Diabetes and Covid 19

trader32176
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Re: Diabetes and Covid 19

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Two pandemics clash as US doctors find that Covid-19 spurs diabetes

5/5/21


https://www.straitstimes.com/world/two- ... s-diabetes


MELBOURNE (BLOOMBERG) - When Dr Ziyad Al-Aly's research team told him how often diabetes appeared to strike Covid-19 survivors, he thought the data must be wrong, so he asked his five colleagues to crunch the numbers again.

Weeks later, they returned the same findings after sifting through millions of patient records. By then, Dr Al-Aly had also gone digging into the scientific literature and was starting to come to terms with an alarming reality: Covid-19 is not just deadlier for people with diabetes, but it was also triggering the metabolic disease in many who did not previously have it.

"It took a while to convince me," said Dr Al-Aly, who directs the clinical epidemiology centre at the Veterans Affairs St Louis Health Care System in Missouri. "It was hard to believe that Covid-19 could be doing this."

Among Covid-19's many ripple effects, the worsening of the global diabetes burden could carry a heavy public-health toll. The underlying mechanisms stoking new-onset diabetes aren't clear, though some doctors suspect the Sars-CoV-2 virus may damage the pancreas, the gland that makes insulin which is needed to convert blood sugar into energy.

Sedentary lifestyles brought on by lockdowns could also be playing a role, as might late diagnoses after people avoided doctors' offices. Even some children's mild coronavirus cases can be followed by the swift onset of diabetes, scientists found.

Considered a lung disease in the early days of the pandemic, Covid-19 is increasingly recognised for its ability to ravage multiple organs and bodily systems, causing persistent and sometimes debilitating symptoms in one in 10 sufferers months after their apparent recovery.

Lingering metabolic complications, sometimes requiring high doses of insulin, suggest a subset of survivors are developing diabetes - swelling the ranks of the more than the 463 million people living with the chronic condition.

Two studies

The disease, in which the body fails to produce enough or properly use insulin, cost an estimated US$760 billion (S$1 trillion) in the year before Covid-19 struck, driven by life-shortening complications spanning stroke and kidney failure to foot ulcers and blindness.

Dr Al-Aly and colleagues were the first to measure the effect in the United States based on evidence from the national healthcare databases of the Department of Veterans Affairs.

They found that Covid-19 survivors were about 39 per cent more likely to have a new diabetes diagnosis in the six months after infection than non-infected users of the VA health system. The risk works out to about 6.5 additional diabetes cases for every 1,000 Covid-19 patients who do not end up in the hospital. For those who do, the probability jumps to 37 per 1,000 - and it is even higher for patients who required intensive care.

The numbers should be viewed in the context of Covid-19's sprawling reach, according to Dr Al-Aly. During the winter peak, more than 130,000 patients were hospitalised with the coronavirus in the US alone. Globally, Sars-CoV-2 is reported to have infected more than 153 million people, including over 20 million in India, the country with the most people living with diabetes after China.

Pandemics collide


Dr Al-Aly's data was published last month in Nature, three weeks after a study of almost 50,000 hospitalised Covid-19 patients in England found that they were 50 per cent more likely to have diabetes some 20 weeks after discharge than matched controls.

"We have a risk of seeing a clash of two pandemics," said Dr Francesco Rubino, chair of metabolic and bariatric surgery at King's College London, who set up a global registry of Covid-related diabetes cases with Dr Paul Zimmet, a professor of diabetes at Melbourne's Monash University.

Researchers have hypothesised pathways in which Covid-19 might increase the likelihood of a diabetes diagnosis, including the possibility that the pancreas' insulin-excreting beta cells are destroyed either by the virus or by the body's response to the infection.

Other explanations may include an acute stress response to the infection, the use of steroid treatments that help survival but increase blood sugar, or just the unmasking of diabetes cases that had previously escaped diagnosis, according to Dr John Nicholls, a clinical professor of pathology at the University of Hong Kong.

Tracking cases

Almost 500 doctors from around the world have agreed to share data via Dr Rubino's diabetes registry. They will upload patients' known risk factors, lab results, clinical features, treatment, and disease course - information that will help identify the most prevalent form of the disease, possible causes, and likely prognoses.

So far, close to 350 cases have been documented through the registry and descriptive anecdotes are flowing in almost every day through e-mails from concerned patients and parents.

"People write to us and say, 'My son just got diagnosed with diabetes. He's an eight-year-old. He just got Covid last month or two months ago. Could it be related?'" Dr Rubino said.

The question of whether Sars-CoV-2 is capable of inducing diabetes is controversial. Surveillance for diabetes from population-based data may be a clearer way to gauge the pandemic's impact, said Prof Jonathan Shaw, deputy director of the Baker Heart and Diabetes Institute in Melbourne.

Worried about kids


In Los Angeles, meanwhile, doctors report a worrying pattern among children with new cases of type-2 diabetes - the chronic form linked to obesity and sedentary lifestyles that is mainly seen in adults.

They found one in five new paediatric type-2 cases last year required hospitalisation for diabetic ketoacidosis, a dangerous build-up of acid in the blood due to inadequate insulin supply. By contrast, only 3 per cent of new patients faced this life-threatening problem in 2019. While none of the children in 2020 had active Covid-19, doctors were not systematically testing for a prior Sars-CoV-2 infection. Of those who were tested, a third were positive.

"Could that explain some of the increase? We really just don't know," said Dr Lily Chao, interim medical diabetes director at Children's Hospital Los Angeles. "But that is one thing that is going through the back of our heads."

Doctors in Canada suggest a drop in utilisation of medical services during the pandemic might have delayed care for children with new-onset type 1 diabetes - the rarer form caused by an autoimmune reaction that destroys insulin-producing cells in the pancreas. A study from Alberta province found the incidence of severe diabetic ketoacidosis in these patients more than doubled to 27 per cent in 2020.

Lifestyle changes

Dr Chao sees other plausible drivers related to Covid-19. The pandemic itself has also resulted in lifestyle changes that may be putting children at risk of diabetes.

"For Los Angeles, schools were shut down for a whole year," she said. "Many of our children have just been home and frankly not getting the best nutrition and gaining more weight. It's a complex situation."

Dr Rubino aims to publish initial findings from the diabetes registry data mid-year, and offers a word of early caution already: There is enough evidence of Covid-19's long-term consequences that it should be avoided at any age.

"This is not just a flu that, OK, you've got it and you're done with it," he said. "You might not be done. It's a serious thing."
trader32176
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Re: Diabetes and Covid 19

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How COVID-19 Can Lead to Diabetes

Posted on June 8th, 2021

https://directorsblog.nih.gov/2021/06/0 ... -diabetes/

by Dr. Francis Collins


Along with the pneumonia, blood clots, and other serious health concerns caused by SARS-CoV-2, the COVID-19 virus, some studies have also identified another troubling connection. Some people can develop diabetes after an acute COVID-19 infection.

What’s going on? Two new NIH-supported studies, now available as pre-proofs in the journal Cell Metabolism [1,2], help to answer this important question, confirming that SARS-CoV-2 can target and impair the body’s insulin-producing cells.

Type 1 diabetes occurs when beta cells in the pancreas don’t secrete enough insulin to allow the body to metabolize food optimally after a meal. As a result of this insulin insufficiency, blood glucose levels go up, the hallmark of diabetes.

Earlier lab studies had suggested that SARS-CoV-2 can infect human beta cells [3]. They also showed that this dangerous virus can replicate in these insulin-producing beta cells, to make more copies of itself and spread to other cells [4].

The latest work builds on these earlier studies to discover more about the connection between COVID-19 and diabetes. The work involved two independent NIH-funded teams, one led by Peter Jackson, Stanford University School of Medicine, Palo Alto, CA, and the other by Shuibing Chen, Weill Cornell Medicine, New York. I’m actually among the co-authors on the study by the Chen team, as some of the studies were conducted in my lab at NIH’s National Human Genome Research Institute, Bethesda, MD.

Both studies confirmed infection of pancreatic beta cells in autopsy samples from people who died of COVID-19. Additional studies by the Jackson team suggest that the coronavirus may preferentially infect the insulin-producing beta cells.

This also makes biological sense. Beta cells and other cell types in the pancreas express the ACE2 receptor protein, the TMPRSS2 enzyme protein, and neuropilin 1 (NRP1), all of which SARS-CoV-2 depends upon to enter and infect human cells. Indeed, the Chen team saw signs of the coronavirus in both insulin-producing beta cells and several other pancreatic cell types in the studies of autopsied pancreatic tissue.

The new findings also show that the coronavirus infection changes the function of islets—the pancreatic tissue that contains beta cells. Both teams report evidence that infection with SARS-CoV-2 leads to reduced production and release of insulin from pancreatic islet tissue. The Jackson team also found that the infection leads directly to the death of some of those all-important beta cells. Encouragingly, they showed this could avoided by blocking NRP1.

In addition to the loss of beta cells, the infection also appears to change the fate of the surviving cells. Chen’s team performed single-cell analysis to get a careful look at changes in the gene activity within pancreatic cells following SARS-CoV-2 infection. These studies showed that beta cells go through a process of transdifferentiation, in which they appeared to get reprogrammed.

In this process, the cells begin producing less insulin and more glucagon, a hormone that encourages glycogen in the liver to be broken down into glucose. They also began producing higher levels of a digestive enzyme called trypsin 1. Importantly, they also showed that this transdifferentiation process could be reversed by a chemical (called trans-ISRIB) known to reduce an important cellular response to stress.

The consequences of this transdifferentiation of beta cells aren’t yet clear, but would be predicted to worsen insulin deficiency and raise blood glucose levels. More study is needed to understand how SARS-CoV-2 reaches the pancreas and what role the immune system might play in the resulting damage. Above all, this work provides yet another reminder of the importance of protecting yourself, your family members, and your community from COVID-19 by getting vaccinated if you haven’t already—and encouraging your loved ones to do the same.

References:


[1] SARS-CoV-2 infection induces beta cell transdifferentiation. Tang et al. Cell Metab 2021 May 19;S1550-4131(21)00232-1.

[2] SARS-CoV-2 infects human pancreatic beta cells and elicits beta cell impairment. Wu et al. Cell Metab. 2021 May 18;S1550-4131(21)00230-8.

[3] A human pluripotent stem cell-based platform to study SARS-CoV-2 tropism and model virus infection in human cells and organoids. Yang L, Han Y, Nilsson-Payant BE, Evans T, Schwartz RE, Chen S, et al. Cell Stem Cell. 2020 Jul 2;27(1):125-136.e7.

[4] SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Müller JA, Groß R, Conzelmann C, Münch J, Heller S, Kleger A, et al. Nat Metab. 2021 Feb;3(2):149-165.
trader32176
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Re: Diabetes and Covid 19

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Americans With Diabetes Were Hit Hard by COVID Pandemic

July 14th, 2021


https://www.usnews.com/news/health-news ... d-pandemic

As many as two of every five Americans who've died from COVID-19 were suffering from diabetes, making the chronic disease one of the highest-risk conditions during the pandemic, an expert says.

About 40% of deaths from COVID-19 in the United States were among diabetics, a "really quite sobering" statistic that should prompt people with the ailment to get vaccinated, said Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association (ADA).


40 Percent of People Who’ve Died from COVID-19 Had Diabetes, Researchers Say

7/20/21

https://www.healthline.com/health-news/ ... rchers-say

Researchers report that 40 percent of people in the United States who have died from COVID-19 had type 1 or type 2 diabetes.
They add that untreated diabetes can increase the severity of COVID-19.
They note that having an inflammatory disease such as diabetes can increase the risks associated with COVID-19 as can accompanying conditions such as high blood pressure and obesity.
trader32176
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Re: Diabetes and Covid 19

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How the pandemic laid bare America’s diabetes crisis

8/12/21

https://www.reuters.com/investigates/sp ... tes-covid/


COVID-19 has torn a particularly lethal path through the 1 in 10 Americans with diabetes, including many who never caught the virus. That's because when the pandemic hit, people with the chronic disease were already in worse shape than in years.

It took the deadly disruption of the COVID-19 pandemic to expose a deeper, more intractable U.S. public-health crisis: For more than a decade, the world’s richest nation has been losing the battle against diabetes.

Long before the pandemic, Kate Herrin was among the millions of Americans struggling to control their diabetes.

Her problems often stemmed from her government-subsidized medical insurance. Doctors routinely rejected her Medicaid plan, and she repeatedly ran out of the test strips she needed to manage her daily insulin injections. She cycled in and out of emergency rooms with dangerously high blood-sugar levels, or hyperglycemia.

Then COVID-19 hit. Herrin – poor and living alone – rarely left her apartment, ordering fast-food delivery instead of risking the grocery store. She stopped going in for regular lab tests. She had a harder time than ever securing medical supplies. Her health deteriorated further.

On Dec. 15, Herrin and Elicia Heaston, her best friend, were swapping messages on Facebook midday when Herrin abruptly dropped off the conversation. Heaston called Herrin’s phone and got no answer. When a few more hours passed without any word, Heaston and her husband drove from their home in rural West Alexandria, Ohio, to Herrin’s apartment nearby and pounded on the door. No lights were on, but they could hear the television.

Heaston called 911. When firefighters arrived, they found the 42-year-old dead on the bathroom floor. Herrin’s rescue dogs, Honey and Sugar, were lying quietly next to her.

The coroner attributed the heart attack that killed Herrin to complications of type 2 diabetes.

COVID-19 ‘isolated her, and her diabetes got worse. She didn’t need to die at 42.’

“She was afraid COVID would kill her,” Heaston said. “Instead, it isolated her, and her diabetes got worse. She didn’t need to die at 42.”

COVID-19, which has killed more than 600,000 people in the United States, has had an especially devastating impact on the millions of Americans with diabetes. Health professionals and scientists noticed early on that many severely ill coronavirus patients also had the chronic disease. The U.S. Centers for Disease Control and Prevention (CDC) cites research showing that 40% or more of the people who died with COVID-19 also had diabetes.

And those numbers don’t reflect the damage the pandemic inflicted on diabetes patients who, like Herrin, never got sick from the virus but fell victim to the isolation and disruption it caused.

Deaths from diabetes last year surged 17% to more than 100,000, based on a Reuters analysis of CDC data. Younger people – those ages 25 to 44 – suffered the sharpest increase, with a 29% jump in deaths. By comparison, all other deaths except those directly attributed to the coronavirus rose 6% last year, Reuters found.

This grim toll is the result of a public-health failure that long predates the pandemic – and that is almost certain to persist after COVID-19 abates. After years of advances in treating diabetes, progress stalled about a decade ago. Since then, despite billions of dollars spent on new treatments, the prognosis for people with diabetes has been getting worse as the number of patients with the disease has increased, especially among working-age and even younger people.

‘It didn’t have to be this bad’

Late in the last century and early in this one, medical breakthroughs steadily chipped away at rates of diabetes-related deaths and complications in the United States. But the trend reversed as rising obesity and its consequences — like diabetes, hypertension and cardiovascular disease — more than offset improved therapies.

From 2009 to 2015, CDC data show that among diabetes patients, rates of hospitalization for hyperglycemic crises soared by 73%, and deaths by 55%. From 2010 to 2015, a jump in the rate of lower-limb amputations – always a risk for diabetes patients – erased more than one-third of a 20-year decline. The sharpest increases in these numbers were among adults 44 and younger. A Reuters analysis of more recent state-level data found that the trend has persisted. By 2019, U.S. deaths attributed primarily to diabetes reached their highest rate in eight years.

So when the pandemic struck, Americans with diabetes were in poorer health than they had been in years, increasing their vulnerability just as the virus overwhelmed the U.S. healthcare system.

“It didn’t have to be this bad,” said Dr Robert Pearl, a Stanford Medical School professor and former chief executive of the Kaiser Permanente Medical Group. “If we had spent more time and effort toward preventing and better managing diabetes, thousands of patients wouldn’t have needed hospitalization in the first place,” Pearl said. “And many of them would still be alive.”

The reasons for the worsening outlook for diabetes patients are rooted in the American lifestyle and medical system.

More Americans are developing diabetes earlier, even in childhood, because of long-term societal shifts toward sedentary lifestyles and unhealthy diets, according to researchers and doctors. Younger patients often have a harder time managing their disease, develop complications faster, and tend to have less consistent access to medical care, doctors say. Some patients ration their medications and limit doctor visits to avoid the hefty out-of-pocket costs of increasingly common high-deductible insurance plans, backed for years by employers, insurers and policymakers. The focus in U.S. healthcare on treating crises over preventing them doesn’t help, downplaying the importance of lifestyle changes that could lessen the severity of the disease.

“Over and over again, the problem is worse in young adults, and there isn’t improvement in older adults,” said Ed Gregg, a former CDC researcher who is now a professor at Imperial College in London. “The magnitude of the increase has set us back 15 to 20 years.”

Dr Giuseppina Imperatore, who oversees disease surveillance and other areas in the CDC’s Division of Diabetes Translation, said that the recent trends on diabetic complications and deaths are “definitely concerning,” and that the agency is still trying to fully understand what’s driving the poor outcomes, particularly among younger adults. She also told Reuters that “the impact of the COVID pandemic on people with diabetes cannot be overstated.”

An American problem

The failure to effectively treat diabetes carries enormous consequences for patients, their families and society at large. Roughly 34 million people, or about 1 in 10 Americans, have diabetes. Treating them costs more than $230 billion a year – more than the U.S. Navy’s annual budget – much of that borne by taxpayers through government-sponsored Medicare insurance for the elderly and Medicaid for the poor.

About 1.6 million people have type 1 diabetes, an autoimmune disease of unknown cause that requires lifelong insulin injections when the pancreas stops producing the hormone. Without insulin, cells are unable to absorb glucose, their primary source of energy, and the sugar builds up in the blood.

But the vast majority of patients, accounting for most of the increase in new cases in recent years, have type 2 diabetes, a chronic condition linked to genetics, weight gain and inactivity. These patients’ bodies don’t make enough insulin or don’t use it well. Diet and exercise can help manage the disease, but many also need medication that helps them use the insulin their bodies produce. Many eventually require insulin injections.

For all diabetes patients, life revolves around checking their numbers. That means testing their current blood glucose levels several times a day. And it means visiting a lab every few months to test their hemoglobin A1c, a measure of their glucose levels over the preceding three months. The higher the number, the worse it can be for a patient.

Uncontrolled diabetes wreaks havoc on the body. Acute hyperglycemia can lead to coma or even death. Over time, the disease degrades blood vessels and damages major organs, leaving patients prone to heart disease, stroke, kidney failure, amputations and blindness.

While the coronavirus battered diabetes patients around the world, the longer-term reversal of fortunes is a particularly American problem. The U.S. mortality rate for diabetes was 42% higher than the average among 10 other industrialized countries in 2017, according to the Organization for Economic Cooperation and Development. In the British medical journal Lancet, researchers in 2018 gave the United States a score of 62 out of 100 on the quality of diabetes care. Most Western European countries scored in the 90s. The United States trailed Libya, Iran and Vietnam.

“Other countries have more of a safety net to get people through hard times,” said Steven Woolf, a professor at the Virginia Commonwealth University School of Medicine who studies death rates from diabetes and other causes. “People here are more vulnerable to the economic shocks of job losses, the last recession and now the pandemic.”

Reversing the gloomy outlook for diabetes patients isn’t easy. Advances in medication and technology to help patients better manage their condition often fail to reach those whose access to care is hampered by their race, income or type of insurance, according to experts in diabetes and public health. And reducing those disparities, they said, would have to come with major investments in primary care and a coordinated effort to curb obesity and inactivity.

“The current approach has failed,” said Dr David Kerr, director of research and innovation at the Sansum Diabetes Research Institute in Santa Barbara, California. “And just creating more expensive pharmaceuticals is not going to cut it at a population level.”

The fear effect

In the early days of the COVID-19 pandemic, the CDC and other agencies recommended that hospitals and medical offices postpone elective procedures and nonessential visits to limit spread of the virus and keep the most vulnerable out of harm’s way. Doctor’s offices and clinics halted in-person appointments for many patients with chronic conditions like diabetes. Diabetes education classes and patient support groups disbanded.

Telehealth and phone calls helped fill the void, but not all care could be delivered remotely. Some patients didn’t get blood drawn for regular A1c readings. Some of the neediest patients didn’t have smartphones or a reliable internet connection. And after some wound-care centers closed, remote monitoring couldn’t provide care that relies on touch and feel, such as evaluating the chronic sores that diabetes patients are prone to suffer.

Many patients became fearful and reluctant to seek care – until they were in crisis. Sandra Arevalo, director of community and patient education at Montefiore Hospital in Nyack, New York, said she knew several patients who had amputations, were admitted to intensive care or died after delaying care. “The diagnosis was uncontrolled diabetes, but it was caused by COVID fear,” Arevalo said. “COVID caused more damage than we realized.”

John Cupo, a 68-year-old building systems manager in Las Vegas, was diagnosed with type 2 diabetes more than a decade ago and struggled for years with diabetic neuropathy – nerve damage resulting in pain and numbness in his legs. Then, in November 2019, he spotted a sore on his left foot. His podiatrist blamed diminished blood circulation due to diabetes and treated the sore. Cupo agreed to visit every other week for checkups.


‘I believe I would still have my leg if it wasn’t for COVID scaring me to stay home.’
- John Cupo, whose lower left leg was amputated during the pandemic

But on March 16, 2020, the pandemic upended his routine. That day, his employer, the University of Nevada Las Vegas, told him to start working from home. “I didn’t leave my house after that. I was hearing all the reports about COVID-19 on the news. I didn’t want to go out,” Cupo said. He canceled his doctor appointments. “That was a mistake.”

On May 2, Cupo noticed that several of his toenails had fallen off. The skin underneath had turned black, a telltale sign of tissue death. He decided to visit his podiatrist, who urged him to go to the emergency room.

But COVID-19 was beginning to spread across the country. Cupo was afraid to go near a hospital. “The reports were relentless on the television. They said if you have diabetes or high blood pressure, plus age, you’re compromised. I thought, ‘Oh man, I have all of those things,’ ” Cupo said. “They were telling everyone, ‘Don’t go to the ER.’ ”

Over the phone, Cupo’s primary care doctor recommended a vascular surgeon. In early June, doctors performed a peripheral artery bypass in a last-ditch attempt to restore blood flow to Cupo’s foot.

It was too late. About a week later, Cupo’s big toe was black. He braved a visit to the emergency room, where staff gave him intravenous antibiotics and sent him home. Days later, doctors amputated four toes on his left foot. At a follow-up appointment the next week, his whole foot looked dead, and doctors feared an infection was spreading. That day, June 25, a surgeon amputated Cupo’s left leg just below the knee.

Cupo had a difficult four-month recovery, including additional surgery after a bad fall reopened his amputation wound. He has since grown accustomed to his prosthetic and the phantom pains from his amputated leg. “I believe I would still have my leg if it wasn’t for COVID scaring me to stay home,” he said.

While national data are not yet available, some U.S. hospitals have reported spikes in major amputations, which are above or below the knee. At the University of Illinois Hospital in Chicago, for example, they shot up 42% last year, according to Dr William Ennis, the hospital’s section chief for wound healing and tissue repair.

He said one patient refused to come in for a routine follow-up visit after spotting hospital workers donning biohazard suits under white triage tents. “He was so frightened by what he saw,” Ennis said. The doctor said staff shortages due to the pandemic made it hard to schedule home healthcare visits for his homebound patients.

Young and vulnerable

Cupo conforms to the conventional idea of the type 2 patient who is diagnosed later in life. But the ranks of the newly diagnosed are shifting younger. In part, that’s because, since the 1970s, more and more Americans are growing up and living in “obesogenic” environments where they get less exercise, eat more processed foods high in carbohydrates and fat, and gain excessive weight at an earlier age.

“It is our physical inactivity, diets and environmental conditions that have caused this,” said Woolf, the Virginia Commonwealth researcher. He was co-author of a recent study by the National Academies of Sciences, Engineering and Medicine that found that diabetes and other endocrine and metabolic diseases are killing working-age adults at faster rates than in prior decades, across all racial and ethnic groups.

The isolation and inactivity imposed by the pandemic compounded many of those risks, triggering medical emergencies and life-altering diagnoses for some young people.

At Children’s National Hospital in Washington, D.C., diagnoses of type 2 diabetes among patients 8 to 20 years old nearly tripled in the first year of the pandemic. The severity of the cases worsened, too. Among the new patients, 23% had diabetic ketoacidosis – a dangerous buildup of acid in the blood due to lack of insulin – compared with 4% a year earlier. Only five of the 141 new patients had COVID-19 when they were diagnosed.

Doctors said they believe that pandemic-induced school closures and decreased physical activity contributed to the spike. “It was really pointing us to the indirect effect of social distancing,” said Dr Brynn Marks, a pediatric endocrinologist at Children’s National.

One of the hospital’s new type 2 patients is 15-year-old Adedotun Adebayo of Glenarden, Maryland. He had been vomiting for days when, on March 25 this year, he passed out at church. His mother, Oyebola Omoyele, who moved to the United States from Nigeria with her three sons several years ago, called 911. “Please do everything to save my boy,” she sobbed to the operator. “I need my son back.”

Adebayo woke up two days later in intensive care, connected to a tangle of tubes and wires, recovering from diabetic ketoacidosis. “I was scared and thought, ‘Am I going to die?’ ” he said. “It was great to have my mom there. But I didn’t want to cry and stress her out.”

Before the pandemic, Adebayo was an active teenager, playing basketball most afternoons at a local gym, singing in the church choir and taking courses at a community college as part of high school. When classes went online, his weight ballooned to 183 pounds on a 5 foot 8 frame. “I was alone and not doing anything,” he said. “Most of the time, I was laying on the sofa.”

Now, Adebayo said, he tries to wake up earlier and eat a better diet. He counts the carbohydrates in his food so he can correctly dose his meal-time insulin injections. He also takes metformin, the first-line drug for type 2 diabetes, and his mother keeps a close eye on his glucose monitor. “We need to face this reality,” she said.


‘I was scared and thought, “Am I going to die?” ’

- Adedotun Adebayo, diagnosed with type 2 diabetes at age 15 after collapsing at church

In younger people, type 2 diabetes is often more severe than in cases that develop later in life, said Dr Deborah Wexler, clinical director of the diabetes center at Massachusetts General Hospital and an associate professor at Harvard Medical School. The potential for damage starts earlier, and younger patients tend to have a harder time managing a complicated medication regimen, a healthy diet and regular exercise amid other competing priorities in life, Wexler said. “This is a harder problem for the patient and clinician to manage,” she said.

At the same time, many younger patients, more so than their older counterparts, are missing out on newer, more-effective drugs for lowering blood glucose in type 2 patients.

Diabetes has become a cash cow for the drug industry. Annual sales of insulin and other diabetes drugs surpassed $75 billion in 2020, according to the IQVIA Institute for Human Data Science. That’s up from $24 billion in 2011 and second in total revenue only to drugs for inflammatory conditions such as rheumatoid arthritis.

But a Johns Hopkins University study published in the New England Journal of Medicine in June that tracked more than 6,000 type 2 patients from 1999 through 2018 found that the drugs weren’t getting to many patients who needed them, especially younger patients and those without insurance.

Nearly 20% of patients between the ages 20 to 44 with raised A1c levels took no glucose-lowering drugs, compared to 10% of those 45 and older, said Dr Elizabeth Selvin, who co-authored the study. The gap was even more pronounced between insured and uninsured patients of all ages.

The newer drugs can reduce the risk of heart disease and promote weight loss, but “they are very expensive and many of the patients that really need them … are not covered,” said Dr Nestoras Mathioudakis, co-medical director of the Baltimore Metropolitan Diabetes Regional Partnership at Johns Hopkins.

In the private insurance market, more than 40% of young and middle-age adults have high-deductible health plans, requiring them to pay hundreds of dollars for routine care and medications before coverage kicks in. To avoid those costs, some diabetes patients forgo filling prescriptions or visiting a doctor regularly. In a 2017 study, Dr J. Frank Wharam of Duke University and other researchers found that lower-income workers and their family members with diabetes had 22% more emergency-room visits for preventable complications after switching to a high-deductible plan.

The American Diabetes Association recommends that patients at least once a year get a checkup, a foot and eye exam, and A1c and cholesterol tests. Another Johns Hopkins study, published in April, found that only 44% of diabetes patients 65 and older met those goals, and just a quarter of patients under 65. Those who didn’t receive this baseline care were more likely to be low-income, uninsured and have uncontrolled diabetes, said Dr Jung-Im Shin, the study’s lead author.

A short, troubled life

Many diabetes patients have a hard time staying on top of their disease, especially when other challenges – financial, familial, medical – complicate their lives. The pandemic only raised these hurdles.

For Kate Herrin, life was challenging long before she died alone in her bathroom from uncontrolled diabetes.

When she was a teenager in the Dallas suburbs, her parents divorced. Soon after, her mother’s death gave rise to the depression that plagued Herrin for the rest of her life.

She was diagnosed with type 2 diabetes in 2007 at age 29. By then, she had lost custody of her three children and was back living with her father, a recovering alcoholic who was also dealing with diabetes. She struggled to hold down any job for long.

In the ensuing years, she rarely had her diabetes under control, unable to find doctors who accepted Medicaid and continually frustrated in her attempts to get the supplies she needed. She vented frequently to the tightly knit circle of friends she made on Facebook.

“I have called endocrinologists in the Metroplex and beyond,” she wrote in 2017, referring to the Dallas-Fort Worth area. “None take Medicaid.”

Each state manages its Medicaid program, dictating what services to cover and how much it will pay medical providers. Low reimbursements are a big reason only 68% of family doctors, who treat most type 2 patients, are willing to accept new Medicaid patients, according to a 2019 federal report. That compares with 90% or more who accept patients on private insurance and Medicare.

When the meter Herrin used to test her blood glucose started giving her error messages, she assumed it was broken. Shawntiah Jones, a medical student she had befriended on Facebook, had seen this mistake among other diabetes patients: Herrin’s blood sugars were so high that the meter couldn’t render a score. “I told her, ‘It’s not broken. You need to go to the doctor,’ ” said Jones, now a family doctor in Mississippi.

After her father’s death in 2018 from a diabetes-related stroke, Herrin checked herself into a psychiatric facility, where her depression and diabetes improved with regular care.

Upon her release, her friend Heaston invited her to live at her house in West Alexandria, a town of 1,300 people surrounded by corn fields in the southwest corner of Ohio. Living in Heaston’s basement, Herrin enrolled in Ohio’s Medicaid program. As in Texas, Herrin struggled to secure consistent care and basic supplies, such as test strips.

Money was tight. Herrin was getting by on food stamps, $775 a month in Social Security disability payments, and a little cash she earned as an administrative assistant for Heaston, who works in marketing. Heaston bought her a glucose monitor for about $40 when Herrin had difficulty getting one through her insurance. Sometimes she also had to ask Heaston for money to buy test strips when she ran low. Test strips can cost $50 to $100 or more a month, depending on the number needed.

She also endured constant pain in her feet and legs from neuropathy. In December 2019, she went to the emergency room after her legs grew painfully swollen from the damage to her circulation caused by persistently high blood sugar.

In May 2020, as the coronavirus was taking hold, Herrin found an apartment nearby. She was elated to send for her two rescue dogs, which she had to leave behind in Texas. “I’m getting my doggos back, y’all,” Herrin messaged to friends.

But the pandemic appeared to sap Herrin’s motivation to eat better and exercise more often as she hunkered down at home. Already overweight, she ordered pizza, chicken wings and other fast-food deliveries, often late at night.

Less than a month after moving, she called Heaston at 5 a.m. She was dizzy and had blurred vision, and she needed a ride to the hospital. Under pandemic rules, Heaston dropped her at the entrance and waited in the parking lot. Herrin’s blood glucose nearly topped 300 milligrams per deciliter, at the threshold of a medical emergency, her medical records show. She was treated and released the same day.

In the weeks that followed, she grew more frustrated trying to find diabetes supplies. “This is why I hate shitty Medicaid. The only places that accept it are a million miles from anywhere and don’t have extended hours,” Herrin messaged Heaston one Friday in late September. She fumed that the medical office with her supplies had closed at 5 p.m. and wouldn’t reopen until Monday.

Dr Mary Applegate, medical director of Ohio’s Medicaid program, acknowledged that many diabetes patients don’t receive the care and support they need to manage their disease, leading to poor outcomes and higher medical costs. To help rectify that, she noted, Ohio eased restrictions this year on diabetic testing supplies and continuous glucose monitors to improve access at pharmacies. The state also began reimbursing medical providers for diabetes education and support services.

“The pandemic made all of the disparities in healthcare much more visible, and we feel even greater urgency to get the entire state to outcomes we would be proud of,” Applegate said.

Ohio’s recent efforts came too late for Herrin. When the engine on her 2002 Honda Civic gave out in November, she didn’t have the money to fix it. So when her doctor’s office at Kettering Health, a regional health system, called Herrin to come in for overdue lab work, she said she had no way to get there, her medical records note. It had been more than a year since her last diabetes lab test. Kettering Health declined to comment on Herrin’s care.

Ten days before Christmas, Herrin died in her bathroom. In her final moments, she clutched her phone, searching on it for symptoms of a heart attack.

Heaston and her husband were allowed into Herrin’s apartment after the coroner arrived. They found it littered with empty take-out food containers and clothes strewn on the floor. On the kitchen floor lay a bag of insulin vials and injection pens.

In the following days, some of Herrin’s online friends received Christmas presents she had mailed before she died.

One of her friends, Kim Missino, also has type 2 diabetes – “a full-time job,” as she put it. Her Medicare plan covers visits to an endocrinologist near her home in Norwich, Connecticut, and other specialists. And during the pandemic, Missino had her husband by her side, nudging her to stay on top of her illness. For Herrin, Missino said, the isolation and the financial and logistical issues proved overwhelming.

“It just got so out of control for her,” Missino said.
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Re: Diabetes and Covid 19

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Why do people with diabetes develop severe COVID-19?

7-Sep-2021


https://www.eurekalert.org/news-releases/927716

A new study reveals the mechanism behind cytokine storm during coronavirus infection


Peer-Reviewed Publication

Michigan Medicine - University of Michigan


Throughout the COVID-19 pandemic, clinicians have noted that certain patients are at especially high risk of developing severe illness or dying from coronavirus infection. Type 2 diabetes—a condition affecting more than 10 percent of the U.S. population-- is one of the main risk factors for severe COVID-19 illness. New research from U-M uncovers why this might be and offers hope for a potential therapy.

The culprit appears to be an enzyme called SETDB2. This same enzyme has been implicated in the non-healing, inflammatory wounds found in people with diabetes. Working in the lab of Katherine Gallagher, M.D. of the Michigan Medicine Departments of Surgery and Microbiology and Immunology, researcher W. James Melvin, M.D., and his colleagues decided to probe a possible link between the enzyme and the runaway inflammation they witnessed first-hand in COVID patients in the ICU.

Starting with a mouse model of coronavirus infection, they found that SETDB2 was decreased in immune cells involved in the inflammatory response, called macrophages, of infected mice with diabetes. They later saw the same thing in monocyte-macrophages in the blood from people with diabetes and severe COVID-19.

“We think we have a reason for why these patients are developing a cytokine storm,” said Melvin.

In the mouse and human models, noted Melvin and Gallagher, as SETDB2 went down, inflammation went up. In addition, they revealed that a pathway known as JAK1/STAT3 regulates SETDB2 in macrophages during coronavirus infection.

Taken together, the results point to a potential therapeutic pathway. Previous findings from the lab demonstrated that interferon, a cytokine important for viral immunity, increased SETDB2 in response to wound healing. In their new study, they found blood serum from patients in the ICU with diabetes and severe COVID-19 had reduced levels of interferon-beta compared to patients without diabetes.

“Interferon has been studied throughout the pandemic as a potential therapy, with efforts going back and forth between trying to increase or decrease interferon levels,” said Gallagher. “My sense is that its efficacy as a therapy will be both patient and timing specific.”

To test this, the study team administered interferon beta to coronavirus-infected diabetic mice and saw that they were able to increase SETDB2 and decrease inflammatory cytokines.

“We’re trying to home in on what controls SETDB2, which is sort of the master regulator of a lot of these inflammatory cytokines that you hear about as being increased in COVID-19, such as IL-1B, TNFalpha, and IL-6,” explained Gallagher.

“Looking upstream at what’s controlling SETDB2, interferon is at the top end, with JaK1 and STAT3 in the middle. Interferon increases both, which increases SETDB2 in a sort of cascade.”

This is important, she added, because identifying the pathway presents other potential ways of targeting the enzyme.

Melvin and Gallagher hope the findings of this study will inform ongoing clinical trials of interferon or other downstream components of the pathway, including epigenetic targets, for COVID-19. Their work also highlights the need to understand the timing and cell-specificity of therapy and to tailor its application to patients’ underlying conditions, especially patients with diabetes.

“Our research is showing that maybe if we are able to target patients with diabetes with interferon, especially early in their infection, that may actually make a big difference,” Melvin said.

Other U-M researchers involved in this study include Christopher O. Audu, Frank M. Davis, Sriganesh B. Sharma, Amrita Joshi, Aaron DenDekker, Sonya Wolf, Emily Barrett, Kevin Mangum, Xiaofeng Zhou, Monica Bame, Alex Ruan, Andrea Obi, Steven L. Kunkel, and Bethany B. Moore.

Paper cited: “Coronavirus induces diabetic macrophage-mediated inflammation via SETDB2”, Proceedings of the National Academy of Sciences, DOI: 10.1073/pnas.2101071118

Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2101071118

Method of Research


Experimental study

Article Title


Coronavirus induces diabetic macrophage-mediated inflammation via SETDB2
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Re: Diabetes and Covid 19

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What are ideal blood sugar levels for preventing repeat strokes, heart attacks?

9/29/21


https://www.eurekalert.org/news-releases/929437


Peer-Reviewed Publication

American Academy of Neurology

MINNEAPOLIS - Blood sugar control has always been important for people with diabetes when it comes to preventing a stroke. But a new study finds for people with diabetes who have a stroke, there may be an ideal target blood sugar range to lower the risk of different types of vascular diseases like a stroke or heart attack later on. The research is published in the September 29, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“We know that having diabetes may be associated with an increased risk of having a first stroke,” said study author Moon-Ku Han, MD, PhD, of Seoul National University College of Medicine in Korea. “But our results indicate that there is an optimal blood sugar level that may start to minimize the risk of having another stroke, a heart attack or other vascular problems, and it’s right in the 6.8% to 7.0% range.”

The study involved 18,567 people with diabetes with an average age of 70. All participants were admitted to the hospital for an ischemic stroke, which is caused by a blood clot. Upon admission, researchers used a test called the hemoglobin A1C to determine people’s average blood sugar level over the past two to three months. This test measures a percentage of hemoglobin proteins in the blood coated with sugar. A level below 5.7% is considered normal; 6.5% or higher generally indicates diabetes. The participants had an average A1C of 7.5%.

Researchers then followed up one year later to find out if there was an association between A1C levels with the risk of having another stroke, a heart attack, or dying from these or other vascular causes.

Of all participants, 1,437, or about 8%, had a heart attack or died from vascular disease within a year of starting the study, and 954, or 5%, had another stroke.

The study found that people admitted to the hospital with A1C levels above the 6.8% to 7.0% range had an increased risk of having a vascular event like a heart attack, as well as having another stroke.

After adjusting for factors like age and sex, researchers found that people’s risk for a heart attack or similar vascular diseases was 27% greater when they were admitted to the hospital with A1C levels above 7.0%, compared to those admitted with A1C levels below 6.5%. People’s risk for having another stroke was 28% greater when admitted to the hospital with A1C levels above 7.0%, compared to those below 6.5%.

“Our findings highlight the importance of keeping a close eye on your blood sugar if you’re diabetic and have had a stroke,” Han said.

A limitation of the study is that people’s blood sugar levels were measured only at the start of the study; no follow-up levels were available.

Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

Journal

Neurology
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Re: Diabetes and Covid 19

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Study finds prescription of antidepressant and antipsychotic drugs common ahead of type 2 diabetes diagnosis

9/29/21


https://www.eurekalert.org/news-releases/929782

Peer-Reviewed Publication

Diabetologia


Almost three in ten people with type 2 diabetes (T2D) in Scotland were prescribed antidepressants before they were diagnosed with diabetes, according to new research being presented at the European Association for the Study of Diabetes (EASD) conference, held online this year.

The study, from Ms Charlotte Greene, Professor Sarah Wild and colleagues at the University of Edinburgh, UK, also found that just over one in ten people were prescribed antipsychotics prior to diagnosis of T2D.

The aim was to provide information about patterns of antidepressant and antipsychotic drug prescribing prior to the diagnosis of diabetes. This is part of a broader piece of research, which aims to look at whether prescribing patterns of these drugs in people with diabetes have changed over time and whether these drugs affect the risk of complications in people with diabetes.

The study used the Scottish Care Information-Diabetes Collaboration (SCI-Diabetes) dataset, which contains information on almost all patients diagnosed with diabetes in Scotland, to provide information on the prevalence and patterns of antidepressant and antipsychotic drug prescribing in the four years prior to diagnosis of T2D in 266,186 adults.

22.5% were prescribed antidepressants, 5.3% were prescribed antipsychotics and 6.6% were prescribed both antidepressants and antipsychotics. (Comparable figures aren’t available for the general population.)

Of those prescribed antidepressants, 32.9% were prescribed a selective serotonin reuptake inhibitor (SSRI), 30.5% a tricyclic antidepressant and 9.9% another type of antidepressant. The remaining 28.6% were prescribed more than one type of antidepressant.

Of those prescribed antipsychotics, 80.4% were prescribed a first-generation drug, 14.2% a second-generation drug and 5.5% antipsychotics of more than one type.

Those prescribed antidepressants and or antipsychotics were more likely to be women than those not given the drugs. They were also more likely to live in more socioeconomically deprived areas, be current smokers, obese and have high blood pressure and high cholesterol.

Hospital admissions for psychiatric disorders were also more common in those prescribed antidepressants or antipsychotics.

The study’s authors say that while it isn’t known why the prescription of these drugs is common ahead of T2D diagnosis, mental illness is thought to increase the risk of T2D for several reasons.

For example, people with mental illness are more likely to have a poor diet, be physically inactive, smoke and misuse alcohol, than people without mental illness. They are also more likely to live in socioeconomically deprived areas – all of which are associated with a higher risk of T2D.

Ms Greene adds: “Additionally, some antidepressants and antipsychotics are thought to increase risk factors related to the development of type 2 diabetes, including weight gain, independently of mental illness.

“More research is needed to investigate prescription patterns after diabetes diagnosis and to determine whether use of these drugs affects the risk of complications of diabetes including heart disease, stroke, and retinopathy.”

Journal

Diabetologia
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Re: Diabetes and Covid 19

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Diabetes divide widens between rich and poor in Scotland

Women in most deprived areas 2.5 times as likely to have type 2 diabetes as the least deprived; prevalence of type 2 diabetes almost twice as high among most deprived men

9/29/21


https://www.eurekalert.org/news-releases/929785

Peer-Reviewed Publication

Diabetologia


New research being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online this year, shows that there are marked socio-economic inequalities in the prevalence of (the proportion of people with) type 2 diabetes (T2D) in Scotland – and the gap is widening.

When research on socio-economic inequality and the prevalence of T2D in Scotland was last published in 2007, it showed that the proportion of people with type 2 diabetes was about 60% and 90% higher in men and women respectively in the most deprived fifth (20%) of the population, compared to the least deprived fifth.

Health inequalities in general in the UK have widened since then, prompting Professor Sarah Wild and colleagues at the University of Edinburgh to produce up-to-date figures.

Professor Wild says: “Describing inequalities in health is the first step in informing policies to address them, for example as part of a ‘levelling up’ agenda.”

Mid-year population estimates for 2019 (the most recent year available) and a February 2021 extract from the Scottish register of diagnosed cases of diabetes were used to estimate the prevalence of T2D in 35 to 84-year-olds, the age group in which T2D is most common.

To make fair comparison across time and populations, differences in age patterns were taken into account.

The Scottish Index of Multiple Deprivation (SIMD) was used to divide the study population into quintiles or fifths, from the most deprived (Q1) to least deprived (Q5).

Data on age, sex and SIMD was available for 255,674 people – almost 99% of those aged 35 to 84 who had been diagnosed with T2D.

The overall prevalence of T2D in this age group was 8.3% (one in 12). This compares with 7.3% in 2007.

Prevalence of T2D was lowest in women aged 35-39 years from Q5 (0.5%) and highest in men aged 75-79 years from Q2 (22.4%), illustrating the expected patterns of increasing prevalence with age and higher prevalence in men than women

The most deprived men and women were, respectively, almost 2.0 and 2.5 times as likely to be diagnosed with diabetes as the least deprived, indicating that socio-economic inequalities have widened over time. (The 2007 figures were 1.58 times for men and 2 times for women.)

Professor Wild says: “Further research is required to find out whether similar patterns have been observed in other parts of the UK and other high-income countries around the world and to investigate the effect of the pandemic and its consequences on diabetes prevalence.

“Effective approaches at a societal level are required to reduce inequalities in key risk factors for diabetes in individuals including physical inactivity and obesity.

“It is also important to find out whether the implementation of large-scale prevention programmes affects inequalities in diabetes prevalence.”


Journal

Diabetologia
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Re: Diabetes and Covid 19

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Men with young-onset type 2 diabetes at higher risk of retinopathy, study finds

9/29/21


https://www.eurekalert.org/news-releases/929817

Peer-Reviewed Publication

Diabetologia


New research being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online this year, found that men who are diagnosed with type 2 diabetes (T2D) at a young age are more likely to develop retinopathy than those diagnosed aged 50-plus.

Men diagnosed with T2D before the age of 40 were 72% more likely to have retinopathy than males who had T2D for the same amount of time but were diagnosed at the more typical age of 50 or over.

Retinopathy is a common complication of diabetes in which damage to the blood vessels of the retina can lead to blindness.

T2D, the most common form of diabetes, usually occurs in middle-aged and older people. However, onset at a younger age is becoming more common globally.

Dr Katrina Tibballs and colleagues at the University of Oslo, Norway, analysed data from the GP records of 10,242 people with T2D to find out the prevalence of young-onset diabetes in Norway and to explore the relationship between age at diagnosis and complications.

The dataset was representative for Norway and the average age of diagnosis with T2D among all the participants was 56.

980 (10.2%) had young-onset diabetes (diagnosis under the age of 40) and their average age of diagnosis was 33.3 years old. This group had T2D for 11.4 years, on average, at the time of the study, and was 55.6% male. 15.5% had retinopathy.

Their risk of retinopathy and coronary heart disease, another complication of T2D, was compared with a group of 6,627 people who were diagnosed with T2D aged 50-plus (normal onset T2D).

The average age of diagnosis in this group was 62.7. This group had T2D for 7.8 years, on average, at the time of the study, and was 53.4% male. 5.9% had retinopathy.

Those diagnosed before the age of 40 had, on average, a higher HbA1c (average blood sugar level) at diagnosis than those diagnosed after 50 (7.6% versus 6.9%).

In those with young-onset T2D, HbA1c levels were higher already from the point of diabetes diagnosis but also increased more rapidly with time. In other words, if two people had T2D for the same length of time, HbA1c levels would likely be higher in the one diagnosed at a younger age.

Risk of coronary heart disease was more strongly linked to age in both groups than to diabetes duration. Risk of retinopathy, however, increased with diabetes duration, with the risk increasing particularly sharply in those with young-onset T2D.

When other relevant factors including diabetes duration, HbA1c, current age, BMI and blood pressure were considered and adjusted for, men with young-onset diabetes were 72% more likely to have retinopathy than those with normal-onset T2D.

In contrast to men with young-onset T2D, women with young-onset T2D weren’t at significantly higher risk of retinopathy than those with normal-onset T2D, after taking all the above-mentioned factors into account.

The analysis also showed that retinopathy developed sooner after diagnosis in men, but not women, with young-onset T2D than in normal-onset T2D.

The study’s authors say that diagnosis may be more likely to be delayed in males, who tend to visit their GP less often than females. This would mean their T2D was uncontrolled for longer, raising their risk of complications.

In addition, young-onset T2D may be a more aggressive form of the condition. T2D occurs when beta cells in the pancreas can’t make enough insulin (a hormone which helps turn the sugar in food into energy) or the insulin it makes doesn’t work properly (a phenomenon known as “insulin resistance”).

The researchers say that the higher average blood sugar levels found in those with young-onset T2D could be a sign of more rapid deterioration of the insulin-producing cells and therefore a more severe form of the condition.

Dr Tibballs, a GP and PhD student, concludes: “It is important that young-onset type 2 diabetes is detected early enough and treated adequately to reduce the likelihood of retinopathy and other complications.

“The current guidelines on diabetes prevention and treatment should be updated to reflect the higher risk of complications in those with young-onset diabetes, particularly the elevated risk of retinopathy in men.”

Journal

Diabetologia
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Re: Diabetes and Covid 19

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Bigger waistlines raise the risk of serious liver damage in people with type 2 diabetes, study suggests

Every extra 1cm in waist circumference increases odds of advanced fibrosis by 5%

9/29/21

https://www.eurekalert.org/news-releases/929822

Peer-Reviewed Publication

Diabetologia


New research being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online this year, found a link between larger waistlines and the progression of non-alcoholic fatty liver disease (NAFLD) in people with type 2 diabetes (T2D).

Each 1cm increase in waist circumference was associated with a 5% higher likelihood of developing advanced fibrosis, a late stage of NAFLD.

NAFLD, in which fat builds up in the liver can progress to serious liver damage, including advanced fibrosis - potentially life-threatening scarring of the liver.

It is already known that that up to 15-20% of those with T2D have advanced fibrosis. But little is known about what effect, if any, it has on the complications of diabetes.

Dr Tiphaine Vidal-Trécan, of Lariboisiere Hospital, Paris, France, and colleagues studied the relationship in 684 T2D patients.

The participants had an average age of 61, a BMI of 28.7 and a waist circumference of 104cm. 59% were male.

Vibration-controlled transient elastography scans (a form of ultrasound) showed that 74.5% had NAFLD. In 12.4% of the participants it had progressed to advanced fibrosis.

24.8% of the participants had macrovascular complications of T2D, such as heart disease. 20.5% had retinopathy (damage to the blood vessels of the retina); 39.4% had neuropathy (nerve damage); and 38.3% had nephropathy (kidney disease).

Analysis revealed nephropathy to be significantly more common in those with advanced fibrosis than the other T2D patients. 52.1% of those with advanced fibrosis had nephropathy, compared to 36.3% of the other T2D patients. The study’s authors say that more research is needed to confirm this link.

Rates of the other complications (macrovascular, retinopathy and neuropathy) did not differ between those with advanced fibrosis and the other T2D patients. Again, more research is needed to confirm this.

The study also found that every 1cm increase in waistline was associated with a 5% increase in the likelihood of the participants developing advanced fibrosis.

Higher levels of AST, a marker of liver damage, were also associated with higher odds of advanced fibrosis.

Dr Vidal-Trécan concludes: “Doctors treating people with type 2 diabetes should be aware of these links and check for advanced fibrosis when their waist circumference or level of AST is high.

“A large waist circumference is linked to metabolic syndrome and fat accumulation in abdomen, which can lead to NAFLD.



“Weight loss can reduce NAFLD, as can some medication, and the search for new drugs is gathering pace.”

Journal


Diabetologia
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