of type 2 diabetes, without disabling complications, between 18-70 years old. The complete lockdown occurred from February 27, 2020, to May 31, 2020. The first patient (non-COVID) to return to the center for face-to-face consultation was in March 2021. Consultations in 2019 were face-to-face and changed to a virtual modality during 2020. We analyzed metabolic, lifestyle, mental health, and diabetes education parameters. Results: A total of 133 patients with type 2 diabetes mellitus were included with complete information in visits before and during the lockdown. Metabolic parameters and self-care measures (nutrition plan, foot evaluation, and self-glucose monitoring) evaluated on our patients had no change during the lockdown. We found a significant increase in the time patients spent sitting during the day (p<0.05). Barriers to exercise increased during lockdown, being joint pain (3.8% to 12.0%, p<0.01) and lack of time to exercise (4.5% to 7.5%, p=0.33) being the most common. There was no significant difference in symptoms of anxiety and depression, quality of life, and empowerment. Conclusion: A multidisciplinary diabetes mellitus program, including diabetes education for self-care activities, positively impacts patients, maintaining good outcomes despite lockdown difficulties.

Comorbidity Between Recent Diagnosis of Type 2 Diabetes and Non-Psychotic Psychiatric Disorders: Metabolic Characteristics and Clinical Correlates.

Purpose: To describe the metabolic status and clinical characteristics associated with NPPD in patients with less than five years of T2D diagnosis and explore the role of age in the presentation of psychiatric comorbidities. Patients and Methods: This was a cross-sectional study of subjects who attended a comprehensive care program. Patients were assessed using the Mini-International Neuropsychiatric Interview, and clinical and metabolic characteristics were registered. Multivariate logistic regression analyses were conducted to identify risk and protective factors for psychiatric disorders. We performed an analysis to further explore age's influence on our results. Results: We included 1953 patients, and 40.1% had any psychiatric disorder. Younger age, female sex, and personal psychiatric history were associated with NPPD. The use of insulin was reported as a protective factor for eating disorders. Body mass index was associated with any psychiatric disorders and eating disorders. The analysis of age reported that patients younger than 45 years had the worst metabolic parameters and increased odds for NPPD, while patients older than 65 years had the best metabolic measures and decreased odds for psychiatric comorbidity. Conclusion: NPPD were frequent comorbidities in our sample; younger age, female sex, and personal psychiatric history were the most important factors associated with psychiatric comorbidities. Younger subjects experience a higher risk for psychiatric disorders and worst metabolic control.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

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Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Very Low Vitamin D Levels are a Strong Independent Predictor of Mortality in Hospitalized Patients with Severe COVID-19.

BACKGROUND: There is controversy regarding the association between hypovitaminosis D and COVID-19 outcomes. AIM OF THE STUDY: We assessed the association between 25-hydroxyvitamin D levels and COVID-19 outcomes in hospitalized subjects with severe SARS-CoV-2 infection. METHODS: Retrospective cohort study. Serum 25-hydroxyvitamin D levels of subjects with severe COVID-19 pneumonia were measured at hospital admission, between March 17th, 2020, and March 1st, 2021. RESULTS: Out of 2,908 patients, 571 (19.6%) had vitamin D deficiency (defined as a serum 25-hydroxyvitamin D level <12.5 ng/mL [<31.25 nmol/L]), and 1069 (36.7%) had levels between 12.5 ng/mL (31.25 nmol/L) and 20 ng/mL 850 nmol/L). Compared to subjects without vitamin D deficiency, those with 25-hydroxyvitamin D level <12.5 ng/mL had higher rates of in-hospital mortality at 30 d (28.0 vs. 17.3%; p <0.001), global mortality (31.9 vs. 20.8%; p <0.001), mechanical ventilation requirement (23.8 vs. 17.2%; p <0.001), and significantly longer hospital stay (median [interquartile range] of 9 [6-17 d] vs. 7 [5-12 d], p <0.001). In the unadjusted analysis, the risk of in-hospital death was greater for patients with vitamin D deficiency (HR 1.43; 95% CI, 1.20-1.70; p <0.001). After adjusting for confounders, the risk of in-hospital death within 30 d remained significantly greater in patients with vitamin D deficiency (HR 1.46; 95% CI, 1.21-1.76; p <0.001). The risk was reduced but remained significant with 25-hydroxyvitamin D levels between 12.5 ng/mL and 20 ng/mL (HR 1.31; 95% CI 1.10-1.55, p = 0.02). In comparison with other clinical biomarkers, vitamin D deficiency was an independent predictive marker of in-hospital mortality after adjusting for confounders. CONCLUSION: Very low 25-hydroxyvitamin D levels measured at hospital admission were significantly associated with in-hospital mortality and are a useful prognostic biomarker in severe COVID-19 patients.

Effect of whole-body vibration training on transcutaneous oxygen levels of the foot in patients with type 2 diabetes: A randomized controlled trial.

Whole body vibration (WBV) has been suggested as improving skin and blood flow. This study aimed to determine the effect of exposure to WBV on levels of partial transcutaneous oxygen pressure (TcPO2) in the foot of patients with type 2 diabetes (T2D) within the metabolic control goals. A block randomized, open, two-arm, parallel and controlled clinical trial was conducted. Participants recruited from the Center of Comprehensive Care for the Patient with Diabetes were assessed at the National Institute of Rehabilitation, Mexico City. Control group underwent multidisciplinary care for T2D; experimental group, in addition to the comprehensive diabetes care, was exposed to WBV through an exercise program, attending three times a week for a period of 3 months. TcPO2 was measured in the feet of the participants at baseline and after 12 weeks. A sample of 50 volunteers with recently-diagnosed T2D and similar baseline characteristics (demographic, cardiovascular risk, presence of diabetic polyneuropathy, and indicators of glycemic control and TcPO2) was recruited. The experimental group (n = 27) showed a mean value of 47.7 ± 6.1 mmHg in TcPO2, significantly higher (p = 0.028) than the 44.3 ± 7.5 mmHg of control group (n = 23), at the end of intervention. In conclusion, exposure to WBV promoted an increase and a significant 3 mmHg difference in the foot TcPO2 levels between those subjects with T2D that underwent the 12-week exercise program and those not exposed to the treatment.

Feasibility and acceptance of a virtual multidisciplinary care programme for patients with type 2 diabetes during the COVID-19 pandemic.

BACKGROUND AND AIMS: Type 2 diabetes mellitus is one of the major public health concerns. The current lifestyle and advances in technology resulted in the development of a virtual mode of professional healthcare, which is an effective alternative method of management of patients. This study aimed to assess the feasibility of implementation of a virtual comprehensive care programme during the COVID-19 pandemic, patients' acceptance and the changes in self-care behaviours, metabolic parameters and emotional factors. METHODS: The programme employed in this study included nine health interventions in 1 day. Due to the COVID-19 pandemic, the mode of interventions, including questionnaires, patient evaluations and a satisfaction survey, was modified to the virtual form in 2020. This study assessed the changes in self-care behaviours, metabolic parameters and emotional factors and compared the data pertaining to patients who received virtual healthcare in 2020 with those who received face-to-face modality of medical care in 2019. RESULTS: During June to November 2020, 130 patients received healthcare by means of the virtual modality. The change in modality of healthcare was feasible and 75% of the patients displayed good acceptance of the same. The evaluation of self-care behaviours included self-monitoring blood glucose (SMBG) levels, foot care and regular exercise. The duration of exercise decreased from 120 to 0 min/week (p < 0.001). However, there was no change in metabolic parameters. Regarding the mental health parameters, we observed an increase in the proportion of patients with anxiety (21.5% versus 11.1%), depressive symptoms (10.8% versus 4.3%), diabetes distress (18.5% versus 11.1%) and prescription of psychotropic drugs (32.8% versus 18.2%) (p < 0.05) in virtual versus face-to-face, respectively. CONCLUSION: The virtual comprehensive care programme for the management of patients with diabetes is a feasible approach that allows healthcare professionals to provide an adequate care during the COVID-19 pandemic.

Cardiac magnetic resonance in recovering COVID-19 patients. Feature tracking and mapping analysis to detect persistent myocardial involvement.

BACKGROUND: Post-COVID-19 patients may incur myocardial involvement secondary to systemic inflammation. Our aim was to detect possible oedema/diffuse fibrosis using cardiac magnetic resonance imaging (CMR) mapping and to study myocardial deformation of the left ventricle (LV) using feature tracking (FT). METHODS: Prospective analysis of consecutively recruited post-COVID-19 patients undergoing CMR. T1 and T2 mapping sequences were acquired and FT analysis was performed using 2D steady-state free precession cine sequences. Statistical significance was set to p < 0.05. RESULTS: Included were 57 post-COVID-19 patients and 20 healthy controls, mean age 59 ± 15 years, men 80.7%. The most frequent risk factors were hypertension (33.3%) and dyslipidaemia (36.8%). The contact-to-CMR interval was 81 ± 27 days. LV ejection fraction (LVEF) was 61 ± 10%. Late gadolinium enhancement (LGE) was evident in 26.3% of patients (19.3%, non-ischaemic). T2 mapping values (suggestive of oedema) were higher in the study patients than in the controls (50.9 ± 4.3 ms vs 48 ± 1.9 ms, p < 0.01). No between-group differences were observed for native T1 nor for circumferential strain (CS) or radial strain (RS) values (18.6 ± 3.3% vs 19.2 ± 2.1% (p = 0.52) and 32.3 ± 8.1% vs 33.6 ± 7.1% (p = 0.9), respectively). A sub-group analysis for the contact-to-CMR interval (<8 weeks vs ≥ 8 weeks) showed that FT-CS (15.6 ± 2.2% vs 18.9 ± 2.6%, p < 0.01) and FT-RS (24.9 ± 5.8 vs 33.5 ± 7.2%, p < 0.01) values were lower for the shorter interval. CONCLUSIONS: Post-COVID-19 patients compared to heathy controls had raised T2 values (related to oedema), but similar native T1, FT-CS and FT-RS values. FT-CS and FT-RS values were lower in post-COVID-19 patients undergoing CMR after < 8 weeks compared to ≥ 8 weeks.