БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
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ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
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INFECTIOUS DISEASE
Damin Abdurakhimovich ASADOV
Jamshid Toshpulotovich GADOEV
Ravshan Xasanovich ASADOV
Public health. Management in Health care
department. Center of Development of
Professional Qualification of Medical personnel.
Tashkent Pediatric Medical Institute, postgraduate
REVIEW OF ARTICLES RELATED TO COVID-19 AND DIABETES MELLITUS
COMORBIDITY
For citation: D.A. Asadov, J.T. Gadoev, R.X. Asadov REVIEW OF ARTICLES RELATED TO
COVID-19 AND DIABETES MELLITUS COMORBIDITY Journal of Biomedicine and Practice.
2021, vol. 6, issue 3, pp. 535-538
http://dx.doi.org/10.26739/2181-9300-2021-3-78
ANNOTATION
This article provides summary recommendations of some manuscripts related to Covid-19 and
diabetes mellitus comorbidity. Manuscripts related to this topic were searched in PubMed. The article
describes the mechanisms how COVID-19 may enhance complications in individuals with diabetes
mellitus and providing special considerations on anti-diabetes drugs commonly used in patients with
type 2 diabetes in view of COVID-19 developed by group of researches. These recommendations can
be useful for those physicians who are involved in case management of Covid-19 and diabetes
mellitus.
Key words
: Covid-19, diabetes mellitus, SARS CoV-2, metformin, insulin.
Дамин Абдурахимович АСАДОВ
Жамшид Тошпулотович ГАДОЕВ
Равшан Хасанович АСАДОВ
Общественное здоровье. Менеджмент в здравоохранении.
Центр развития профессиональной квалификации
медицинских работников при МЗ РУз
Ташкентский медицинский педиатрический институт.
COVID-19 И КОМОРБИДНОСТЬ САХАРНОГО ДИАБЕТА (ОБЗОРНВЯ СТАТЬЯ)
АННОТАЦИЯ
В этой статье представлены сводные рекомендации, собранные при анализе научных статей,
касающиеся Covid-19 и сопутствующей патологии как сахарный диабет. Научные статьи,
относящиеся к этой теме, были собраны на платформе PubMed. В статье описываются
БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
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ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
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механизмы, с помощью которых COVID-19 может усиливать осложнения у больных с
сахарным диабетом, а также приводятся особые рекомендации по применению
антидиабетических препаратов, обычно используемых у пациентов с диабетом 2 типа. Эти
рекомендации могут быть полезны врачам, которые занимаются лечением Covid-19 и
сахарного диабета.
Ключевые слова:
Covid-19, сахарный диабет, SARS CoV-2, метформин, инсулин.
Дамин Абдурахимович АСАДОВ
Жамшид Тошпулотович ГАДОЕВ
Равшан Хасанович АСАДОВ
Жамоат саломатлиги ва соғлиқни сақлашни бошқариш.
Тошкент тиббиёт ходимларининг касбий малакасини ривожлантириш маркази
Тошкент педиатрия тиббиёт институти.
COVID-19 ВА ҚАНДЛИ ДИАБЕТНИНГ БИРГА КЕЛИШИ
АННОТАЦИЯ
Ушбу мақолада COVID-19 ва қандли диабетнинг бирга келиши билан боғлиқ бўлган
мақолалар таҳлилидан йиғилган тавсияларнинг қисқача мазмуни келтирилган. Ушбу мавзуга
оид мақолалар PubMed платформасидан тўпланган. Ушбу мақолада, COVID-19, қандли
диабети бор беморларда оғир асоратларга олиб келиш механизмлари баён этилган ва қандли
диабетнинг 2-тури бўлган беморларда тез-тез ишлатиладиган диабетга қарши препаратларни
қўллаш бўйича аниқ тавсиялар берилган. Ушбу тавсиялар Covid-19 ва қандли диабетни
даволаш билан шуғулланадиган шифорлар учун фойдали бўлиши мумкин.
Калит сўзлар
: Covid-19, қандли диабет, SARS CoV-2, метформин, инсулин
Background.
The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2), first reported in Wuhan, China, in December
2019. On 30 January 2020, WHO Director-General Dr Tedros Adhanom Ghebreyesus declared the
COVID-19 outbreak a Public Health Emergency of International Concern. The declaration is WHO’s
highest level of alarm – a rallying call to all countries to immediately take notice and take action.
The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose
when an infected person coughs or sneezes. The best way to prevent and slow down transmission is
to be well informed about the COVID-19 virus, the disease it causes and how it spreads. Protect
yourself and others from infection by washing your hands or using an alcohol based rub frequently
and not touching your face. Most people infected with the COVID-19 virus will experience mild to
moderate respiratory illness and recover without requiring special treatment. Older people, and those
with underlying medical problems like diabetes mellitus (DM), cardiovascular disease, chronic
respiratory disease, and cancer are more likely to develop serious illness (1).
COVID-19 and DM
Patients with DM have experienced and continue to experience significant challenges during
the period of the COVID-19 pandemic. Even if they are not infected, they are at risk of dysregulated
glycemic control due to the overall restrictive measures which compromise and disrupt the quality of
healthcare delivery, especially to patients with chronic diseases. Moreover, restrictive measures in
many countries have restricted the physical activity of city dwellers. In addition, many people with
diabetes discontinued scheduled visits for diabetes control either because hospitals discontinued
regular outpatient clinics or because people with diabetes, due to the fear of SARS-CoV-2 exposure
in hospitals, canceled their scheduled visits. In the case of infection, patients with DM have an
increased risk of developing severe and potentially fatal complications. Nevertheless, it would be
inappropriate to conclude that all patients with DM have an equally increased risk for severity and
mortality due to COVID-19. Certain clinical and biological characteristics determine high risk
phenotypes within the DM population and such prognostic markers need to be clearly characterized
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in future studies. Whether these phenotypic features include long-standing DM, advanced age,
concomitant obesity and other cardiometabolic complications, profound insulin resistance or
subclinical inflammation remains to be determined (2).
People with diabetes do not exhibit increased susceptibility to SARS-CoV-2 infection.
However, COVID-19 infection results in increased rates of hospitalization and greater severity of
illness in people with type 1 diabetes, type 2 diabetes, or obesity. A few illustrative reports highlight
the extent of these findings, with relative proportions often differing across centers. On November
20, 2020, the International Severe Acute Respiratory and Emerging Infection Consortium
(https://isaric.tghn.org/), representing dozens of countries and multiple continents, reported 95,966
clinical COVID-19 cases (93.4% with laboratory-confirmed SARS-CoV-2 infection) wherein
prevalence of diabetes was 17.4% (3). Yongli Yan et al reported that of 193 patients with severe
covid-19, 48 (24.9%) had diabetes. Compared with patients with severe covid-19 without diabetes,
patients with diabetes were older, susceptible to receiving mechanical ventilation and admission to
ICU, and had higher mortality. In addition, patients with severe covid-19 with diabetes had higher
levels of leukocyte count, neutrophil count, high-sensitivity C reaction protein, procalcitonin, ferritin,
interleukin (IL) 2 receptor, IL-6, IL-8, tumor necrosis factor α, D-dimer, fibrinogen, lactic
dehydrogenase and N-terminal pro-brain natriuretic peptide. Among patients with severe covid-19
with diabetes, more non-survivors were men (30 (76.9%) vs 9 (23.1%)). The authors concluded that
the mortality rate in patients with severe covid-19 with diabetes is considerable. Diabetes may lead
to an increase in the risk of death (4)
COVID-19 may enhance complications in individuals with DM through an imbalance in
angiotension-converting enzyme 2 (ACE2) activation pathways leading to an inflammatory response.
ACE2 imbalance in the pancreas causes acute β-cell dysfunction and a resultant hyperglycemic state.
These individuals may be prone to worsened COVID-19 complications including vasculopathy,
coagulopathy as well as psychological stress. It can also be associated with a higher basal level of
pro-inflammatory cytokines present in patients with diabetes, which enables a hyperinflammatory
“cytokine storm” in response to the virus. Apart from general preventive measures, remaining
hydrated, monitoring blood glucose regularly and monitoring ketone bodies in urine if on insulin is
essential. All this while concurrently maintaining physical activity and a healthy diet (5).
Research works in many countries demonstrates that DM in patients with COVID-19 is
associated with a two-fold increase in mortality as well as severity of COVID-19, as compared to
non-diabetics (6). Further studies on the pathogenic mechanisms and therapeutic implications need
to be done. Multiple datasets from China, Italy and the USA have consistently reported that the
clinical course of COVID-19 is more severe in patients with advanced age (>70 years old) and pre-
existing comorbidities, predominantly DM, hypertension and cardiovascular disease (7).
Recommendations for health care managers and clinicians to mitigate severe
complications for COVID and DM comorbidities.
The group of researches leading by Prof. Stefan R Bornstein reviewed guidelines for the
management of COVID-19 published by WHO, American Diabetes Association, and the US Centers
for Disease Control and Prevention. They also reviewed relevant references cited in retrieved articles.
Articles published in English, Italian, and Chinese were included. The final reference list was
generated on the basis of relevance to the topics, with the aim of emphasizing the multiple challenges
the health-care professionals from practitioners to intensive care staff might face in the management
of patients with diabetes and at risk of or with COVID-19. Based on analysis of those resources they
provided the following special considerations on anti-diabetes drugs commonly used in patients with
type 2 diabetes in view of COVID-19 (8).
Consideration of potential metabolically interfering effects of drugs in suspected or COVID-
19 positive patients with type 2 diabetes
Metformin
• Dehydration and lactic acidosis will probably occur if patients are dehydrated, so patients should
stop taking the drug and follow sick day rules
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• During illness, renal function should be carefully monitored because of the high risk of chronic
kidney disease or acute kidney injury
Sodium-glucose-co-transporter 2 inhibitors
• These include canagliflozin, dapagliflozin, and empagliflozin
• Risk of dehydration and diabetic ketoacidosis during illness, so patients should stop taking the drugs
and follow sick day rules
• Patients should avoid initiating therapy during respiratory illness
• Renal function should be carefully monitored for acute kidney injury
Glucagon-like peptide-1 receptor agonists
• These include albiglutide, dulaglutide, exenatide-extended release, liraglutide, lixisenatide, and
semaglutide
• Dehydration is likely to lead to a serious illness so patients should be closely monitored
• Adequate fluid intake and regular meals should be encouraged
Dipeptidyl peptidase-4 inhibitors
• These include alogliptin, linagliptin, saxagliptin, and sitagliptin
• These drugs are generally well tolerated and can be continued
Insulin
• Insulin therapy should not be stopped
• Regular self-monitoring of blood-glucose every 2–4 hours should be encouraged, or continuous
glucose monitoring
• Carefully adjust regular therapy if appropriate to reach therapeutic goals according to diabetes type,
comorbidities, and health status
Connected Health models and Telemedicine should be used to continue regular reviews and self-
management education programmes virtually and ensure patients are adherent to therapy.
References:
1.
https://www.who.int/health-topics/coronavirus#tab=tab_ 1 accessed on 15.03.2021.
2.
Chrysi Koliaki, Anastasios Tentolouris, Ioanna Eleftheriadou et al. Clinical Management of
Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities and Concerns. J Clin
Med. 2020 Jul; 9(7): 2288. Published online 2020 Jul 18. doi: 10.3390/jcm9072288.
3.
Hall M., Pritchard M., Dankwa E.A.,et al. Diabetes, obesity, metabolism, and SARS-CoV-2
infection: the end of the beginning. Daniel J. Drucker. Cell Metab. 2021 Mar 2; 33(3): 479–
498.Published online 2021 Jan 21. doi: 10.1016/j.cmet.2021.01.016;. ISARIC clinical data report
20 November 2020. medRxiv. 2020 doi:10.1101/2020.07.17.20155218.
4.
Yongli Yan, Yan Yang, Fen Wang et al. Clinical characteristics and outcomes of patients with
severe covid-19 with diabetes. BMJ Open Diabetes Res Care. 2020 Apr;8(1):e001343. doi:
10.1136/bmjdrc-2020-001343.
5.
Sarah Cuschieri, Stephan Grech. COVID-19 and diabetes: The why, the what and the how..
PMID: 32456846 PMCID: PMC7242955 DOI: 10.1016/j.jdiacomp.2020.107637.
6.
Ashish Kumar, Anil Arora, Praveen Sharma et al. Is diabetes mellitus associated with mortality
and severity of COVID-19? A meta-analysis. PMID: 32408118 PMCID: PMC7200339 DOI:
10.1016/j.dsx.2020.04.044
7.
Chrysi Koliaki, Anastasios Tentolouris, Ioanna Eleftheriadou et al. Clinical Management of
Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities and Concerns. J Clin
Med. 2020 Jul; 9(7): 2288. Published online 2020 Jul 18. doi: 10.3390/jcm9072288.
8.
Stefan R Bornstein, Francesco Rubino, Kamlesh Khunti. Practical recommendations for the
management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020 Jun; 8(6):
546–550.Published online 2020 Apr 23. doi: 10.1016/S2213-8587(20)30152-2.
