Prevalence and outcome of newly diagnosed diabetes in COVID-19 patients: A systematic review

BackgroundPatients with COVID-19 with diabetes mellitus (DM) are reportedly more likely to develop severe clinical course and increased mortality.AimsWe aimed to investigate the prevalence of newly diagnosed DM in COVID-19 patients and observe the association of underlying DM with increasing incidence of serious adverse events and mortality in COVID-19 patients.Methods We searched PubMed/Medline, Cochrane, Google Scholar, and Embase/Ovid for relevant articles that match our inclusion criteria. We assessed the quality of studies using the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Our outcomes of interest were mainly the prevalence of ICU admissions and mortality.Results The pooled proportion of newly diagnosed DM in hospitalized COVID-19 patients was 44.5 per cent. We report that newly diagnosed diabetics indicate a poor prognosis of COVID-19 compared with non-diabetics or previously-known DM. We also show that COVID-19 patients with newly diagnosed DM are at increased risk of getting ICU admissions compared with patients with pre-existing DM.ConclusionWe show that 44.5 per cent of hospitalized COVID-19 patients are likely to develop DM. We also confirm that DM worsens the prognosis of COVID-19 patients and raises the incidence rates of both ICU admissions and mortality

Serum cortisol as a predictor of major adverse outcomes in patients with COVID-19

BackgroundSeveral biomarkers were found to predict the severity and outcome of COVID-19 infection.AimsTo determine the serum cortisol response in patients with Coronavirus Disease 2019 (COVID-19) and its correlation with disease outcomes.Methods A prospective study among confirmed COVID-19 patients aged 18 years old and above. Morning cortisol levels were measured within 24 hours of admission. Relationship between cortisol levels and outcomes (intensive care unit (ICU) admission, intubation, and death) were analysed.Results A total of 206 patients positive for COVID-19 (mean age of 53.6±15.2 years) were included in the study. Mortality was recorded in 21 (30.4 per cent) patients with cortisol levels of ≥570nmol/L, 6 (8.8 per cent) among patients with 181–569nmol/L cortisol level, and 8 (11.6 per cent) among patients with ≤180nmol/L cortisol. Patients with cortisol levels of ≥570nmol/L were more likely to be admitted to the ICU, be intubated and longer hospital stay. Serum cortisol and ferritin levels were the most significant predictors of mortality. ConclusionOn admission, the morning cortisol level was predictive of mortality, ICU admission, intubation, and length of hospital stay in patients with COVID-19 and may be listed as an independent predictor for worse outcomes of COVID-19 infection

GLIM Criteria for Assessment of Malnutrition in Saudi Patients with Type 2 Diabetes

The Global Leadership Initiative on Malnutrition (GLIM) is a new approach established for the assessment of malnutrition. This study aimed to validate the GLIM for the diagnosis of malnutrition in patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia, using the Subjective Global Assessment (SGA) as a reference. In addition, the association between the GLIM criteria and vascular complications in those patients was examined. A cross-sectional study was conducted on 101 patients with T2DM. The level of agreement between the GLIM and SGA tools was calculated using the kappa coefficient (κ). A receiver operating characteristic curve was used to determine the sensitivity and specificity of the GLIM. In addition, binary logistic regression was performed to investigate the association between each GLIM criterion and T2DM vascular complications. According to both the GLIM and the SGA, malnutrition was found in 15.8% and 17.8% of patients, respectively. The GLIM criteria achieved a very good level of accuracy (AUC = 0.877). The agreement between the tools was substantial (κ = 0.778). The ‘disease/inflammation’ criterion of the GLIM was significantly associated with macrovascular complications. To conclude, the GLIM criteria for diagnosis of malnutrition presented satisfactory levels of validity, and as such are acceptable for assessing the nutritional status of patients with T2DM

CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries

BackgroundThere is a paucity of global data on cardiovascular disease (CVD) prevalence in people with type 2 diabetes (T2D). The primary objective of the CAPTURE study was to estimate the prevalence of established CVD and its management in adults with T2D across 13 countries from five continents. Additional objectives were to further characterize the study sample regarding demographics, clinical parameters and medication usage, with particular reference to blood glucose-lowering agents (GLAs: glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors) with demonstrated cardiovascular benefit in randomized intervention trials.MethodsData were collected from adults with T2D managed in primary or specialist care in Australia, China, Japan, Czech Republic, France, Hungary, Italy, Argentina, Brazil, Mexico, Israel, Kingdom of Saudi Arabia, and Turkey in 2019, using standardized methodology. CVD prevalence, weighted by diabetes prevalence in each country, was estimated for the overall CAPTURE sample and participating countries. Country-specific odds ratios for CVD prevalence were further adjusted for relevant demographic and clinical parameters.ResultsThe overall CAPTURE sample included 9823 adults with T2D (n=4502 from primary care; n=5321 from specialist care). The overall CAPTURE sample had median (interquartile range) diabetes duration 10.7 years (5.6-17.9 years) and glycated hemoglobin 7.3% (6.6-8.4%) [56 mmol/mol (49-68 mmol/mol)]. Overall weighted CVD and atherosclerotic CVD prevalence estimates were 34.8% (95% confidence interval [CI] 32.7-36.8) and 31.8% (95% CI 29.7-33.8%), respectively. Age, gender, and clinical parameters accounted for some of the between-country variation in CVD prevalence. GLAs with demonstrated cardiovascular benefit were used by 21.9% of participants, which was similar in participants with and without CVD: 21.5% and 22.2%, respectively.ConclusionsIn 2019, approximately one in three adults with T2D in CAPTURE had diagnosed CVD. The low use of GLAs with demonstrated cardiovascular benefit even in participants with established CVD suggested that most were not managed according to contemporary diabetes and cardiology guidelines.Study registration NCT03786406 (registered on December 20, 2018), NCT03811288 (registered on January 18, 2019)