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1.
Niger J Clin Pract ; 23(9): 1194-1200, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913156

RESUMO

Aim: This retrospective analysis aims to evaluate the correlation between blood glucose fluctuation (BGF) and heart rate variability (HRV) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). Subjects and Methods: In total, 210 patients with CHD and T2DM from January 2014 to January 2019 admitted to Wenling Hospital of Traditional Chinese Medicine were enrolled in this study. Based on whether BGF existed, patients were allocated to BG control group and BG fluctuation group. The HRV parameters, frequency of adverse events, and Gensini score between groups were recorded and Pearson analysis was performed. Results: Results displayed that no significant differences in age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), alcohol consumption history, drinking history, or serum lipid were found between groups (P > 0.05 for all items). However, the BGF parameters were significantly higher while the HRV parameters were significantly lower in BG fluctuation group, compared with BG control group (P < 0.05 for all items). Pearson analysis showed that despite mean blood glucose (MBG) and mean amplitude of glycemic excursions (MAGE) both correlated with a standard deviation of NN intervals (SDNN) level, the correlation coefficient of MAGE-SDNN was much higher (-0.705 vs -0.185). Additionally, the frequencies of adverse events and Gensini scores were also significantly higher in the BG fluctuation group than the BG control group. Conclusions: It suggests that BGF strongly correlated with HRV in patients with CHD and T2DM. It also provides experimental instructions for clinical practice.


Assuntos
Glicemia/análise , Doença das Coronárias/complicações , Diabetes Mellitus Tipo 2/complicações , Glucose/metabolismo , Frequência Cardíaca/fisiologia , Adulto , Idoso , Índice de Massa Corporal , Doença das Coronárias/sangue , Doença das Coronárias/fisiopatologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Vasc Health Risk Manag ; 16: 343-352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32943869

RESUMO

Purpose: The impact of glycemic control on macrovascular complications and arterial stiffness in type II diabetes (T2D), as well as the extent of additive effect of hypertension, is unclear. The aims of this study were to investigate the impact of glycemic control on the cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, and to determine the relative risk of concomitant diabetes and hypertension with arterial stiffness. Methods: One hundred and nine participants were enrolled and classified as non-diabetes (n= 37) and diabetes (n=72); the diabetic group was further identified as controllable and uncontrollable T2D depending on their hemoglobin A1c (HbA1c) levels. Univariate and multiple regression analyses were used to assess the association between CAVI and glycemic control status and hypertension. Relative risk analysis for abnormal CAVI with exposure to diabetes and hypertension was investigated. Results: In all participants, age, systolic blood pressure, body mass index, and fasting blood sugar were independent predictors of CAVI. In diabetic participants, glycemic control status or HbA1c levels did not significantly correlate with CAVI. Systolic blood pressure was an independent predictor for CAVI with ß = 0.26. In addition, the coexistence of diabetes together with hypertension was significantly associated with a 2.4-fold increase in the risk of abnormal CAVI (95% CI, 1.410-4.184; p <0.001). Conclusion: This study demonstrates that HbA1c as well as fasting blood sugar levels in diabetic participants do not correlate with arterial stiffness. Concomitant diabetes and hypertension significantly increase the risk of arterial stiffness.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Hemoglobina A Glicada/metabolismo , Hipertensão/fisiopatologia , Rigidez Vascular , Adulto , Idoso , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Índice Vascular Coração-Tornozelo , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco
3.
Revista Digital de Postgrado ; 9(2): 208, ago. 2020. tab, graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1103357

RESUMO

La diabetes mellitus tipo 2 (DM2) representa un problema de salud pública, debido a su alta incidencia y prevalencia en el mundo. Un método para evaluar el riesgo de desarrollar DM2 es la escala Latin American Finnish Diabetes Risk Score (LA FINDRISC). La DM2 es un factor de riesgo de enfermedad arterial periférica (EAP) la cual puede ser diagnosticada mediante el índice tobillo-brazo (ITB). Objetivo: evaluar la presencia y severidad de enfermedad arterial periférica mediante ITB y relacionarlo con el riesgo de desarrollar DM2 según LA FINDRISC. Métodos: estudio descriptivo, correlacional, de corte transversal. Se evaluaron 134 personas y se les midió glicemia capilar para descartar diabetes. Posteriormente, se realizó el LA FINDRISC y el ITB. Resultados: El puntaje LA FINDRISC y la glicemia alteradas en ayunas aumentaron proporcionalmente (R2=0,5). Esta relación no se observó entre LA FINDRISC y el ITB arrojado por la población general. Sin embargo, al seleccionar los pacientes con vasos no comprimibles aparece una correlación positiva (R2=0,36) entre los dos instrumentos diagnósticos. Conclusión: LA FINDRISC y el ITB son instrumentos de diagnósticos no invasivo, sencillos y válidos para detectar riesgo de desarrollar DM2, y detectar presencia y severidad de enfermedad arterial periférica, respectivamente(AU)


Type 2 diabetes mellitus (DM2) represents a public health problem, due to its high incidence and prevalence in the world. One method to assess the risk of developing DM2 is the Latin American Finnish Diabetes Risk Score (LA FINDRISC) scale. DM2 is a risk factor for peripheral arterial disease (PAD) which can be diagnosed using the ankle-brachial index (ABI). Objective: to evaluate the presence and severity of peripheral arterial disease using ABI and to relate it to the risk of developing DM2 according to LA FINDRISC. Methods: descriptive, correlational, cross-sectional study. 134 people were evaluated, and capillary glycemia was measured to rule out diabetes. Subsequently, the LA FINDRISC and the ITB were held. Results: The LA FINDRISC score and impaired fasting blood glucose increased proportionally (R2 = 0.5). This relationship was not observed between LA FINDRISC and the ITB showed by the general population. However, when selecting patients with non-compressible vessels, a positive correlation (R2 = 0.36) appears between the two diagnostic instruments. Conclusion: FINDRISC and ITB are simple and valid non-invasive diagnostic instruments to detect the risk of developing DM2, and detect the presence and severity of peripheral arterial disease, respectively(AU)


Assuntos
Humanos , Masculino , Feminino , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Doença Arterial Periférica/complicações , Pesos e Medidas Corporais , Antropometria , Circunferência Abdominal
4.
Diab Vasc Dis Res ; 17(7): 1479164120945910, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32746630

RESUMO

BACKGROUND: The effect of interarm blood pressure difference on the development of diabetic retinopathy, proteinuria and chronic kidney disease remains unknown. We investigated to determine the impact of interarm blood pressure difference on the prevalence of diabetic retinopathy, proteinuria and chronic kidney disease in patients with type 2 diabetes. METHODS: The study included 563 patients with diabetes, who were evaluated with a simultaneous bilateral blood pressure measurement. The cutoff values for interarm blood pressure difference were 5, 10 and 15 mmHg. Logistic regression analysis was used to explore the relation between interarm blood pressure difference and diabetic retinopathy, proteinuria and chronic kidney disease. RESULTS: Diabetic patients with systolic interarm blood pressure difference ⩾5, ⩾10 and ⩾15 mmHg showed an increased risk of diabetic retinopathy [adjusted odds ratio = 1.48 (95% confidence interval = 1.01-2.18), odds ratio = 1.80 (95% confidence interval = 0.99-3.22), odds ratio = 2.29 (95% confidence interval = 1.00-5.23)] after adjustment. There were significant associations between interarm blood pressure difference ⩾5 and ⩾10 mmHg and proteinuria [odds ratio = 1.68 (95% confidence interval = 1.15-2.44), 1.89 (95% confidence interval = 1.05-3.37)]. CONCLUSION: The association between interarm blood pressure difference and the presence of diabetic retinopathy emerged even for systolic interarm blood pressure difference ⩾5 mmHg without interaction of systolic blood pressure. Systolic interarm blood pressure difference should be considered a surrogate marker for vascular complication in patients with type 2 diabetes.


Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/fisiopatologia , Extremidade Superior/irrigação sanguínea , Idoso , Índice Tornozelo-Braço , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Proteinúria/diagnóstico , Proteinúria/epidemiologia , Proteinúria/fisiopatologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Seul/epidemiologia
5.
Nat Metab ; 2(7): 572-585, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32694793

RESUMO

For infectious-disease outbreaks, clinical solutions typically focus on efficient pathogen destruction. However, the COVID-19 pandemic provides a reminder that infectious diseases are complex, multisystem conditions, and a holistic understanding will be necessary to maximize survival. For COVID-19 and all other infectious diseases, metabolic processes are intimately connected to the mechanisms of disease pathogenesis and the resulting pathology and pathophysiology, as well as the host defence response to the infection. Here, I examine the relationship between metabolism and COVID-19. I discuss why preexisting metabolic abnormalities, such as type 2 diabetes and hypertension, may be important risk factors for severe and critical cases of infection, highlighting parallels between the pathophysiology of these metabolic abnormalities and the disease course of COVID-19. I also discuss how metabolism at the cellular, tissue and organ levels might be harnessed to promote defence against the infection, with a focus on disease-tolerance mechanisms, and speculate on the long-term metabolic consequences for survivors of COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Doenças Metabólicas/etiologia , Doenças Metabólicas/metabolismo , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Pandemias , Fatores de Risco
6.
Am J Cardiol ; 128: 191-195, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650919

RESUMO

Abnormal P-wave axis may reflect preclinical atrial dysfunction and has been associated with an increased risk of incident atrial fibrillation (AF) in the general population. Patients with diabetes mellitus (DM) have a higher prevalence of AF, but the association of abnormal P-wave axis and the risk of incident AF in those with diabetes has not been previously explored. For this analysis, we included 8,965 eligible participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. P-wave axis was automatically measured on study electrocardiogram and visually confirmed, with the normal range being between 0° and 75°. At baseline, 8% of the study population had an abnormal P-wave axis. During 43,856 person-years of follow-up, there were 145 cases of incident AF. Using multivariable-adjusted Cox proportional hazards models, participants with abnormal P-wave axis had an increased risk of incident AF (hazard ratio 2.65, 95% confidence interval 1.76 to 3.99, p < 0.0001). Findings were similar in prespecified subgroups, without evidence of effect modification. Both left- and right-axis deviation of the P-wave were associated with incident AF. Our results suggest that abnormal P-wave axis is associated with incident AF in those with DM and that this relation is conserved in prespecified subgroups. There may be utility in considering P-wave axis values from routine ECGs in these patients.


Assuntos
Fibrilação Atrial/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Átrios do Coração/fisiopatologia , Idoso , Fibrilação Atrial/fisiopatologia , Comorbidade , Diabetes Mellitus Tipo 2/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
7.
Diabetes Metab Syndr ; 14(5): 1143-1146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32668399

RESUMO

BACKGROUND: Hypoglycemia is the limiting factor in the glycemic management of diabetes, which need to be addressed critically to avoid complications. Lockdown because of new coronavirus strain (COVID-19) pandemic has further complicated the issue of hypoglycemia due to limitations in access to food, outpatient clinics, pathological services and medicines. AIM: To assess the factors associated with the risk of hypoglycemia during April-May 2020 lockdown in people with type 2 diabetes mellitus. METHODOLOGY: We analyzed the data retrospectively from 146 patients of type 2 diabetes mellitus (T2DM) reporting to the emergency department (ED) during lockdown period with symptoms suggestive of hypoglycemia. RESULTS: The majority of patients were male (90/146) with a mean age of 59.88 ± 10.09 years and a mean random blood glucose level of 57.67 ± 9.00 mg/dL. Two-third of patients (70.83%) had level 1 hypoglycemia, while level 2 hypoglycemia was reported in 29.16% of patients. A combination of Metformin and Sulfonylureas (SU) was most commonly associated with the risk of hypoglycemia (65.75%) followed by insulin (33.56%). Subjects who received insulin reported a lower blood glucose value (50.75 ± 8.20 mg/dL) as compared to those receiving a combination of metformin and SU (60.95 ± 7.10 mg/dl). 330.56% of patients who had received prophylaxis hydroxychloroquine (HCQ) 400 mg twice a day along with the routine anti-hyperglycemic agents without their dose adjustment reported hypoglycemia. Patients with hypertension, micro-vascular, macro-vascular complications, and coexistent with each other had a higher propensity to the risk of hypoglycemia (46.58%, 33.56%, 23.29%, and 32.88%) respectively. CONCLUSION: The COVID-19 lockdown has shown to influence the risk of hypoglycemia in patients with T2DM, especially those receiving SU, insulin, HCQ especially in patients with associated co-morbidities. Patient education, support, and telemedicine plays a pivotal role to prevent hypoglycemia.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Hipoglicemia/epidemiologia , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Glicemia/análise , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/virologia , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos
9.
Adv Exp Med Biol ; 1250: 159-176, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32601944

RESUMO

Diabetes mellitus type 2 (type-2 diabetes) is a metabolic disorder characterized by the increased blood glucose concentration and insulin resistance in peripheral tissues (e.g., muscles and adipose tissue). The initiation of the pathological cascade of events that lead to type-2 diabetes has been subject of debate; however, it has been commonly accepted that the oversecretion of human islet amyloid polypeptide (hIAPP, a hormone co-secreted with insulin) by the pancreatic 𝛽-cells is the main trigger of type-2 diabetes. In fact, 90% of the type-2 diabetes patients present hIAPP deposits in the extracellular space of the 𝛽-cells. These hIAPP supramolecular arrangements (both fibrillar and oligomeric) have been reported to be the origin of cytotoxicity, which leads to 𝛽-cell dysfunction through a series of different mechanisms, including the interaction of hIAPP oligomers with the cell membrane that leads to the influx of Ca2+ and increase in the cellular oxidative stress, among others. This overview shows the importance of developing type-2 diabetes treatment strategies able to (1) remodel of the secondary structure of cytotoxic hIAPP oligomers entrapping them into off-pathway nontoxic species and (2) reestablish physiological levels of oxidative stress. Natural polyphenols are a class of antioxidant compounds that are able to perform both functions. Herein we review the published literature of the most studied polyphenols, in particular for their ability to remodel the hIAPP aggregation pathway, to rescue the in vitro pancreatic 𝛽-cell viability and function, as well as to perform under a complex biological environment, i.e., in vivo animal models and clinical trials. Overall, natural polyphenols are able to control the cytotoxic hIAPP aggregation and minimize hIAPP-mediated cellular dysfunction and can be considered as important lead compounds for the treatment of type-2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Polipeptídeo Amiloide das Ilhotas Pancreáticas , Polifenóis , Animais , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Modelos Animais de Doenças , Humanos , Polipeptídeo Amiloide das Ilhotas Pancreáticas/metabolismo , Polifenóis/farmacologia
10.
Medicine (Baltimore) ; 99(29): e21123, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702863

RESUMO

INTRODUCTION: Gitelman syndrome (GS) is an autosomal-recessive disease caused by SLC12A3 gene mutations. It is characterized by hypokalemic metabolic alkalosis in combination with hypomagnesemia and hypocalciuria. Recently, patients with GS are found at an increased risk for developing type 2 diabetes mellitus (T2DM). However, diagnosis of hyperglycemia in GS patients has not been thoroughly investigated, and family studies on SLC12A3 mutations and glucose metabolism are rare. Whether treatment including potassium and magnesium supplements, and spironolactone can ameliorate impaired glucose tolerance in GS patients, also needs to be investigated. PATIENT CONCERNS: We examined a 55-year-old Chinese male with intermittent fatigue and persistent hypokalemia for 17 years. DIAGNOSES: Based on the results of the clinical data, including electrolytes, oral glucose tolerance test (OGTT), and genetic analysis of the SLC12A3 gene, GS and T2DM were newly diagnosed in the patient. Two mutations of the SLC12A3 gene were found in the patient, one was a missense mutation p.N359K in exon 8, and the other was a novel insert mutation p.I262delinsIIGVVSV in exon 6. SLC12A3 genetic analysis and OGTT of 9 other family members within 3 generations were also performed. Older brother, youngest sister, and son of the patient carried the p.N359K mutation in exon 8. The older brother and the youngest sister were diagnosed with T2DM and impaired glucose tolerance by OGTT, respectively. INTERVENTIONS: The patient was prescribed potassium and magnesium (potassium magnesium aspartate, potassium chloride) oral supplements and spironolactone. The patient was also suggested to maintain a high potassium diet. Acarbose was used to maintain the blood glucose levels. OUTCOMES: The electrolyte imbalance including hypokalemia and hypomagnesemia, and hyperglycemia were improved with a remission of the clinical manifestations. CONCLUSION: GS is one of the causes for manifestation of hypokalemia. SLC12A3 genetic analysis plays an important role in diagnosis of GS. Chinese male GS patients characterized with heterozygous SLC12A3 mutation should be careful toward occurrence of T2DM. Moreover, the patients with only 1 SLC12A3 mutant allele should pay regular attention to blood potassium and glucose levels. GS treatment with potassium and magnesium supplements, and spironolactone can improve impaired glucose metabolism.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Síndrome de Gitelman/complicações , Hipopotassemia/etiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Fadiga/etiologia , Síndrome de Gitelman/fisiopatologia , Humanos , Hipopotassemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mutação/genética , Membro 3 da Família 12 de Carreador de Soluto/genética
11.
Diabetes Res Clin Pract ; 166: 108298, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623031

RESUMO

INTRODUCTION: The COVID-19 pandemic creates a challenge in the provision of care for patients with diabetes. Furthermore, those with uncontrolled diabetes are at a higher risk for complications due to COVID-19. The purpose of this study is to find an innovative method to sustain effective diabetes care services amidst the COVID-19 pandemic. METHODS: Outpatient diabetes care was successfully transformed from traditional face-to-face encounters in the clinic to an online telemedicine service. RESULTS: 1,972 patients were encountered over a 4-week study period during which we had a low proportion of unreached patients (4%). Some patients were still seen in person because they came as walk-in visits or insisted to be seen in person. CONCLUSION: Telemedicine has become an essential healthcare service and could be augmented by the use of technology like web-based applications and communication via transfer of data from patients' glucometer, insulin pumps, or sensors. Diabetes care can be transitioned to telemedicine effectively and would be successful in reaching more patients than by traditional face-to-face visits. This model of care is time consuming and unfortunately does not reduce the need for medical staff.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/normas , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Instituições de Assistência Ambulatorial , Barein/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/virologia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico
12.
Diabetes Res Clin Pract ; 166: 108294, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623037

RESUMO

AIMS: Diabetes mellitus (DM) is associated with significant morbidity and mortality. The disease severity in 2019 novel coronavirus (Covid 19) infection has varied from mild self-limiting flu-like illness to fulminant pneumonia, respiratory failure and death. Since DM and Covid 19 infection are closely associated with inflammatory status, mean platelet volume (MPV) was suggested to be useful in predicting Covid infection onset. This study aimed to evaluate the diagnostic role of MPV in Covid patients with diabetes. METHODS: A total of 640 subjects (160 Covid patients with type 2 diabetes, 160 healthy controls, 160 patients with non-spesific infections and 160 Covid patients without type 2 diabetes) enrolled in the study. RESULTS: MPV was significantly higher (11.21 ± 0.61 fL) as compared to the results from the last routine visits of the the same individuals with diabetes (10.59 ± 0.96 fL) (p = 0.000). CONCLUSIONS: MPV could be used as a simple and cost-effective tool to predict the Covid infection in subjects with diabetes in primary care.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Volume Plaquetário Médio/métodos , Pneumonia Viral/diagnóstico , Estudos de Casos e Controles , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Turquia/epidemiologia
13.
Diabetes Res Clin Pract ; 166: 108300, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32663490

RESUMO

Coronavirus disease 2019 (COVID-19) is considered to be spread primarily by people who have tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss a patient with severe COVID-19 and a history of type 2 diabetes who had a recurrence of positive SARS-CoV-2 ribonucleic acid (RNA) after recovering. The patient was initially discharged after two consecutive negative SARS-CoV-2 RNA tests and partially absorbed bilateral lesions on chest computed tomography (CT). However, at his first follow-up, reverse transcription-polymerase chain reaction (RT-PCR) assay with an oropharyngeal swab sample was positive for SARS-CoV-2. Despite this, he displayed no obvious clinical symptoms and improved chest CT. The patient was prescribed anti-viral medication. Eight consecutive RT-PCR assays on oropharyngeal swab specimens were conducted after he was re-admitted to our hospital. The results tested positive on the 12th, 14th, 19th, 23rd and 26th of March and negative on the 28th of March, and 6th and 12th of April. After his second discharge, he has tested negative for 5 weeks. This case highlights the importance of active surveillance of SARS-CoV-2 RNA during the follow-up period so that an infectivity assessment can be made.


Assuntos
Betacoronavirus/isolamento & purificação , Glicemia/metabolismo , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , RNA Viral/análise , Adulto , Betacoronavirus/genética , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/virologia , Humanos , Masculino , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , RNA Viral/genética , Tomografia Computadorizada por Raios X/métodos
14.
Diabetes Res Clin Pract ; 166: 108340, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32707213

RESUMO

OBJECTIVE: To investigate the characteristics of lymphocytes in type 2 diabetic patients with coronavirus disease (COVID-19). METHODS: Patients with COVID-19 admitted to hospital in Wuxi, China from January 29 to March 15 were included in the study. Lymphocytes were measured and recorded at admission and during treatment. Hospitalization days, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid positive days, minimal lymphocyte count, and occurrence time were collected and comparatively analyzed. Correlations between minimal lymphocyte count and hospitalization days as well as SARS-CoV-2 nucleic acid positive days were analyzed. RESULTS: A total of 63 patients were included in the study, with 16 in the diabetic group and 47 in the non-diabetic group. After adjusting for potential confounding factors, we observed lower minimal lymphocyte count (0.67 ± 0.36 * 109/L vs. 1.30 ± 0.54 * 109/L, adjusted P = 0.001), earlier occurrence of the minimal lymphocyte count (2.68 ± 2.33 days vs. 5.29 ± 4.95 days, adjusted P = 0.042), and longer hospitalization time (20.44 ± 5.24 days vs. 17.11 ± 4.78 days, adjusted P = 0.047) in the diabetic group than in the non-diabetic group. There was a negative correlation between minimal lymphocyte count and hospitalization days (R = -0.600, P < 0.05) as well as SARS-CoV-2 nucleic acid positive days (R = -0.420, P < 0.05). CONCLUSIONS: The diabetic group with COVID-19 had lower lymphocyte count, reached the minimal count faster, and had longer hospital stays than the non-diabetic group. Hospitalization days and SARS-CoV-2 nucleic acid positive days were negatively correlated with the minimal lymphocyte count.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/imunologia , Diabetes Mellitus Tipo 2/imunologia , Linfócitos/imunologia , Pneumonia Viral/imunologia , Adulto , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/virologia , Feminino , Hospitalização , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos
15.
Life Sci ; 257: 118073, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32663574

RESUMO

AIMS: The preservation of pancreatic beta-cell function is crucial for the treatment of type 2 diabetes. Inhibition of class I histone deacetylase (HDAC) has been proved to protect beta-cells from palmitate- or cytokine-induced apoptosis and increase insulin secretion. However, the underlying molecular mechanism is unclear. MAIN METHODS: Rat islets were isolated for insulin secretion, real-time PCR, RNA- sequencing, ChIP-PCR, and oxygen consumption rate analysis after treated with the HDAC1 and HDAC3 inhibitor MS-275. KEY FINDINGS: MS-275 pretreatment significantly potentiated insulin secretion from rat islets. RNA-sequencing revealed that multiple signaling pathways were involved in MS-275-regulated islet function. Cacna1g and Adcy1 in calcium and cAMP signaling pathways were up-regulated in MS-275-treated islets, which was validated by real-time PCR. The expressions of the two genes displayed a similar increase in islets isolated from mice treated with MS-275. Knockdown of HDAC1 elevated Cacna1g and Adcy1 expressions in islets. ChIP-sequencing analysis showed that the pan-HDAC inhibitor sodium butyrate increased H3K27 acetylation level in the upstream region of Adcy1 and the promoter region of Cacna1g. ChIP-PCR revealed a similar result in MS-275-treated rat islets. However, MS-275 had minor effect on glucose-induced oxygen consumption rate in rat islets. Unlike glucose, MS-275 did not alter the expressions of glucose-sensitive genes such as Glut2 and Gck, but elevated intracellular Ca2+ concentration in beta-cells. SIGNIFICANCE: Our findings support the notion that MS-275-potentiated insulin secretion is involved in calcium and cAMP signaling-mediated gene expressions independent of glucose oxidation. Therefore, HDAC inhibition may serve as a therapeutic strategy for type 2 diabetes.


Assuntos
Benzamidas/farmacologia , Glucose/metabolismo , Inibidores de Histona Desacetilases/farmacologia , Secreção de Insulina/efeitos dos fármacos , Piridinas/farmacologia , Animais , Cálcio/metabolismo , AMP Cíclico/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Técnicas de Silenciamento de Genes , Histona Desacetilase 1/antagonistas & inibidores , Histona Desacetilases/efeitos dos fármacos , Células Secretoras de Insulina , Masculino , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
16.
Diabetes Res Clin Pract ; 166: 108300, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: covidwho-638523

RESUMO

Coronavirus disease 2019 (COVID-19) is considered to be spread primarily by people who have tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss a patient with severe COVID-19 and a history of type 2 diabetes who had a recurrence of positive SARS-CoV-2 ribonucleic acid (RNA) after recovering. The patient was initially discharged after two consecutive negative SARS-CoV-2 RNA tests and partially absorbed bilateral lesions on chest computed tomography (CT). However, at his first follow-up, reverse transcription-polymerase chain reaction (RT-PCR) assay with an oropharyngeal swab sample was positive for SARS-CoV-2. Despite this, he displayed no obvious clinical symptoms and improved chest CT. The patient was prescribed anti-viral medication. Eight consecutive RT-PCR assays on oropharyngeal swab specimens were conducted after he was re-admitted to our hospital. The results tested positive on the 12th, 14th, 19th, 23rd and 26th of March and negative on the 28th of March, and 6th and 12th of April. After his second discharge, he has tested negative for 5 weeks. This case highlights the importance of active surveillance of SARS-CoV-2 RNA during the follow-up period so that an infectivity assessment can be made.


Assuntos
Betacoronavirus/isolamento & purificação , Glicemia/metabolismo , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , RNA Viral/análise , Adulto , Betacoronavirus/genética , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/virologia , Humanos , Masculino , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , RNA Viral/genética , Tomografia Computadorizada por Raios X/métodos
17.
Nat Metab ; 2(7): 572-585, 2020 07.
Artigo em Inglês | MEDLINE | ID: covidwho-643353

RESUMO

For infectious-disease outbreaks, clinical solutions typically focus on efficient pathogen destruction. However, the COVID-19 pandemic provides a reminder that infectious diseases are complex, multisystem conditions, and a holistic understanding will be necessary to maximize survival. For COVID-19 and all other infectious diseases, metabolic processes are intimately connected to the mechanisms of disease pathogenesis and the resulting pathology and pathophysiology, as well as the host defence response to the infection. Here, I examine the relationship between metabolism and COVID-19. I discuss why preexisting metabolic abnormalities, such as type 2 diabetes and hypertension, may be important risk factors for severe and critical cases of infection, highlighting parallels between the pathophysiology of these metabolic abnormalities and the disease course of COVID-19. I also discuss how metabolism at the cellular, tissue and organ levels might be harnessed to promote defence against the infection, with a focus on disease-tolerance mechanisms, and speculate on the long-term metabolic consequences for survivors of COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Doenças Metabólicas/etiologia , Doenças Metabólicas/metabolismo , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Pandemias , Fatores de Risco
18.
Diabetes Metab Syndr ; 14(5): 1143-1146, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-642952

RESUMO

BACKGROUND: Hypoglycemia is the limiting factor in the glycemic management of diabetes, which need to be addressed critically to avoid complications. Lockdown because of new coronavirus strain (COVID-19) pandemic has further complicated the issue of hypoglycemia due to limitations in access to food, outpatient clinics, pathological services and medicines. AIM: To assess the factors associated with the risk of hypoglycemia during April-May 2020 lockdown in people with type 2 diabetes mellitus. METHODOLOGY: We analyzed the data retrospectively from 146 patients of type 2 diabetes mellitus (T2DM) reporting to the emergency department (ED) during lockdown period with symptoms suggestive of hypoglycemia. RESULTS: The majority of patients were male (90/146) with a mean age of 59.88 ± 10.09 years and a mean random blood glucose level of 57.67 ± 9.00 mg/dL. Two-third of patients (70.83%) had level 1 hypoglycemia, while level 2 hypoglycemia was reported in 29.16% of patients. A combination of Metformin and Sulfonylureas (SU) was most commonly associated with the risk of hypoglycemia (65.75%) followed by insulin (33.56%). Subjects who received insulin reported a lower blood glucose value (50.75 ± 8.20 mg/dL) as compared to those receiving a combination of metformin and SU (60.95 ± 7.10 mg/dl). 330.56% of patients who had received prophylaxis hydroxychloroquine (HCQ) 400 mg twice a day along with the routine anti-hyperglycemic agents without their dose adjustment reported hypoglycemia. Patients with hypertension, micro-vascular, macro-vascular complications, and coexistent with each other had a higher propensity to the risk of hypoglycemia (46.58%, 33.56%, 23.29%, and 32.88%) respectively. CONCLUSION: The COVID-19 lockdown has shown to influence the risk of hypoglycemia in patients with T2DM, especially those receiving SU, insulin, HCQ especially in patients with associated co-morbidities. Patient education, support, and telemedicine plays a pivotal role to prevent hypoglycemia.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Hipoglicemia/epidemiologia , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Glicemia/análise , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/virologia , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos
19.
Diabetes Res Clin Pract ; 166: 108298, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: covidwho-628399

RESUMO

INTRODUCTION: The COVID-19 pandemic creates a challenge in the provision of care for patients with diabetes. Furthermore, those with uncontrolled diabetes are at a higher risk for complications due to COVID-19. The purpose of this study is to find an innovative method to sustain effective diabetes care services amidst the COVID-19 pandemic. METHODS: Outpatient diabetes care was successfully transformed from traditional face-to-face encounters in the clinic to an online telemedicine service. RESULTS: 1,972 patients were encountered over a 4-week study period during which we had a low proportion of unreached patients (4%). Some patients were still seen in person because they came as walk-in visits or insisted to be seen in person. CONCLUSION: Telemedicine has become an essential healthcare service and could be augmented by the use of technology like web-based applications and communication via transfer of data from patients' glucometer, insulin pumps, or sensors. Diabetes care can be transitioned to telemedicine effectively and would be successful in reaching more patients than by traditional face-to-face visits. This model of care is time consuming and unfortunately does not reduce the need for medical staff.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/normas , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Instituições de Assistência Ambulatorial , Barein/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/virologia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico
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