bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of Patients With Type 2 Diabetes Mellitus and COVID-19
Authors: Videa Elvin Omar , Murillo Nancy Gabriela Rodríguez , Alvarenga Pamela Carolina , Ochoa Vania Lizeth Barahona 
Published: May 2021

Abstract
The coronavirus is a pathogen that mainly attacks the human respiratory system Previous coronavirus outbreaks (CoV) include severe acute respiratory syndrome (SARS), the clinical spectrum of COVID19 is very broad ranging from mild symptoms to ARDS to multiple organ failure and death. A history of DM2, advanced age and other comorbidities are considered predictors of higher morbidity and mortality, it is also known that blood glucose and DM levels are independent predictors of morbidity and mortality in patients with SARS. It should be remembered that patients with DM2 suffer from a chronic low grade inflammation that could facilitate the cytokine storm which in turn would be the cause of severe cases of COVID 19 pneumonia and the eventual death of many patients. Glucocorticoids have a stimulating and inhibitory effect on the immune response according to the moment in which it is administered and its circulating levels insulin therapy has been shown to decrease inflammation. For the control of glycemia the objectives must be individualized. Glycemic and individualized targets for non critical hospitalized patients have been established by different scientific societies such as ADA and AACE and Endocrine Society. In Honduras the protocol for the clinical management of adult patients with COVID 19 was developed to establish and standardize timely treatment in patients with suspected or confirmed COVID 19 which consists of the MAIZ scheme and the MAIZ scheme AAA. A retrospective longitudinal descriptive study was carried out with a review of the data obtained from 32 patients diagnosed with DM2 and COVID19 during the months of June through September 2020 at the CAMI Comprehensive Medical Care Clinic located in the city of Tegucigalpa Honduras collecting epidemiological and clinical data. The results of the research show that of the 32 patients with DM2 and COVID 19, 59% (19) belong to the male gender and 41% (13) to the female gender, with an average age of 60 years. In the COVID19 severity classification the evaluated patients presented in the following condition mild 25% (8), moderate 69% (22) and severe 6% (2). The diagnostic method used was detection of anti SARS CoV2 antibodies 56% (17) and TR-PCR 43% (14). 75% (24) received steroids, 8.69% (2) of the patients who used steroids in their management had hyperglycemia and required management with regular insulin. 100% (32) of the patients who were treated recovered without registering any death. Conclusions: are that the pathophysiological factors of DM2 in relation to the immune system of patients can be a determining factor to present a degree of severity greater than that presented by the general population that falls ill with COVID19. Adequate glycemic control can determine a better prognosis in the evolution of the disease despite its degree of severity.
Covid Lockdown Impact on Type 1 Diabetes Health and Well-Being
Authors: Calma Jamie , Sangha Sabrina , Basina Marina 
Published: May 2021

Abstract
Introduction: Data on the impact of the COVID-19 lockdown on glycemic control and psychological well-being in individuals with Type 1 Diabetes Mellitus (T1DM) showed mixed results. Some studies showed improvement in glycemic control attributed to more time for self-care and a more regular lifestyle schedule during the lockdown. However, most published data reflects a short duration of 3–5 months. The impact of long-term social isolation and transition to telemedicine on the health of T1DM patients remains unknown. Our study analyzes patient perception surrounding the impact of an 11-month lockdown on glycemic control, well-being, and self-reported depression symptoms. Methods: PHQ-9 was integrated into a 55-question survey created using RedCap, a secure portal for managing surveys. The survey was sent to 160 T1DM patients over the age of 18 to gauge their current diabetes management and overall well-being prior to, and during the pandemic. The survey also inquired about patients’ perceived effectiveness of telemedicine visits. PHQ9 scores were collected and analyzed along with survey responses. Results: Data collection is still ongoing. From the 47 responders, the PHQ9 screening showed 51% were in the minimal depression score, 34% in the range of mild depression, 11% in moderate depression, and 4% scored in moderate to severe depression. No patients scored within severe depression. In a regular week during the pandemic, 40% of patients experienced difficulty with their motivation and diabetes management and 60% reported no concern, as compared to 36% and 64% respectively before the pandemic. Among the 47 of patient respondents, 30 reported both A1c levels prior and during the pandemic of which 46% showed an improved A1c amid the pandemic, 10% had no change, and 44% reported a worsened A1c level. For the telehealth part of the survey, 90% of patients reported feeling “comfortable with the level of care” they receive via telemedicine, whereas the other 10% were not. Whilst 54% of patients preferred in-person visits and 46% indicated a preference for telehealth visits. Conclusion: T1DM management is challenging. The pandemic adds to the complexity and burden to both self-management and healthcare delivery. Staying locked down for a prolonged period of time imposes economical, psychological, and medical constraints to diabetes care, as nearly half of the patients reported worsening of glycemic control. Our comprehensive survey reports the longest duration reported up to date of how the COVID-19 lockdown impacts patient’s perceived changes in their mental health and diabetes management. It helps clinicians understand the connection between mental and physical health during the pandemic and improve time-restricted telehealth visits by understanding patient concerns. Additional larger scale studies are imperative to expand the knowledge in this field.
COVID19 Induced Diabetes; New Type of Diabetes Mellitus? Viral Genetic Material a Step Towards Cure of Diabetes?
Authors: Phatale Hemant Nagnath , Nikalje Anand , Phatale Priti Hemant 
Published: May 2021

Abstract
The worldwide pandemic of coronavirus disease 2019 (COVID-19), seen in multiple races, ethnicities, age groups, with various co-morbidities. The bidirectional relationship between COVID-19 and diabetes (DM) is already established. The associations of DM with a variety of virus infections have been reported previously. COVID-19 infection could be causally linked to new-onset of DM. We report 13 cases of new type of COVID-19 induced DM. While working in noncovid endocrine clinic we could notice 5 patients presented with fever and URI or osmotic symptoms or post URI cramps in legs. All 5 cases was having hyperglycemia with ketonuria and HbA1c more than 11% with fasting or premeal C peptide levels more than 10 ng/ml. All five patients have new onset DM and they are neither obese nor having family history of DM. Presentation includes fever with cough and/OR osmotic symptoms with hyperglycemia, weight loss in weeks. Out of five, in four patients either RT PCR OR Rapid Antigen Test was positive. One patient presented with cramps in legs with past history of URI without fever. In her COVID 19 IgG antibody was positive. All patients initially treated with insulin but on follow up they are controlled with metformin plus gliptin. All patients have HbA1c less than 6.7 on follow up at 3 months. We have retrospectively analysed data at COVID hospital. We have used inclusion criteria as1Not known diabetes 2Either RT PCR + ve OR COVID-19 Ag +ve OR HR CT SCAN show atypical pneumonia or COVID-19 Ab positive 3Presented as hyperglycemia RBG &gt; 200 mg% 4HbA1c &gt; 7 with Urine Ketones + Exclusion Criteria Received steroids in recent past &lt;2 wk. Total 30 patients presented with hyperglycemia at admission in last one month (September). Out of these, 8 patients who are neither obese nor having family history of DM, nor received steroids in last 2 weeks. All 13 patients (5 + 8) are of new onset DM with BMI around 24, presented with ketonuria, with no family history of DM and who did not received steroids. Hence we propose COVID-19 can cause switch in metabolism to form new type of DM. There are case reports are published about COVID-19 induced DM with ketoacidosis. In another retrospective analysis of 658 COVID-19 patients, 42 presented with ketosis.(Am J Emerg Med 2020:S0735-6757(20)30488-5) Out of these 27 were newly diagnosed DM. But other features like BMI, family history of DM, C peptide levels, use of steroid are missing. We coined new type of DM which cause metabolic switch in metabolism leading to ketosis with HbA1c more than 11 & high normal C peptide requiring insulin initially but later controlled with metformin and gliptin with HbA1c less than 6.7!We further propose that genetic material of virus can cause switch in metabolism, then why should not we use other viral genetic material to reswitch leading towards cure of DM. Further research is needed in this direction.
Do GLP-1 Receptor Agonists Increase the Risk of Breast Cancer? A Systematic Review and Meta-Analysis
Authors: Piccoli Giovana Fagundes , Mesquita Leonardo A , Stein Cinara , Aziz Marina M , Zoldan Maira , Degobi Nathalia A H , Spiazzi Bernardo Frison , Junior Gilberto L Lopes , Colpani Veronica , Gerchman Fernando 
Published: May 2021

Abstract
Background: Risk of cancer is a major concern in the development of drugs for the treatment of obesity and diabetes. In randomized controlled trials (RCTs) of the liraglutide development program, a glucagon-like peptide-1 receptor agonist (GLP-1RA), subjects treated with the active drug had a higher absolute number of breast cancer events. Aim: To assess whether patients treated with GLP-1RAs had a higher risk of breast neoplasms. Methods: We searched MEDLINE, Embase, Web of Science, and CENTRAL from inception to February 8, 2020. Three pairs of reviewers examined and retrieved abstractsand full-text articles for RCTs of GLP-1RAs versus non-GLP-1RA controls(active or placebo) in adults with overweight, obesity, prediabetes, or diabetes,with a minimum follow-up period of 24 weeks and which reported at least oneevent of breast cancer or benign breast neoplasm. Divergences were dealt withby consensus. Researchers extracted study-level data and assessed within-study risk of bias with the RoB 2.0 tool and quality of evidence with GRADE. This study follows PRISMA reporting guidelines. Results: We included 52 trials, of which 50 reported breast cancer events and 11 reported benign breast neoplasms. Overall methodological quality was high. Among 48267 subjects treated with GLP-1RAs, 130 developed breast cancer compared to 107 of 40755 controls (relative risk [RR], 0.98; 95% confidence interval [CI], 0.76 to 1.26). Subset analyses according to follow-up, participant/investigator blinding, and type of GLP-1RA did not reveal any differences. The risk of benign breast neoplasms also did not differ between groups (RR, 0.99; 95% CI, 0.48 to 2.01). Trial sequential analysis provided evidence that the sample size was sufficient to avoid missing alternative results. Conclusion: Treatment with GLP-1RAs for obesity and diabetes does not increase the risk of breast neoplasms. Register: This systematic review was preregistered in PROSPERO (CRD42019132704).
Anaphylactic Reaction to Dulaglutide: A Glucagon Like Peptide- 1 Receptor Agonist
Authors: Quadri Hamza , Ataallah Basma , Haggerty Gregory 
Published: May 2021

Abstract
Introduction: The development of Glucagon like peptide-1 (GLP-1) receptors agonists represents an important advancement in the management of type 2 diabetes. The long-acting GLP-1 receptor agonists improve glycemic control, promote weight loss. Anaphylaxis to GLP-1 receptor agonists and mainly Dulaglutide is a rare but serious side effect. We report a patient with Type 2 DM who was recently started on Dulaglutide and started to experience systemic hypersensitivity reactions that required discontinuing the medication and inpatient hospitalization. Case: A 53-Year-old Caucasian female with past medical history of type 2 DM on Metformin presented to the ED with sudden onset of sporadic itchy rash on the lip and chin associated with lip swelling within one hour of her first injection of Dulaglutide. She denied difficulty breathing, rash or pruritus on any other part of the body. She denied any food allergies. The patient used two tablets of Oral Diphenhydramine 25 mg with minimal improvement in her symptoms which warrant her to come to the ED. On arrival, she was Afebrile with a HR 97 beats/minute, a BP of 105/58 mm of Hg and a RR of 17 breaths/minute. The rash was blotchy, non- tender, more evident on the upper lip as compared to the lower lip. Lab results showed WBC count of 11 k/uL with basophils of 2% and HbA1c 8.6%. She was treated for her allergic reaction with Intramuscular injection of Epinephrine 0.3mg, Intravenous Dexamethasone 6mg and Intravenous Diphenhydramine 25mg. She was then transferred to the observation unit for monitoring. Her home metformin 500mg two times a day was continued. After 48 hours, the patient’s symptoms were improved and she was discharged home. She was advised to follow up with her PCP and endocrinologist and stop Dulaglutide. Discussion: GLP-1 receptor agonists are commonly used currently in the management of DM due to their beneficial effect in controlling blood glucose as compared to other diabetic medications. Rarely, a potentially life-threatening reaction, such as anaphylactic reactions have been documented with GLP-1 receptor agonist. Systemic allergic reaction to GLP-1 Agonist Exenatide has been reported in the literature. Our patient had anaphylactic reaction after using Dulaglutide. The mechanism of action of anaphylaxis in GLP-1 receptor agonists is thought to be related to IgE mediated and the immune response was demonstrated by basophil activation.
Continuous Subcutaneous Insulin Infusion Therapy Resulting in Improved Glycemic Control in Patient With Low Health Literacy
Authors: Mandal Shobha , Fnu Manas , Baniya Srijana , Singh Sneha , MolsKowalczewski Barbara 
Published: May 2021

Abstract
Introduction: According to White et al., health literacy is defined as ‘the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions. Nearly 36 percent of adults in the United State have low health literacy. Low health literacy not only affects the individual and the communities but also puts a lot of burden on healthcare resulting in high healthcare costs. It has adversely influenced diabetes care due to lack of use of preventive services, poor physician-patient communication, poor comprehension of medical instructions, and errors in medication dosing, and timing. Continuous subcutaneous insulin infusion (CSII), also known as insulin pump therapy, and continuous glucose monitors (CGM) are commonly indicated in patients with inadequate glycemic control, high glucose variability, unpredictable hypoglycemia, patients with an erratic schedule or varied work shifts. We present a case of uncontrolled diabetes mellitus in a patient with low health literacy, with significant improvement in glycemic control after starting CSII with CGM.
Case: A 59-year-old female with a 13-year history of Latent Autoimmune Diabetes in Adults, on Insulin and Semaglutide, presented for evaluation in the clinic. She was struggling with insulin dosing and blood glucose control with multiple hospital admissions for hypo- and hyperglycemia. Her home blood glucose levels ranged from 92 to 536 mg/dl. Her HbA1C was between 12 and 18% in the past years. She had developed microvascular complications like diabetic nephropathy, neuropathy, and had a cerebrovascular accident in the past. Her current insulin dose was Glargine 50 units daily at nighttime and Lispro 25 units with each meal. Her most recent HbA1c was 14.5. She was not compliant with diet and has difficulty exercising due to residual weakness from CVA. The patient was struggling with insulin injection with errors in the dosing and timing of insulin due to difficulty in understanding medical instructions. Considering all the struggles and uncontrolled diabetes, CSII with CGM was initiated, with a simple protocol for her, one-click, or two clicks depending on the meal size. Within two months there was a significant improvement in her glycemic control. Her recent HbA1C was 9.5%.
Conclusion: CSII can be considered as a viable treatment option in patients with low health literacy with uncontrolled diabetes mellitus like in our patient.
Diabetes and Tuberculosis: Is There a Relationship?
Authors: Webster John , Vinales Karyne Lima , Correa Ricardo Rafael 
Published: May 2021

Abstract
Background: There is growing evidence that Diabetes Mellitus (DM) is an important risk factor for Tuberculosis (TB) and might affect disease presentation and treatment response. Risk factors for TB include HIV/AIDS, immune suppression (i.e. steroids), silicosis, malnutrition, smoke from domestic stoves and cigarettes, and DM. In recent decades, TB incidence has declined in high-income countries, but incidence remains high in countries that have high rates of HIV infection, malnutrition, and crowded living conditions. Furthermore, DM prevalence is increasing globally, fueled by obesity. Several case–control studies have shown that the odd ratios of developing TB in diabetic patients ranges from 2.44 to 8.33 compared with non-diabetic patients. Several large-scale longitudinal cohort studies have shown similar findings.
Case: A 63-year-old male with poorly controlled type 2 DM (HbA1C of 15%), HTN, COPD and history of pulmonary TB who had previously received 2 courses of treatment, was admitted with sudden dyspnea with non-productive cough. In the ED, he was hypoxic, had bilateral pleural effusions, lower extremity edema and newly diagnosed acute systolic CHF. Sputum smear analysis was AFB positive and Mycobacterium tuberculosis was confirmed via PCR. The smear microbes were resistant to rifampin, poor sample limited further sensitivities, and the patient was started on empiric treatment for multi drug resistant TB with RIPE, Capreomycin, Linezolid, and Moxifloxacin. Endocrinology was consulted to assist in control of hyperglycemia. The patient was managed with high doses of insulin. At the time of discharge his blood glucose where in the range of 120–180 mg/dl during the entire day and the importance of having good BG control was reinforced. He continues his treatment for TB.
Discussion: Diabetes leads to increased susceptibility to Mycobacterium tuberculosis infection and disease via multiple mechanisms, including those directly related to hyperglycemia, as well as indirectly via the effect on macrophage and lymphocyte function, leading to diminished ability to contain the organism. It is possible the refractory course of this patient’s TB and subsequent development of MDR disease was in part due to his poorly controlled diabetes due to poor compliance to prior regimens.
Conclusion: DM is associated with increased risk of contracting TB, the possible delay in sputum culture conversion, increased mortality, and increased risk of recurrent and refractory disease. Adequate screening and treatment of DM may be essential to help prevent patients with diabetes from contacting the disease especially in countries with high prevalence of TB. Also, it is important to ensure adequate treatment response and prevent the development of multidrug resistant disease in diabetics who have already contracted TB.
Diabetes Apps: Information about COVID-19 and Risk Factors?
Authors: Wu Gloria , Lau Chap-Kay Kendra , Nguyen Brian 
Published: May 2021

Abstract
Background: Annually, there are 3.7 billion downloads of mobile health apps. There are 275.6 million smartphones in the US. Diabetes affects 34.2 million people and 88 million have prediabetes. Diabetes is a risk factor for COVID-19 and affects longterm health of the survivors. Other risk factors for COVID-19, include race and gender. There are also linguistic barriers to care in Diabetes and COVID-19. Both diabetes and COVID-19 have higher risks associated with race and ethnicity. With the pandemic, the US government, Google and Facebook, in March 2020, provided emergency grants for COVID-19 and dissemination of public education. Did the Diabetes apps meet this moment of public health crisis?. Purpose: Do Diabetes Apps provide information about COVID-19 and its risk factors? Methods: Using the search term “diabetes,” the top ten most downloaded android and iOS apps were assessed in the Google Play Store/Apple App Store, respectively. Inclusion criteria: 1) Android: Downloads &gt; 100,000; iOS: Reviews &gt; 300, star rating &gt;4. Apple App store does not provide download information. 2) Free; 3) Ability to track health data: HbA1C, FBS; 4) Language Accessibility via in-app language settings. Results: In the Google Play Store(DROID), the top ten apps in descending order were: 1) mySugr, 2) Onetouch Reveal, 3) OneDrop Diabetes Management, 4) Diabetes: M, 5) Health2Sync - Diabetes Care, 6) Diabetes, 7) Ontrack Diabetes, 8) Blood Glucose Tracker, 9) Glucose Buddy Diabetes Tracker, and 10) Diabetes Connect. In the Apple App Store(iOS), the top ten apps in descending order were: 1) OneTouch Reveal, 2) Glucose Buddy Diabetes, 3) One Drop for Diabetes, 4) Glucose - Blood Sugar Tracker, 5) Blood Sugar Monitor by Dario, 6) mySugr, 7) Sugarmate, 8) DiabetesPal, 9) Diabetes:M, 10) Center Health - The Diabetes App. Of the 10 DROID apps: 0/10 had COVID symptom information in the app; 3/10 had a COVID statement; In-app language settings: 2/10 had Spanish and 1/10 had Chinese. Gender: 7/10 Droid apps. Race/Ethnicity: 0/10. Of the ten iOS apps: 0/10 had COVID symptom information in the app; 4/10 had a COVID statement (Only mySugr has CDC link for COVID information); In-app language settings: 1/10 had Spanish and 0/10 had Chinese settings. Gender: 9/10 Droid apps; 7/10 iOS apps, Race/Ethnicty:1/10. Conclusion: Of the top 20 diabetes apps, none had information about COVID-19 and its symptoms within the app. Also, the overall language accessibility is limited. Despite popularity of ehealth, physicians can continue to play an important role in public education about Diabetes and COVID-19 during this important time of the pandemic.