Query: covid-19 diabetes

title: Diabetes and COVID 19
abstract: After the recognition in December 2019 of a cluster of patients with pneumonia of unknown cause in Wuhan caused by the novel coronavirus, CoV 19, China and the world have faced the extraordinary challenge of a previously unrecognized viral illness with high infectivity. Every year, millions of persons (5% 15% of the world's population) contract influenza, causing between 300 000 and 600 000 excess respiratory deaths. In China alone, recent estimates put the annual influenza associated mortality rate at more than 88 000 persons, likely in excess of any potential outcome of coronavirus disease 2019 (COVID 19) Regardless of the potential for spread of COVID 19, as with influenza related mortality, diabetes is an important risk factor for adverse outcome. Mortality rates among persons with diabetes in Hong Kong age 75 and over from pneumonia currently exceed mortality rates in this age group from cardiovascular disease and from cancer. Similar evidence of risk among persons with diabetes has been reported for the two earlier CoV infections, severe acute respiratory syndrome (SARS) beginning in 2002 and affecting more than 8000 persons, mainly in Asia and the Middle East respiratory syndrome (MERS) in 2012 affecting more than 2000 persons, mainly in Saudi Arabia. As MERS CoV binds to the receptor binding domain of human dipeptidyl peptidase IV (DPP IV) a transgenic mouse model expressing this DPP IV receptor on pulmonary alveolar cells has been used to study the effect of diabetes in worsening disease severity, showing an association of diabetes with greater weight loss and greater pulmonary inflammation, with macrophage infiltrates similar to those seen clinically in the disease. We acknowledge the frontline medical staff working day and night in China to rescue critical cases and protect the public health. We know that these great efforts are now and will be in the future crucial in overcoming COVID 19. Providing care to people with diabetes is an important part of the effort. The Journal of Diabetes was started more than a decade ago in a spirit of collaboration between East and West addressing the epidemiology, etiology, pathogenesis, management, complications, and prevention of diabetes. The journal is issuing a call for submission of commentaries, original articles, and case reports regarding issues with COVID 19 in patients with diabetes, as well as descriptions of basic aspects of the interrelationships between diabetes and the novel CoV. We hope in this way to support the thousands of Chinese medical workers involving themselves in the care of patients with COVID 19, and we look forward to these efforts helping our goal of eradication of the disease.

title: COVID 19 and diabetes: Knowledge in progress
abstract: We aimed to briefly review the general characteristics of the novel coronavirus (SARS CoV 2) and provide a better understanding of the coronavirus disease (COVID 19) in people with diabetes, and its management.  We searched for articles in PubMed and Google Scholar databases till 02 April 2020, with the following keywords: "SARS CoV 2" "COVID 19" "infection" "pathogenesis" "incubation period" "transmission" "clinical features" "diagnosis" "treatment" "diabetes" with interposition of the Boolean operator "AND"  The clinical spectrum of COVID 19 is heterogeneous, ranging from mild flu like symptoms to acute respiratory distress syndrome, multiple organ failure and death. Older age, diabetes and other comorbidities are reported as significant predictors of morbidity and mortality. Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS CoV 2 might be among the underlying mechanisms of the association between diabetes and COVID 19. No conclusive evidence exists to support the discontinuation of angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers because of COVID 19 in people with diabetes. Caution should be taken to potential hypoglycemic events with the use of chloroquine in these subjects. Patient tailored therapeutic strategies, rigorous glucose monitoring and careful consideration of drug interactions might reduce adverse outcomes.  Suggestions are made on the possible pathological mechanisms of the relationship between diabetes and COVID 19, and its management. No definite conclusions can be made based on current limited evidence. Further research regarding this relationship and its clinical management is warranted.

title: Commentary: COVID 19 in patients with diabetes
abstract: This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

title: COVID 19 pandemic, coronaviruses, and diabetes mellitus
abstract: The pandemic of coronavirus disease (COVID 19) a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) is causing substantial morbidity and mortality. Older age and presence of diabetes mellitus, hypertension, and obesity significantly increases the risk for hospitalization and death in COVID 19 patients. In this Perspective, informed by the studies on SARS CoV 2, Middle East respiratory syndrome (MERS CoV) and the current literature on SARS CoV 2, we discuss potential mechanisms by which diabetes modulates the host viral interactions and host immune responses. We hope to highlight gaps in knowledge that require further studies pertinent to COVID 19 in patients with diabetes.

title: Diabetes in COVID 19: Prevalence, pathophysiology, prognosis and practical considerations
abstract: High prevalence of diabetes makes it an important comorbidity in patients with COVID 19. We sought to review and analyze the data regarding the association between diabetes and COVID 19, pathophysiology of the disease in diabetes and management of patients with diabetes who develop COVID 19 infection.  PubMed database and Google Scholar were searched using the key terms 'COVID 19' 'SARS CoV 2' 'diabetes' 'antidiabetic therapy' up to April 2, 2020. Full texts of the retrieved articles were accessed.  There is evidence of increased incidence and severity of COVID 19 in patients with diabetes. COVID 19 could have effect on the pathophysiology of diabetes. Blood glucose control is important not only for patients who are infected with COVID 19, but also for those without the disease. Innovations like telemedicine are useful to treat patients with diabetes in today's times.

title: Coronavirus Disease COVID 19
abstract: 150 new cases tested positive for COVID 19 and 7 additional deaths reported since 20 March 2020 Out of 380 confirmed cases, 38.2% are still under investigation. Department of Health (DOH) stepping up its case investigation and contact tracing system with Epidemiological Surveillance Units (ESU) through online system at regional, provincial, city and municipal level. Many hospitals reportedly running low on Personal Protection Equipment, causing an increasing number of health workers to self quarantine because of exposure to suspected COVID 19 cases. Many parts of the Philippines with enhanced community quarantine in place. DOH preparing three hospitals in National Capital Region (NCR) dedicated for COVID 19 patients: Lung Centre, Philippine General Hospital, and Dr Jose M Rodriguez Memorial Hospital (75 beds) Community quarantine measures aimed at decreasing stress on health facilities through minimizing risk of infection, potentially resulting in lower morbidity and mortality. Key focus on at risk groups including elderly and people with underlying health conditions such as diabetes and hypertension Increase in the daily testing capacity at the Research Institute for Tropical Medicine (RITM) and 4 sub national laboratories in Cebu, Davao, Baguio and Manila. Laboratory assessment among additional public and private hospitals ongoing. Increased cooperation among public and private partners in procurement of urgently needed supplies in view of global shortages. Government finalizing National COVID 19 Contingency Plan complemented by Humanitarian Country Team Response Plan.

title: COVID 19, diabetes mellitus and ACE2: The conundrum
abstract: A novel coronavirus disease (COVID 19) caused by severeacute respiratory syndrome coronavirus 2 (SARS CoV 2) hasscourged the world since its outbreak in December 2019 atWuhan, China resulting in the World Health Organizationdeclaring it as a pandemic. As of March 22, 2020, COVID 19has affected over292,000peoplein at least 185countriesworld wide with most of the cases being reported from China, Europeand the United States of America. The absolute number ofdeaths has already surpassed 12,750 globally and is expectedto increase further as the disease spreads rapidly. The diseasehas also infiltrated the Indian masses and is spreading fast.India being a developing nation with more than 1.3 billion peo ple, failure to contain the virus can lead to disastrous conse quences with death toll perhaps surpassing all other nations.Although the overall mortality rate of COVID 19 is low (1.4 2.3% patients with comorbidities are more likely to have sev ere disease and subsequent mortality[1,2] Most of the avail able studies have shown that diabetes mellitus (DM) as adistinctive comorbidity is associated with more severe dis ease, acute respiratory distress syndrome and increased mor tality[1,3,4] Amongst the 32 non survivors from a group of 52intensive care unit (ICU) patients, DM (22% was a predomi nant underlying comorbidity[3] Of the 1099 confirmedCOVID 19 patients reported by Guan et al. from China, 173had severe disease; patients with severe disease had a higherprevalence of DM (16.2% as compared to those with non sev ere disease (5.7%[1] Further, in the largest series reported bythe Chinese Center for Disease Control and Prevention com prising of 72,314 cases of COVID 19, patients with DM hadhigher mortality (7.3% in DM vs. 2.3% overall)[2].It can be assumed that patients with DM are more likely tobe older than those without DM and advancing age has consis tently been shown to be associated with poor prognosis inCOVID 19, however, most of the aforementioned studies didnot adjust for age. Nevertheless, diabetes has been uniformlyreported to be associated with poor prognosis in other viralinfections, notably seasonal influenza, pandemic influenza AH1N1 (2009) Severe Acute Respiratory Syndrome (SARS) andMiddle East Respiratory Syndrome ( Multipleexplanations can be put forward for this apparent associationbetween pre existing DM and COVID 19 severity. Innateimmunity, the first line of defense against SARS CoV 2, isinevitably compromised in patients with uncontrolled DMthereby allowing unhindered proliferation of the pathogenwithin the host[9] Even short term hyperglycemia has beenshown to transiently stun the innate immune system[10].Moreover, DM is characterized by exaggerated pro inflamma tory cytokine response, notably interleukin (IL) 1, IL 6 andhtumor necrosis factor (TNF) a, in the absence of appropriateimmunostimulation; this may be further exaggerated inresponse to a stimulus as seen in patients with COVID 19 com plicated by acute respiratory distress syndrome (ARDS)[9].The role of angiotensin converting enzyme 2 (ACE2) in theassociation between DM and COVID 19 is plausible. ACE2 is atype 1 integral membrane glycoprotein that is constitutivelyexpressed by the epithelial cells of the lungs, kidney, intestineand blood vessels. In normal physiology, ACE2 breaks downangiotensin II and to a lesser extent, angiotensin I to smallerpeptides, angiotensin (1 7) and angiotensin (1 9) respectively[11] ACE2/Ang (1 7) system plays an important anti inflam matory and anti oxidant role protecting the lung againstARDS; indeed ACE2 has been shown to be protective againstlethal avian influenza A H5N1 infection[12] ACE2 expressionis reduced in patients with DM possibly due to glycosylation;this might explain the increased predisposition to severe lunginjury and ARDS with COVID 19[4,11].Strange it might sound, even overexpression of ACE2would be counterproductive in COVID 19. SARS CoV 2 utilizesACE2 as a receptor for entry into the host pneumocytes[13].Herein comes the confounding role of ACE inhibitors (ACEi)and angiotensin receptor blockers (ARBs) drugs that are sowidely used in DM. The expression of ACE2 is markedlyincreased in patients with DM (and hypertension) on ACEior ARBs as an adaptive response to counteract the elevatedlevels of Ang II and Ang I. Thus, use of ACE2 stimulatingdrugs would facilitate the entry of SARS CoV 2 into pneumo cytes and consequently might result in more severe and fataldisease[14] Amongst others, pioglitazone and liraglutidehave also been shown to be associated with ACE2 upregula tion in animal studies[14,15] Unfortunately, none of thestudies have taken into account the baseline treatment.Furthermore, a recently concluded study showed that severeand critically ill patients with COVID 19 had a higherprevalence of hypokalemia that resulted from renal potas sium wasting. This can be explained by downregulation ofACE2 following viral intrusion resulting in decreased degrada tion of angiotensin II, increased aldosterone secretion andsubsequent increased urinary potassium loss. Infact earlynormalization of serum potassium has been proposed to bea predictor of good prognosis in COVID 19[16] Thus, ACE2overexpression, while facilitating entry of SARS CoV 2, isunable to protect against lung injury as the enzyme getsdegraded by the virus  The prevalence of DM in India is 7.3%[17] therebypredisposing a large section of the community to COVID 19and its complications. Hence it is advisable that commu nity dwelling residents having underlying DM take extra pre cautions not to contract the virus. Social distancing, stricthand and respiratory hygiene are the need of the hour. Peoplewith DM should ensure good glucose control as improvementin glycemia does boost host immune response[9] Althoughnot recommended due to lack of robust data, use of ACEi/ARBs/thiazolidinediones/liraglutide merits reconsiderationin patients with DM during this outbreak.

title: Statement on COVID 19
abstract: When the first coronavirus infections were reported in China at the end of December 2019, it was hardly foreseeable that a worldwide pandemic would develop from this outbreak. Initially, it was thought that the spread of SARS CoV 2 could be halted by isolating those infected and quarantining suspected cases. It is now clear that the virus will spread worldwide despite all the drastic measures taken so far. No epidemiologist still believes that isolation and quarantine can completely eliminate the virus.

title: COVID 19 and Smoking
abstract: 1Departement de pharmacologie, Hopital Pitie Salpetriere, Paris, France; 2Centre Universitaire de Medecine Generale et Sante Publique, UNISANTE, Universite de Lausanne, Lausanne, Switzerland; 3Institut de Cardiologie, Hopital PitieSalpetriere, Paris, France; 4Centre ambulatoire d'addictologie, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Centre, Federation Hospitalo Universitaire Network of Research in Substance Use Disorder, Universite de Paris, Paris, France

title: Novel coronavirus (COVID 19)
abstract: Advice for staff and students planning to travel to, or currently travelling through China.