# pos

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pos: NNS
token:
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lemma:
  https://www.diabetes.org.uk/professionals/resources/shared-practice/inpatient-and-hospital-care#patient


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  Syndr DOI 10 1016 j dsx 2020 07 046 sha dd6e63e8cd731d9cd4d0c1d80754de4c31e6a990 doc_id 255687 cord_uid jud875xc nan


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  durch ein Gewichtsmanagementprogramm eine starke Gewichtsreduktion und eine Diabetesremission erreicht


id: cord-028967-l5ioyhur
type: PROTEIN
entity:
  Kontrollgruppe eine Gewichtsabnahme von mindestens 15 kg erreicht Eine Diabetesremission definiert durch einen HbA1c Wert von


id: cord-028967-l5ioyhur
type: PROTEIN
entity:
  unter einer alleinigen Standardtherapie nicht zur Abheilung gebracht werden konnten Die Ergebnisse waren ausgesprochen positiv Nach 12


id: cord-028967-l5ioyhur
type: GGP
entity:
  Die 2019 publizierten 2 Jahres Ergebnisse der Studie ergaben nun dass eine Remission des Diabetes immer noch bei mehr als 1 3


id: cord-028967-l5ioyhur
type: CHEMICAL
entity:
  publizierte dänische Studie bei der Personen mit Typ 2 Diabetes über 6 Wochen hinweg entweder mit einer kohlenhydratarmen Diät mit 30 Kohlenhydraten


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  vascular endothelial growth factor VEGF fibroblast growth factors FGFs matrix metalloproteinases MMPs


id: cord-013477-dzm4xi21
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  the Treatment of COVID 19 Infection Food Drug Administration GRAS Notice Inventory Scientific Opinion on the Re Evaluation of Curcumin


id: cord-013477-dzm4xi21
type: ORG
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  Adverse Neonatal Outcomes in Women with Gestational Diabetes STRONG Study Impact of Risk Factors for Gestational Diabetes GDM


id: cord-013477-dzm4xi21
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  Overweight Obese Women with Polycystic Ovary Syndrome A Randomized Double Blind Placebo Controlled Clinical Trial


id: cord-013477-dzm4xi21
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  Spinal Anesthesia Open Access Maced Dietary Curcumin Supplementation Attenuates Inflammation Hepatic Injury and Oxidative Damage


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  Placental Tissue of Premature Birth of Infected Mice Asian Pac Correction to Bisphenol A Mediated Inhibition of Hippocampal Neurogenesis


id: cord-013477-dzm4xi21
type: ORG
entity:
  Cardiovascular Disease A Systemic Review on the Antioxidant and Anti Inflammatory Effects of Resveratrol Curcumin


id: cord-013477-dzm4xi21
type: ORG
entity:
  Dietary Nitric Oxide Supplementation on Human Cardiovascular Health Analysis of Causes of Maternal Death A Systematic Review Disruption of Placental Homeostasis Leads


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type: GGP
entity:
  C I 1 33 2 57 p 0 001 Figure 1A Several other pre existing conditions were associated with COVID 19 severity including hypertension cardiovascular disease atrial fibrillation CKD and COPD Table S2 Among prehospitalization treatments use of ARBs novel oral anticoagulants


id: cord-030631-cc79j9j4
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entity:
  insulinomassoziierte Antigen 2 IA 2A und Zinktransporter 8 Autoantikörper ZnT8A Autoantikörpern markiert das Frühstadium des Typ 1 Diabetes Der Nachweis von 2 oder mehr dieser Autoantikörper beim asymptomatischen Kind ohne gestörten Glukosestoffwechsel ist


id: cord-030631-cc79j9j4
type: PROTEIN
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  Tatsache dass anhand von Biomarkern HLA Merkmalen HLA humanes Leukozytenantigen und dem Fehlen von ZnT8A


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  RAAS renin angiotensin aldosterone system ACEi angiotensin converting enzyme inhibitors ARB angiotensin receptor blocker


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  Attitudes An Econometric Study of a Chronic Disease Focused Online Health Community Value Co Creation


id: cord-214006-0w6bqrox
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  Improve Diabetes Self Management and Clinical Outcomes Evidence Logistics Evaluation Considerations and Needs for Future Research Self Management Interventions Proposal and Validation of a New Operational


id: cord-214006-0w6bqrox
type: ORG
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  Chronic Illness and Disability Health Care Customer Value Cocreation Practice Styles Group Education


id: cord-214006-0w6bqrox
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entity:
  A Metadesign Theory for Tailorable Decision Support Group Participants Experiences of a Patient Directed Group Based Education Program for the Management of Type 2 Diabetes Mellitus Service Experiences


id: cord-266702-6oxtlzqo
type: ORG
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  the Chinese Center for Disease Control and Prevention Infections in Patients with Diabetes Mellitus A Review of Pathogenesis Common Infections in Diabetes Pathogenesis Management and Relationship to Glycaemic Control Lung Function and Glucose Metabolism


id: cord-266702-6oxtlzqo
type: ORG
entity:
  the Third National Health and Nutrition Examination Survey Cross Sectional and Prospective Study of Lung Function


id: cord-266702-6oxtlzqo
type: ORG
entity:
  Their Association with Glycemic Control and Duration of the Disease Clinical Considerations for Patients with Diabetes in Times of Covid 19 Epidemic Inhibition


id: cord-266702-6oxtlzqo
type: ORG
entity:
  Susceptibility to Pneumonia Transplantation of Ace2 Mesenchymal Stem Cells Improves the Outcome of Patients


id: cord-260119-pgu2crhs
type: ORG
entity:
  the Diabetic Foot With Peripheral Arterial Disease Using the Angiosome Concept Establishing Differences


id: cord-260119-pgu2crhs
type: WORK_OF_ART
entity:
  Manufactured Shoes in the Prevention of Diabetic Foot Ulcers Effect of Therapeutic Footwear on Foot Reulceration in Patients With Diabetes


id: cord-260119-pgu2crhs
type: ORG
entity:
  New Monitoring Technology to Objectively Assess Adherence to Prescribed Footwear and Assistive Devices


id: cord-260119-pgu2crhs
type: ORG
entity:
  Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes Prospective Open


id: cord-309474-9h9w46eq
type: ORG
entity:
  ISPAD Clinical Practice Consensus Guidelines 2018 Management and Support of Children and Adolescents With Type 1 Diabetes


id: cord-274548-yeucn13x
type: DISEASE
entity:
  diabetes of the total health expenditure 38 The variables listed above were classified as follows percentage of


id: cord-276256-gmlsoo2z
type: LAW
entity:
  19 COVID 19 Pandemic Triggers Telemedicine Regulation and Intensifies Diabetes Management Technology Adoption


id: cord-306670-c2jm0g88
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  GraphPad Prism version 7 00 software GraphPad Software Inc or SPSS version 25 0 IBM United States A P value 0 05


id: cord-287362-dhl7ynrc
type: GGP
entity:
  Syndr DOI 10 1016 j dsx 2020 09 022 sha c5c67db837a062293dd1bde4433bac6b24f5135a doc_id 287362 cord_uid dhl7ynrc BACKGROUND AND AIMS The link between diabetes and increased risk of infectious disease


id: cord-312875-gn6hg6oc
type: WORK_OF_ART
entity:
  Pharmacologic Treatments for Coronavirus Disease 2019 COVID 19 A Review Potential Effect of Hydroxychloroquine in Diabetes Mellitus A Systematic Review on Preclinical and Clinical Trial Studies Antidiabetogenic


id: cord-309795-2kozsv4z
type: ORG
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  the American Association for the Study of Liver Diseases EASL EASD EASO Clinical Practice Guidelines


id: cord-309795-2kozsv4z
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  Fatty Liver Disease Evidence against Pathway Selective Hepatic Insulin Resistance in Mice Mechanisms of Disease


id: cord-309795-2kozsv4z
type: WORK_OF_ART
entity:
  The Opportunities and Challenges of Peroxisome Proliferator Activated Receptors Ligands in Clinical Drug Discovery and Development Elafibranor an Agonist of the Peroxisome Proliferator Activated Receptor


id: cord-309795-2kozsv4z
type: ORG
entity:
  the Phase 2b CENTAUR Study Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases


id: cord-335894-6m0nnufu
type: GGP
entity:
  dipeptidyl peptidase 4 inhibitors DPP4 inhibitors sodium glucose transporter 2 inhibitors SGLT 2 inhibitors pioglitazone alpha glucosidase inhibitors metformin


id: cord-336201-fl606l3b
type: PROTEIN
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  mannose binding lectin MBL surfactant protein D SP D dendritic cell specific intercellular adhesion molecule 3


id: cord-336201-fl606l3b
type: PROTEIN
entity:
  granulocyte colony stimulating factor G CSF macrophage inflammatory protein 1α MIP1α serum ferritin fibrinogen plasminogen C reactive protein CRP


id: cord-336201-fl606l3b
type: GGP
entity:
  antibioticresistant Escherichia coli Proteus spp Klebsiella spp coagulasenegative staphylococci Enterobacter


id: cord-345360-wlzgq7f9
type: ORG
entity:
  China Epidemiology and Genetic Risk Factors and Their Clinical Utility in Personalized Medication Global


id: cord-345360-wlzgq7f9
type: ORG
entity:
  China Epidemiology and Genetic Risk Factors and Their Clinical Utility in Personalized Medication Risk


id: cord-350373-dftdxzsm
type: PROTEIN
entity:
  N Kennon B Cottrell C Nagi D Page E Voigt D Courtney H C Atkins H Platts J Higgins K Dhatariya K Patel M Narendran P Kar P Newland Jones P Stewart R Burr O Thomas S title


id: cord-352544-7b6btzrx
type: PROTEIN
entity:
  glutamyl transferase creatinine C reactive protein CRP D dimer N terminal brain natriuretic peptide precursor NT proBNP cardiac troponin I cTnI prothrombin


id: cord-023157-0lqlx2rv
type: PROTEIN
entity:
  LDL cholesterol apolipoprotein B 88 3 AE 27 0 vs 96 8 AE 21 1 mg dl and interleukin 6 2 37 AE 2 06 vs 3 54 AE 3 07


id: cord-023157-0lqlx2rv
type: PROTEIN
entity:
  Picu 1 L Petcu 1 D Lixandru 2 I Stoian 2 C Cristescu 3 E Rusu 3 C Ionescu Tirgoviste 1 1 NIDNMD N C Paulescu 2 Biochemistry University of Medicine and Pharmacy Carol Davila 3 Titu Maiorescu University Bucharest Romania Background


id: cord-023157-0lqlx2rv
type: PROTEIN
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  I B 38 7 AE 5 5 mU ml 2 1 22 G 33 3 AE 9 8 P 0 3 HOMA IR B 8 9 AE 5 2 77 G 7 1 AE 2 P 0 5 CARO 0 2 AE 0 15 0 33 0 25 AE 0 13 P 0 8 Conclusions Obesity


id: cord-023157-0lqlx2rv
type: PROTEIN
entity:
  K Elksne 1 Z Paunina 1 A Jurka 2 D Rezeberga 1 P Tretjakovs 2 1 Obstetrics and Gynecology 2 Physiology Rigas


id: cord-023157-0lqlx2rv
type: PROTEIN
entity:
  casein protein 50 g maltodextrin 19 and 10 g lactulose or 2 50 g maltodextrin 19 and 10 g lactulose control Procedures Fifteen prediabetic and 15 healthy volunteers


id: cord-023157-0lqlx2rv
type: PROTEIN
entity:
  G Kistauri 1 G Devidze 2 M Jibladze 1 A A Kistauri 3 1 Internal Medicine Tbilisi State Medical University Tbilisi 2 Surgery Kutaisi Ortodox Christian Hospital Kutaisi Georgia 3


id: cord-023157-0lqlx2rv
type: GGP
entity:
  NO r 0 34 GGTP NO r 0 88 P 0 05 The biopsy of liver showed all signs of NAFLD including changes of tiny bilious ductules


id: cord-023157-0lqlx2rv
type: GGP
entity:
  SUA r 0 27 P 0 01 and SDMA with SUA and hs CRP concentrations r 0 37 P 0 05 r 0 48 P 0 01 respectively We demonstrated that


id: cord-023157-0lqlx2rv
type: GGP
entity:
  51times 3 81 times and 13 21 times more risk of increasing regional adiposity using WHtR WHR and WC respectively Among females WHtR WHR and WC respectively showed 9 53 times 3 96 times and 6 00 times higher risk of developing regional adiposity with irregular pattern of PA The increased risk of being obese was 7 16 times more among males with irregular pattern of physical activity while among females fat percentage and obesity level using BMI category were found to be


id: cord-023157-0lqlx2rv
type: GGP
entity:
  GH R 2 17 4 P 0 001 and IGF 1 R 2 15 2 P 0 01 and negatively with disease duration R 2 12 8 P 0 04 The GH


id: cord-023157-0lqlx2rv
type: GGP
entity:
  TRIMPS P 0 05 Furthermore high workers had lower levels of fat mass percentage and 2 h glucose as well as higher lean body


id: cord-023157-0lqlx2rv
type: GGP
entity:
  fibrinogen C reactive protein uric acid creatinine triglycerides t cholesterol HDL LDL homocysteine glucose insulin


id: cord-023157-0lqlx2rv
type: GGP
entity:
  glucose 3 37 1 06 10 72 and 1 4 78 1 32 17 29 and 2 risk factors 7 16 2 38 21 54 higher than those without the phenotype Those with a high WHTR had lower clustered risk P 0 05 higher odds of having low HDL cholesterol 2 57 1 11 5


id: cord-023157-0lqlx2rv
type: GGP
entity:
  glucose 5 6 mmol l In this particulary population with coronary artery disease and or cardiovascular risk factors


id: cord-023157-0lqlx2rv
type: GGP
entity:
  growth factors IGFs sex hormones adipocytokines inflammatory cytokines c Myc oncogenic transcription factor


id: cord-023157-0lqlx2rv
type: GGP
entity:
  Cushing s disease Conclusion A longer duration of CD symptoms was associated with greater risk of metabolic complications such as prediabetes and secondary diabetes The efficacy of surgical treatment for corticotroph adenoma does not depend directly on the presence of preoperative glucose


id: cord-023157-0lqlx2rv
type: WORK_OF_ART
entity:
  A Kopp A Schmid M Mü ller A Schä ffler Internal Medicine I University Hospital Regensburg Regensburg Germany Introduction Proteins


id: cord-023157-0lqlx2rv
type: ORG
entity:
  Department of Physiology Federal University of Juiz de Fora Juiz de Fora 2 Biology State University of Maring a Maring


id: cord-023157-0lqlx2rv
type: ORG
entity:
  Clinical Endocrinology Institute for Endocrine Pathology Problems Kharkiv Ukraine Introduction Active


id: cord-023157-0lqlx2rv
type: PERCENT
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  between T1 T2 and T3 and iv significant decline in LDL triglycerides and BMI between T3 T2 and T1 39 3 and 38 7 of the group and personal therapy respectively


id: cord-023157-0lqlx2rv
type: ORG
entity:
  Institute for Sport and Physical Activity Research ISPAR University of Bedfordshire Bedford UK Objective Hypertriglyceridemic


id: cord-023157-0lqlx2rv
type: ORG
entity:
  Institute of Molecular Biomedicine Comenius University Medical Faculty 2 Department of Health Bratislava Self Governing Region 3 Regional Public Health Office


id: cord-023157-0lqlx2rv
type: WORK_OF_ART
entity:
  Medical Laboratory Technology Women s Polytechnic 2 Medical Officer Government of Tripura Health Services Agartala India Introduction Saliva


id: cord-023157-0lqlx2rv
type: CHEMICAL
entity:
  Kidron 1 E Arbit 2 1 Oramed Pharmaceuticals Jerusalem Israel 2 Biomedical Engineering NYU Oramed Pharmaceuticals Englewood NJ USA


id: cord-023157-0lqlx2rv
type: DISEASE
entity:
  diabetes F Saad 1 2 A Yassin 3 4 G Doros 5 1 Results After 5 years the following changes were observed weight kg


id: cord-023157-0lqlx2rv
type: CHEMICAL
entity:
  apolipoprotein B apo B were 4 4 AE 1 2 mmol l 2 6 AE 1 0 mmol l 0 97 AE 0 27 mmol l 1 9 AE 1 4 mmol l 1 13 AE 0 18 g l and 0 91 AE 0 25 g l respectively Eighty one percent 13 and 6 of


# url

id: cord-350373-dftdxzsm
domain: www.diabetes.org.uk
url:
  http://www.diabetes.org.uk/professionals/resources/shared-practice/inpatient-and-hospital-care#patients


# bib

id: cord-013477-dzm4xi21
title: Curcumin: Could This Compound Be Useful in Pregnancy and Pregnancy-Related Complications?
author: Filardi, Tiziana
date: 2020-10-17
txt: ./txt/cord-013477-dzm4xi21.txt
cache: ./cache/cord-013477-dzm4xi21.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603145/
doi: 10.3390/nu12103179
summary:
  The reported anti-inflammatory, antioxidant, antitoxicant, neuroprotective, immunomodulatory, antiapoptotic, antiangiogenic, anti-hypertensive, and antidiabetic properties of curcumin appear to be encouraging, not only for the management of pregnancy-related disorders, including gestational diabetes mellitus (GDM), preeclampsia (PE), depression, preterm birth, and fetal growth disorders but also to contrast damage induced by natural and chemical toxic agents. Results showed that 100 mg/kg curcumin significantly reduced blood glucose and insulin levels, increased hepatic glycogen content, and improved oxidative stress by reducing thiobarbituric acid reactive substance (TBARS) and increasing glutathione (GSH) levels, superoxide dismutase (SOD), and catalase (CAT) activities in the liver of diabetic pregnant mice at gestational day 20. The authors evaluated the possible mechanisms responsible for these effects and found that curcumin-induced apoptosis was associated with the modulation of pro-and anti-apoptotic molecules (i.e., increased Bax and reduced Bcl-2 expression), ROS generation, and caspase-3 activation [66] .

abstract:
  Curcumin, the main polyphenol contained in turmeric root (Curcuma longa), has played a significant role in medicine for centuries. The growing interest in plant-derived substances has led to increased consumption of them also in pregnancy. The pleiotropic and multi-targeting actions of curcumin have made it very attractive as a health-promoting compound. In spite of the beneficial effects observed in various chronic diseases in humans, limited and fragmentary information is currently available about curcumin’s effects on pregnancy and pregnancy-related complications. It is known that immune-metabolic alterations occurring during pregnancy have consequences on both maternal and fetal tissues, leading to short- and long-term complications. The reported anti-inflammatory, antioxidant, antitoxicant, neuroprotective, immunomodulatory, antiapoptotic, antiangiogenic, anti-hypertensive, and antidiabetic properties of curcumin appear to be encouraging, not only for the management of pregnancy-related disorders, including gestational diabetes mellitus (GDM), preeclampsia (PE), depression, preterm birth, and fetal growth disorders but also to contrast damage induced by natural and chemical toxic agents. The current review summarizes the latest data, mostly obtained from animal models and in vitro studies, on the impact of curcumin on the molecular mechanisms involved in pregnancy pathophysiology, with the aim to shed light on the possible beneficial and/or adverse effects of curcumin on pregnancy outcomes.


id: cord-023157-0lqlx2rv
title: Poster Sessions
author: nan
date: 2013-04-18
txt: ./txt/cord-023157-0lqlx2rv.txt
cache: ./cache/cord-023157-0lqlx2rv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167176/
doi: 10.1111/1753-0407.12032_1
abstract: nan
summary:
  The patients revealed the increase of free fatty acids level (2.19 AE 0.10) mmol/l/ml, that meaningfully differed from such indexes in the control group (P < 0.001) and low level of adiponektin (3.70 AE 0.70) mg/ml that confirms their role in development of NAFLD even for persons with normal body weight after the presence of abdominal type of adipose tissue distribution. Results: This study has shown effectiveness in reduction in fasting blood glucose (P < 0.01), systolic blood pressure (P = 0.03), diastolic blood pressure (P = 0.01), weight (P = 0.03), added sugar (P = 0.03) and fat consumption (P < 0.01) while improving physical activity (P < 0.01) and insulin sensitivity (P < 0.01) in the intervention group when compared with the control group at follow up assessment. Conclusion: Our study shows that infiltration of macrophages in human adipose tissue, estimated by the expression of macrophage markers, is increased in subjects with obesity and diabetes and associated with insulin sensitivity and serum lipid levels independent of BMI.


id: cord-026990-d3l1sbeb
title: Economic menace of diabetes in India: a systematic review
author: Oberoi, Sumit
date: 2020-06-17
txt: ./txt/cord-026990-d3l1sbeb.txt
cache: ./cache/cord-026990-d3l1sbeb.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299136/
doi: 10.1007/s13410-020-00838-z
summary:
  Thus, the present study aims at capturing the evidence from the literature on the cost of diabetes mellitus in India, reviewing the materials and methods used to estimate the costs and, lastly, exploring future research area. Majority of research publications were excluded on the grounds if they (a) did not provide the detailed analysis of how costs were estimated; (b) were conference articles or posters; (c) only presented the costs of diabetes prevention; and (d) were published in non-peer-reviewed journals. (cost for patients with foot complication was ₹19,020/-, also average cost for renal patients Under the north zone, 8 studies were included to calculate both direct and indirect costs of diabetes at the individual/household level (Fig. 1) . Therefore, the findings of the present study suggest that per annum median direct and indirect cost of diabetes at the individual/household level is very colossal in India.

abstract:
  AIM: Diabetes mellitus is recognised as a major chronic pandemic disease that does not consider any ethnic and monetary background. There is a dearth of literature on the cost of diabetes in the Indian context. Therefore, the present study aims to capture the evidence from the literature on the cost of diabetes mellitus in India. METHODS: An extensive literature was reviewed from ACADEMIA, NCBI, PubMed, ProQuest, EBSCO, Springer, JSTOR, Scopus and Google Scholar. The eligibility criterion is based on ‘PICOS’ procedure, and only those studies which are available in the English language, published between 1999 and February 2019, indexed in ABDC, EBSCO, ProQuest, Scopus and peer-reviewed journals are included. RESULTS: A total of thirty-two studies were included in the present study. The result indicates that the median direct cost of diabetes was estimated to be ₹18,890/- p.a. for the north zone, ₹10,585/- p.a. for the south zone, ₹45,792/- p.a. for the north-east zone and ₹8822/- p.a. for the west zone. Similarly, the median indirect cost of diabetes was ₹18,146/- p.a. for the north zone, ₹1198/- p.a. for the south zone, ₹18,707/- p.a. for the north-east and ₹3949/- p.a. for the west zone. CONCLUSION: The present study highlighted that diabetes poses a high economic burden on individuals/households. The study directed the need to arrange awareness campaign regarding diabetes and associated risk factors in order to minimise the burden of diabetes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13410-020-00838-z) contains supplementary material, which is available to authorized users.


id: cord-027036-lvcxrmih
title: The impact of diabetes on COVID‐19 infection
author: Shaw, Ken
date: 2020-06-09
txt: ./txt/cord-027036-lvcxrmih.txt
cache: ./cache/cord-027036-lvcxrmih.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300780/
doi: 10.1002/pdi.2272
abstract: nan
summary:
  For example, studies are described reporting defects of cell-mediated immunity and diminished lymphocyte transformation response in people with poorly-controlled diabetes, while impaired leucocyte function, the first line of defence against secondary bacterial infection, can be demonstrated from observation of reduced phagocytic activity with increasing levels of blood glucose. These early reports of COVID-19 infection included observations of 52 critically ill adult patients with coronavirus pneumonia admitted to the ICU at the Wuhan Jin Yin-tan hospital, where diabetes was found in twice the number of individuals who died compared to those who survived (22% vs 10%). 5 This outcome has since been replicated on a wider scale from 552 hospitals across China 6 where, in a total of 1099 patients with established COVID-19 infection, diabetes was present in 7.4% of cases overall, but recorded in a significantly greater proportion of those with severe compared to non-severe disease (16.2% vs 5.7%).


id: cord-028967-l5ioyhur
title: Diabetes Update 2020: das Wichtigste für die ärztliche Praxis
author: Scherbaum, Werner A.
date: 2020-07-10
txt: ./txt/cord-028967-l5ioyhur.txt
cache: ./cache/cord-028967-l5ioyhur.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349470/
doi: 10.1007/s11428-020-00642-7
summary:
  Die 2019 publizierten 2-Jahres-Ergebnisse der Studie ergaben nun, dass eine Remission des Diabetes immer noch bei mehr als 1/3 der Teilnehmer/Innen der Interventionsgruppe, aber nur bei 3 % der Kontrollgruppe vorlag. Das zeigte auch eine kürzlich publizierte dänische Studie, bei der Personen mit Typ-2-Diabetes über 6 Wochen hinweg entweder mit einer kohlenhydratarmen Diät mit 30 % Kohlenhydraten und einer entsprechenden Erhöhung des Fettgehalts auf 40 % oder einer isokalorischen Kost mit 50 % Kohlenhydraten und 33 % Fett ernährt worden waren und danach über 6 Wochen hinweg die andere Kost zuführten. Im Gegensatz zu den klassischen Ernährungsempfehlungen für Patienten/Innen mit Typ-2-Diabetes von 6 Mahlzeiten pro Tag ergab eine neue Studie, dass Menschen mit T2D von einer Beschränkung auf 3 Mahlzeiten pro Tag profitieren. Die Alltagstauglichkeit eines modernen Closed-Loop-Systems wurde in einer multizentrischen Studie aus den USA belegt, in der 168 Patienten/Innen mit T1D (Alter: 14-71 Jahre, HbA1c: 5,4-10,6 %) randomisiert entweder mit einem Closed-Loop-System oder mit einer sensorunterstützten Pumpentherapie über 6 Monate hinweg behandelt wurden.

abstract:
  At the virtual event Diabetes Update 2020, numerous new findings and recommendations on diagnosis, therapy and management of diabetes and related topics were presented, of which the topics type 2 diabetes, diabetes and heart, diabetes and pregnancy as well as vaccinations are described in detail in separate articles in the current issue of Der Diabetologe. In the following, the most important and, from the author’s point of view, most relevant news from the other diabetes-related subject areas are briefly presented.


id: cord-030631-cc79j9j4
title: Typ-1-Diabetes: Früherkennung und Ansätze zur Prävention: Update 2020
author: Marcus, Benjamin A.
date: 2020-08-19
txt: ./txt/cord-030631-cc79j9j4.txt
cache: ./cache/cord-030631-cc79j9j4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437100/
doi: 10.1007/s11428-020-00668-x
summary:
  Autoantikörpern markiert das Frühstadium des Typ-1-Diabetes Der Nachweis von 2 oder mehr dieser Autoantikörper beim asymptomatischen Kind ohne gestörten Glukosestoffwechsel ist inzwischen als eines der Frühstadien des Typ-1-Diabetes (Stadium 1) anerkannt. Um zu prüfen, ob Teplizumab die klinische Manifestation verhindern kann, wurden in einer TrialNet-Studie Angehörige von Personen mit Typ-1-Diabetes behandelt, die selbst bereits ein Frühstadium mit multiplen Inselautoantikörpern und eine Dysglykämie oder gestörte Glukosetoleranz (Stadium 2) entwickelt hatten. Somit konnte erstmals die Manifestation der Erkrankung wirksam hinausgezögert werden, was einen Durchbruch für die präventive Therapie des Typ-1-Diabetes darstellt. Bei 19 (43%) der 44 mit Teplizumab behandelten Teilnehmenden und 23 (72 %) von 32 in der Plazebogruppe wurde ein klinischer Typ-1-Diabetes diagnostiziert. Für eine individualisierte Sekundärprävention interessant wird die Tatsache, dass anhand von Biomarkern -HLA-Merkmalen (HLA: humanes Leukozytenantigen) und dem Fehlen von ZnT8A -abgeschätzt werden kann, bei welchen Patienten ein Ansprechen auf die Anti-CD3-Behandlung bessere Erfolgschancen hat [28] .

abstract:
  The incidence of type 1 diabetes is increasing, especially in young children. Early diagnosis is possible in the asymptomatic stage of islet autoimmunity. Screening is offered to high-risk families, but also feasible and useful in the general population, in studies such as Fr1da(plus) in Bavaria (Germany). Complications at clinical manifestation can be prevented by early diagnosis. Participation in experimental interventions to delay stage progression is possible. Numerous approaches to secondary prevention are being pursued. Treatment with the monoclonal antibody teplizumab successfully delayed progression to clinical diabetes in patients in stage 2. Infants at high risk for developing type 1 diabetes can be identified by genetic screening. Primary prevention pursues, among others, the goal of preventing the onset of the autoimmune reaction. The POInT trial aims to improve immune tolerance to insulin by oral exposure in high-risk children and to delay or prevent the onset of autoimmunity. Following up on the focus issue “Early detection and preventive treatment of type 1 diabetes” published in this journal in 2018, this article gives an update on selected developments over the past 2 years.


id: cord-214006-0w6bqrox
author: Aghdam, Atae Rezaei
date: 2020-10-26
txt: ./txt/cord-214006-0w6bqrox.txt
cache: ./cache/cord-214006-0w6bqrox.txt
extension: .txt
mime: text/plain
url: https://arxiv.org/pdf/2010.13276v1.pdf
doi: nan
summary:
  OHCs as affordable and easily accessible 24/7 services, can facilitate self-management of diabetics by offering health-related advice and stories, social and emotional support (Aghdam et al. OHCs provide opportunities for members to exchange new ideas, knowledge and information about diabetes selfmanagement, functioning as a bridge among people with type-2 diabetes and healthcare professionals and providing online discussion platforms to brainstorm potential solutions (Sim et al. Information sharing by peers, experience and advice sharing, life-style related advice sharing, and sharing daily-basis activities are the most common activities identified by researchers in this study through thematically analysing the content of threads in the Reddit diabetes online communities. Furthermore, participating in diabetes group-based education program provides opportunities for patients to meet and discuss with other members of the communities, obtaining social and emotional support (Steinsbekk et al. This study provides an opportunity for leveraging peer-to-peer support within digital health platforms such as OHCs to empower patients in their self-management of diabetes.

title:
  Towards Empowering Diabetic Patients: A perspective on self-management in the context of a group-based education program

abstract:
  This paper provides a novel framework for maximizing the effectiveness of the Diabetes Group Education Program, which could be generalized in any similar problem context.


id: cord-254494-wbfgrez1
author: Shi, Chunhong
date: 2020-10-14
url: https://doi.org/10.2147/dmso.s268481
doi: 10.2147/dmso.s268481
title:
  Barriers to Self-Management of Type 2 Diabetes During COVID-19 Medical Isolation: A Qualitative Study

abstract:
  PURPOSE: Diabetes self-management behaviors are necessary to obtain optimum glycemic control, reduce the risk of complications, and improve health outcomes. The COVID-19 pandemic imposes an additional struggle for self-management by diabetes patients. Although previous studies have reported socio-demographic, behavioral, psychological, and cultural barriers to diabetes self-management, little is known about perceived barriers to diabetes self-management among patients during isolation following their recovery from COVID-19. The purpose of this study was to explore perceived barriers among type 2 diabetes patients during isolation following their recovery from COVID-19. PATIENTS AND METHODS: A qualitative, exploratory, and descriptive research design was utilized. Semi-structured telephonic interviews were conducted with 12 patients with diabetes who had been discharged from one COVID-19 designated hospital and underwent isolation in the designated facilities in Wuhan City, Hubei Province, China. Data were analyzed using Colaizzi’s seven steps. RESULTS: Barriers to diabetes self-management identified by patients with diabetes during isolation were categorized into five major themes: inadequate knowledge and behavioral beliefs, shortage of resources, suffering from health problems, negative emotions, and lack of support. CONCLUSION: Perceived barriers to diabetes self-management described by diabetes patients indicated a lack of environmental resources and support strategies to meet their needs. Efforts to remove barriers are important in assisting patients with diabetes to improve their quality of life and health outcomes.


id: cord-255687-jud875xc
title: Diabetes care during COVID 19: Experience in telemedicine from a developing country
author: García-Villasante, Eilhart
date: 2020-08-04
txt: ./txt/cord-255687-jud875xc.txt
cache: ./cache/cord-255687-jud875xc.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1871402120302940
doi: 10.1016/j.dsx.2020.07.046
abstract: nan
summary:
  title: Diabetes care during COVID 19: Experience in telemedicine from a developing country Please cite this article as: García-Villasante E, Baca-Carrasco Ví, Gutierrez-Ortiz C, Pinedo-Torres I, Diabetes care during COVID 19: Experience in telemedicine from a developing country, Diabetes & Metabolic Syndrome: Clinical Research & Reviews (2020), doi: https://doi.org/10.1016/ j.dsx.2020.07.046. We have read with interest an article published in this journal (1) . The authors detail with accuracy the main telemedicine problems and most of them are being seen in our country. Our main concern is about diabetic patients because they are at major risk to get infected and develop severe forms of disease (3). Also, in the publication is not been considered the importance of the health institution creating systems for the safe delivery of medications avoiding COVID-19 infection. Risk factors for mortality in patients with coronavirus disease 2019 (covid-19) infection: a systematic review and meta-analysis of observational studies.


id: cord-260119-pgu2crhs
author: Golledge, Jonathan
date: 2020-08-13
url: https://www.ncbi.nlm.nih.gov/pubmed/32823514/
doi: 10.3390/s20164527
title:
  The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease

abstract:
  Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene, is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed.


id: cord-260713-wxfc1aaz
title: The COVID19 Pandemic – Perspectives from People Living with Diabetes
author: Kyle Jacques, Rose
date: 2020-07-22
txt: ./txt/cord-260713-wxfc1aaz.txt
cache: ./cache/cord-260713-wxfc1aaz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32711002/
doi: 10.1016/j.diabres.2020.108343
summary:
  During the unprecedented times of the COVID 19 pandemic, the lives of people with diabetes have been severely impacted. Since the COVID19 outbreak, certain psychosocial factors have been amplified due to the manner in which mainstream media and policy makers have carelessly emphasized the vulnerability of people with diabetes. The authors discuss the increased importance of support networks due to people living in isolation and quarantine. Add a global pandemic to the already monumental expectations placed on us to live healthily and maintain glucose levels in range, and it''s not surprising that many people with diabetes are finding these trying times especially difficult. Impact of the Pandemic COVID-19 has exacerbated many factors involved in diabetes care and increased stress. The COVID19 Pandemic -Perspectives from People Living with Diabetes 2 -Food -Scarcity of healthy foods, as well as having to change diets, makes consistent diabetes management challenging.

abstract:
  During the unprecedented times of the COVID 19 pandemic, the lives of people with diabetes have been severely impacted. This article discusses the extent of this impact presenting the obstacles and challenges from the perspective of the patient, including specifics of practical day-to-day diabetes self-management routines. Since the COVID19 outbreak, certain psychosocial factors have been amplified due to the manner in which mainstream media and policy makers have carelessly emphasized the vulnerability of people with diabetes. The authors discuss the increased importance of support networks due to people living in isolation and quarantine. A new layer of complexity has been added to the already difficult task of managing one's diabetes and it has increased anxiety and stress levels. Guidelines and tips for people living with diabetes are discussed based on the authors' personal experiences as well as those of the diabetes associations they work with.


id: cord-263908-4ti8l2ea
title: Diabetes and COVID-19: evidence, current status and unanswered research questions
author: Gupta, Ritesh
date: 2020-05-13
txt: ./txt/cord-263908-4ti8l2ea.txt
cache: ./cache/cord-263908-4ti8l2ea.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1038/s41430-020-0652-1
doi: 10.1038/s41430-020-0652-1
summary:
  Similarly, despite the recognition of angiotensin converting enzyme 2 (ACE2) as the receptor for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), and the role of ACE2 in lung injury; there are conflicting results with the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in these patients. There is a need to further study the natural course of COVID-19 in patients with diabetes and to understand the individual, regional and ethnic variations in disease prevalence and course. It is not known whether patients with diabetes with well-controlled blood glucose levels have an increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). While one study in China did not find any association of ACE inhibitor use with severity of disease, there was an increased mortality in patients with COVID-19 receiving ACE inhibitors and ARBs in another study [29, 30] .

abstract:
  Patients with diabetes who get coronavirus disease 2019 (COVID-19) are at risk of a severe disease course and mortality. Several factors especially the impaired immune response, heightened inflammatory response and hypercoagulable state contribute to the increased disease severity. However, there are many contentious issues about which the evidence is rather limited. There are some theoretical concerns about the effects of different anti-hyperglycaemic drugs. Similarly, despite the recognition of angiotensin converting enzyme 2 (ACE2) as the receptor for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), and the role of ACE2 in lung injury; there are conflicting results with the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in these patients. Management of patients with diabetes in times of restrictions on mobility poses some challenges and novel approaches like telemedicine can be useful. There is a need to further study the natural course of COVID-19 in patients with diabetes and to understand the individual, regional and ethnic variations in disease prevalence and course.


id: cord-264295-7ojvhwb0
author: Maddaloni, Ernesto
date: 2020-10-01
txt: ./txt/cord-264295-7ojvhwb0.txt
cache: ./cache/cord-264295-7ojvhwb0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s12933-020-01140-2
doi: 10.1186/s12933-020-01140-2
summary:
  Data collected included: demographic information (age and sex); presence of diabetes (defined as at least one random blood glucose value > 200 mg/dl, or fasting blood glucose > 126 mg/dl, or HbA 1c > 6.5%, or self-reported history of diabetes with ongoing anti-diabetes therapy), type of diabetes (type 1, type 2, other); smoking habits (never, ex, current); prior history of hypertension, dyslipidemia, chronic obstructive pulmonary disease (COPD), heart failure, cardiovascular events (myocardial infarction, percutaneous coronary intervention, coronary artery-bass graft or stroke), malignancy (any neoplasia diagnosed within the last five years or active neoplasia); presenting symptoms of SARS-CoV-2 infection (fever, cough, cold, conjunctivitis, chest pain, dyspnea, nausea, vomiting, diarrhea). Logistic regression models adjusted for age and sex were used to investigate associations of the primary and secondary outcomes with diabetes, and with other risk factors explored in the study, namely hypertension, dyslipidemia, COPD, heart failure, previous cardiovascular events, malignancy and smoking status (never vs.

title:
  Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II)

abstract:
  BACKGROUND: Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity. METHODS: We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders. RESULTS: Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15(th), 2020, was higher in those with diabetes (Adjusted Odds Ratio ((adj)OR) 2.04, 95%CI 1.12–3.73, p = 0.020), hypertension ((adj)OR 2.31, 95%CI: 1.37–3.92, p = 0.002) and COPD ((adj)OR 2.67, 95%CI 1.23–5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions ((adj)OR 3.19 95%CI 1.61–6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors ((adj)OR 1.66, 0.90–3.06, (adj)p = 0.10). CONCLUSIONS: Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.


id: cord-266702-6oxtlzqo
title: SARS-CoV-2 and Diabetes: New Challenges for the Disease
author: Cristelo, Cecília
date: 2020-05-22
txt: ./txt/cord-266702-6oxtlzqo.txt
cache: ./cache/cord-266702-6oxtlzqo.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.diabres.2020.108228
doi: 10.1016/j.diabres.2020.108228
summary:
  Emerging evidence demonstrates that the correct management of diabetes in those patients infected with SARS-CoV-2 is of utmost importance for the viral disease progression, therefore, the importance of blood glucose control will also be addressed. In vitro and in vivo studies showed that angiotensin-converting enzyme 2 (ACE2) is the cellular receptor for SARS-CoV virus [7, 8] . It has been confirmed in some clinical studies that the long-term use of ACEIs or ARBs by patients is not associated with an increased risk of SARS-CoV-2 infection, neither of developing severe COVID-19 or even with a higher risk of in-hospital death [40] [41] [42] . In the case of SARS-CoV-2 the same transient damage in the pancreas has already been documented [44] , and given its higher infectivity and affinity for the ACE2 receptor, there is increased concern relative to the complications caused by hyperglycemia, as well as the long-term effects of the infection on recovered patients.

abstract:
  A novel small enveloped RNA virus with the typical characteristic of the family to which it belongs, a crown, hence the name coronavirus, appeared in December 2019 in Wuhan, China, and subdued the world to its influence. The particular severity of the disease and higher mortality rates in patients with associated morbidities, including hypertension, obesity and diabetes, increases the concern over the consequences of this pandemic. In this review, the features of SARS-CoV-2 will be addressed, as well as the reasons why it poses a particular challenge to diabetic patients. We will also highlight the recent treatment strategies being explored to control this pandemic. Emerging evidence demonstrates that the correct management of diabetes in those patients infected with SARS-CoV-2 is of utmost importance for the viral disease progression, therefore, the importance of blood glucose control will also be addressed.


id: cord-269856-6h3j89wn
author: Paolo Fadini, Gian
date: 2020-08-15
txt: ./txt/cord-269856-6h3j89wn.txt
cache: ./cache/cord-269856-6h3j89wn.txt
extension: .txt
mime: text/plain
url: http://www.diabetesresearchclinicalpractice.com/article/S0168822720306276/pdf
doi: 10.1016/j.diabres.2020.108374
summary:
  Abstract Aims We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders. Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p<0.001). In the present study, we investigated the role of pre-existing diabetes, newly-diagnosed diabetes, and admission glucose levels on the outcome of patients hospitalized for COVID-19. In unadjusted analysis, presence of diabetes (including pre-existing and newly-diagnosed) compared to its absence was associated with a higher incidence of the primary outcome (37.4% vs 20.3%; RR 1.85; 95% C.I. 1.33-2.57; p<0.001; Figure 1A ). In this study, we found that newly-detected diabetes and admission hyperglycemia were more strongly associated with COVID-19 severity outcome than pre-existing diabetes. The association between hyperglycemia and COVID-19 severity was significantly stronger for patients with newly-diagnosed diabetes than for those with pre-existing diabetes.

title:
  Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration

abstract:
  Abstract Aims We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders. Methods We retrospectively analyzed data on patients with COVID-19 hospitalized between February and April 2020 in an outbreak hospital in North-East Italy. Pre-existing diabetes was defined by self-reported history, electronic medical records, or ongoing medications. Newly-diagnosed diabetes was defined by HbA1c and fasting glucose. The primary outcome was a composite of ICU admission or death. Results 413 subjects were included, 107 of whom (25.6%) had diabetes, including 21 newly-diagnosed. Patients with diabetes were older and had greater comorbidity burden. The primary outcome occurred in 37.4% of patients with diabetes compared to 20.3% in those without (RR 1.85; 95%C.I. 1.33-2.57; p<0.001). The association was stronger for newly-diagnosed compared to pre-existing diabetes (RR 3.06 vs 1.55; p=0.004). Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p<0.001). Admission glucose was correlated with most clinical severity indexes and its association with adverse outcome was mostly mediated by a worse respiratory function. Conclusion Newly-diagnosed diabetes and admission hyperglycemia are powerful predictors of COVID-19 severity due to rapid respiratory deterioration.


id: cord-274548-yeucn13x
author: Altobelli, Emma
date: 2020-09-13
txt: ./txt/cord-274548-yeucn13x.txt
cache: ./cache/cord-274548-yeucn13x.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/nu12092806
doi: 10.3390/nu12092806
summary:
  Full-text articles excluded, with reasons n = 48 type 1 diabetes registries n=14 paper without Studies included in qualitative synthesis (n = 18) (n = 9 EU-28 countries n = 9 outside EU-28 countries) The data covered the type of health system, presence or absence of a national diabetes plan (NDP), presence of a population-based register, care setting, methods for reimbursement of drugs, devices and coverage of any comorbidities associated with diabetes, and the prevalence of and mortality from diabetes, gathered from the institutional sites of individual European countries to investigate the presence of national data and policies for diabetes control. A multiple correspondence analysis (MCA) was carried out in order to to evaluate the possible association between the variables taken into consideration, including EUROSTAT data for the countries of the European Union, data relating to mortality per 100,000 inhabitants and the mortality trend [32] , the prevalence of diabetes [32] , the organization of the health system [35, 36, 38] , the presence of a national diabetes plan, the year of approval [35, 36] , the general practitioners and diabetic centers involved, and the cost percentage of diabetes of the total health expenditure [38] .

title:
  Lifestyle Risk Factors for Type 2 Diabetes Mellitus and National Diabetes Care Systems in European Countries

abstract:
  Background. Diabetes is increasing by 3.09% per year in males and 1.92% in females. Lifestyle risk factors are related to diabetes. The aim of this work is to highlight within EU-28 countries the distribution percentages of some lifestyle risk factors and some components of diabetes health care. Methods. A literature search was conducted to highlight the presence of diabetes registries, which are fundamental tools for disease surveillance and health planning; the presence of a national diabetes plan (NDP); the care setting; and methods used for reimbursement of drugs, devices, and coverage of any comorbidities associated with diabetes. A multiple correspondence analysis (MCA) was carried out to evaluate the possible associations between the variables considered. Results. The highest percentages of diabetes (>10%) are registered in Bulgaria, Malta, and Hungary. Concerning the prevalence of overweight, no European country shows overall percentages of less than 50%. Regarding obesity, 57% of countries show prevalence rates of 25%. The record for physical inactivity belongs to Malta, with 45% of individuals being inactive. The percentage of physical inactivity for females is higher than for males across Europe. In total, 57% of the countries have an insurance-based health system, while 12 countries have public national health systems. Further, 57% of countries have an NDP, while 42% of the EU countries have established a prevalence register for diabetes. Conclusions. Prevalence rates for type 2 DM in the range of 8–9% are noted in 50% of EU-28 countries. In total, 21 out of EU countries show a high prevalence rate for overweight, while 7% of EU-28 countries have an obesity prevalence rate of 25%. Diabetes treatment is entrusted to general practitioners in most countries. The results of this work highlight the differences between countries, but also between genders.


id: cord-276256-gmlsoo2z
author: Avilés-Santa, M. Larissa
date: 2020-10-10
txt: ./txt/cord-276256-gmlsoo2z.txt
cache: ./cache/cord-276256-gmlsoo2z.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33037442/
doi: 10.1007/s11892-020-01341-9
summary:
  All these factorscoupled with biological susceptibility, income, education, access health care, cultural influences on nutrition, health, selfimage, and self-care-influence the development of diabetes in LatAm. We conducted a review of the most current publications on the state of prevalence, awareness, treatment, and control of diabetes mellitus across LatAm. By laying out a detailed accounting of what is known, we aim to identify population, clinical, and health care needs, and opportunities for future research studies and potential interventions. The number of epidemiological studies published since 2005 indicates greater public health awareness about diabetes mellitus across LatAm. Multiple countries have performed at least one national survey on chronic non-communicable diseases in which self-reported diabetes mellitus and/or elevated glycemia has been included (Table 1) .

title:
  Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

abstract:
  PURPOSE OF REVIEW: Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS: The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. SUMMARY: The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.


id: cord-284245-y8q0cjbk
title: Mental Health in Diabetes: Never a Better Time
author: Vallis, Michael
date: 2020-08-10
txt: ./txt/cord-284245-y8q0cjbk.txt
cache: ./cache/cord-284245-y8q0cjbk.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1499267120301775
doi: 10.1016/j.jcjd.2020.06.004
abstract: nan
summary:
  Morrissey et al (5) present a paper on the role of diabetes distress in adolescents and young adults living with type 1 diabetes. Additionally, there are contributions examining the potential for negative mental health impacts in the form of bereavement and grief reactions in those with type 1 diabetes (Fraser [7] ) and an important perspective paper on self-injury and suicide in those with diabetes (Barnard-Kelly et al [8] ). Cimo et al (10) present the outcomes of a diabetes education intervention in those living with diabetes and mental health disorders. Alessi et al (13) examine alcohol use and clinical outcomes in youth and adults with type 1 diabetes, and Mehta and Hirji (14) review the outcome of structured education for patients living with type 2 diabetes and substance abuse. Diabetes distress in adults living with type 1 and type 2 diabetes: A public health issue


id: cord-287362-dhl7ynrc
title: Infections and diabetes: Risks and mitigation with reference to India
author: Unnikrishnan, Ranjit
date: 2020-09-22
txt: ./txt/cord-287362-dhl7ynrc.txt
cache: ./cache/cord-287362-dhl7ynrc.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S187140212030374X
doi: 10.1016/j.dsx.2020.09.022
summary:
  While mortality due to COVID-19 has been lower in south Asian countries such as India, the sheer number of individuals with diabetes in this region represents a huge population at high risk of adverse outcomes due to this infection (22, 23) . The increased susceptibility of the individual with diabetes to infection has recently returned to sharp focus with the advent of the COVID-19 pandemic, reiterating the need for achieving tight control of hyperglycemia and managing comorbidities appropriately J o u r n a l P r e -p r o o f in this population from the time of diagnosis of diabetes. Impact of glycemic control on risk of infections in patients with type 2 diabetes: a population-based cohort study

abstract:
  BACKGROUND AND AIMS: The link between diabetes and increased risk of infectious disease has long been recognized, but has re-entered sharp focus following the COVID-19 pandemic. METHODS: A literature search was conducted in PubMed for articles in English on diabetes and infection. RESULTS: Diabetes predisposes to infections through alterations in innate and acquired immune defenses. Outcomes of infection are worse in people with uncontrolled diabetes, and infection can worsen hyperglycemia in hitherto well controlled diabetes (bidirectional relationship). Diabetes does not increase the risk of infection with COVID-19 per se, but predisposes to severe disease and poor outcomes. COVID-19 has also been linked to deterioration of glycemic control as well as new-onset diabetes. CONCLUSIONS: Clinicians caring for people with diabetes should be aware of the increased risk of infections in this population, as well as the possibility of worsening hyperglycemia. A holistic approach with frequent monitoring of blood glucose levels and appropriate titration of medications, along with close attention to nutritional status, is essential to ensure the best possible outcomes.


id: cord-292344-3bj567gr
title: The burden of type 2 diabetes: are we doing enough?
author: Zimmet, P.
date: 2003-09-30
url: https://www.sciencedirect.com/science/article/pii/S1262363603727839
doi: 10.1016/s1262-3636(03)72783-9
abstract:
  Summary Increasing levels of obesity, arising from energy-rich diets and sedentary lifestyles, are driving a global pandemic of type 2 diabetes. The prevalence of type 2 diabetes worldwide is set to increase from its present level of 150 million, to 225 million by the end of the decade and to as many as 300 million by 2025. Shocking as they are, these figures represent only clinically diagnosed diabetes, and many more cases of diabetes remain undiagnosed and untreated. In addition, up to one-quarter of western populations have impaired glucose tolerance or the dysmetabolic syndrome, which are considered to represent pre-diabetic states. Type 2 diabetes is appearing increasingly in children and adolescents, and the frequency of diagnosis of paediatric type 2 diabetes is outstripping that of type 1 diabetes in some areas. The long-term complications associated with type 2 diabetes carries a crushing burden of morbidity and mortality, and most type 2 diabetic patients die prematurely from a cardiovascular event. Diabetic patients are more than twice as costly to manage as non-diabetic patients, due mainly to the high costs associated with management of diabetic complications. Indeed, diabetes care already accounts for about 2-7% of the total national health care budgets of western European countries. Controlling the type 2 diabetes epidemic will require changes to the structure of healthcare delivery. Well-resourced interventions will be required, with effective co-ordination between all levels of government, health care agencies, multidisciplinary health care teams, professional organisations, and patient advocacy groups. Above all, intervention is needed today.


id: cord-294966-3jolt83r
author: Joensen, L. E.
date: 2020-05-29
txt: ./txt/cord-294966-3jolt83r.txt
cache: ./cache/cord-294966-3jolt83r.txt
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url: https://doi.org/10.1111/dme.14319
doi: 10.1111/dme.14319
summary:
  The COVID-19 outbreak and associated mass media coverage about the course of the pandemic worldwide and the frightening mortality levels in some countries are expected to increase the prevalence and change the character of psychological problems, including anxiety, depression and stress among citizens in affected countries [4] [5] [6] . Alongside with items on COVID-19-specific worries, the questionnaire included items on sociodemographic and health status, social relations, diabetes-specific social support, diabetes distress as well as changes in diabetes-specific behaviours. • This study showed a high prevalence of diabetesspecific worries related to COVID-19, especially fear of being overly affected by the virus, labelling of people with diabetes as a high-risk group, and inability to manage diabetes if infected. This study of 1396 people with diabetes showed that worries related to the COVID-19 pandemic were highly prevalent.

title:
  Diabetes and COVID‐19: psychosocial consequences of the COVID‐19 pandemic in people with diabetes in Denmark—what characterizes people with high levels of COVID‐19‐related worries?

abstract:
  AIM: To map COVID‐19‐specific worries and overall psychosocial health among people with diabetes in the initial phase of the COVID‐19 pandemic in Denmark, and to explore characteristics of people with diabetes and high levels of worries related to the COVID‐19 pandemic. METHODS: A cross‐sectional survey was conducted by distributing online questionnaires to 2430 adult members (> 18 years) of two user panels consisting of people with diabetes who have volunteered to share information about their life with diabetes. The questionnaire included items on COVID‐19‐specific worries as well as such worries related to diabetes, sociodemographic and health status, social relations, diabetes‐specific social support, diabetes distress and changes in diabetes‐specific behaviours. Responses were analysed with descriptive statistics and logistic regressions. RESULTS: People with diabetes have COVID‐19‐specific worries related to their diabetes. More than half were worried about being overly affected due to diabetes if infected with COVID‐19, about one‐third about being characterized as a risk group due to diabetes and not being able to manage diabetes if infected. Logistic regressions showed that being female, having type 1 diabetes, diabetes complications and diabetes distress, feeling isolated and lonely, and having changed diabetes behaviours were associated with being more worried about COVID‐19 and diabetes. CONCLUSION: People with diabetes have COVID‐19‐specific worries related to their diabetes which is associated with poorer psychosocial health. These worries should be addressed through support targeting specific questions and needs of individuals with diabetes as well as frequent updates on new knowledge regarding COVID‐19 and diabetes.


id: cord-299637-6qarauys
author: Assaloni, Roberta
date: 2020-07-03
txt: ./txt/cord-299637-6qarauys.txt
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url: https://www.sciencedirect.com/science/article/pii/S0168822720305490?v=s5
doi: 10.1016/j.diabres.2020.108297
summary:
  title: Coronavirus disease (Covid-19): how does the exercise practice in active people with Type 1 Diabetes change? This measure could lead people with type 1 diabetes (PWT1D) to disrupt daily care routine including PA practice with difficulties in glycemia management. In particular, people with type 1 (PWT1D) and poor glucose control, in particular high glycated hemoglobin (HbA1c) or/and insulin resistance, showed higher risk to counteract infections due to the impaired body immune response, this also holds true with Covid-19 [6, 7] . The aim of this study is to explore the PA level in Italian people with type 1 diabetes before and after the national quarantine introduced to contrast Covid-19 disease and describe variation in glycemia values. In our study, PWT1D reported a significant decrease both perceived and measured PA level and an increase of glycemia values during the national quarantine. Physical activity level and exercise in patients with diabetes mellitus.

title:
  Coronavirus disease (Covid-19): how does the exercise practice in active people with Type 1 Diabetes change? A preliminary survey

abstract:
  Abstract Aims Coronavirus disease (Covid-19) could lead persons with pre-existing medical conditions to severe respiratory infections. The Italian Government introduced quarantine to limit viral transmission. This measure could lead people with type 1 diabetes (PWT1D) to disrupt daily care routine including PA practice with difficulties in glycemia management. This study aims to explore PA level in PWT1D before and during quarantine and to describe variation in glycemia values. Methods An online survey investigating medical factors and the perceived and PA level in pre-established period before and after the introduction of quarantine was developed. Comparison between pre and post quarantine was assessed by Wilcoxon Signed Ranks test for continuous variables. Results A total of 154 subjects satisfied the eligibility criteria (54.5% males, 44.8±12.5 years). We found a decrease of PA level (Godin Scale Score 25±1.7vs38.6±1.7 points), steps number and minutes of exercise (respectively 12.606±5026vs4.760±3.145 and 66±4vs38±3) and an increase of glycemia values (142.1± 25.4 mg/dLvs150.8±29.4 mg/dL) Conclusions PWT1D reported a decrease in exercise and worst glycemia. Although PWT1D tried to remain active, their PA level was inadequate to prevent glycemia rising. The difficult to maintain a glycemic control could expose patients to diabetes complications and to an higher risk to counteract infections.


id: cord-304240-rqlfnywm
title: Does glycemic control affect outcome of COVID‐19?
author: Bloomgarden, Zachary
date: 2020-10-03
txt: ./txt/cord-304240-rqlfnywm.txt
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url: https://doi.org/10.1111/1753-0407.13116
doi: 10.1111/1753-0407.13116
abstract: nan
summary:
  In a whole-population study of a UK data set of >60 million persons, approximately 5% had diabetes, but of 23 698 in-hospital COVID-19-related deaths in this population, 33.2% were of people with diabetes, with mortality rates among persons those with type 1 and type 2 diabetes approximately 5-fold and 10-fold greater than that in the nondiabetic population; with adjustment for age and other risk factors, type 1 and type 2 diabetes were associated with near tripling and doubling of mortality rates, respectively. It is then logical to ask whether the adverse outcome of COVID-19 among persons with diabetes is related to the degree of hyperglycemia and, if so, whether this represents a causal relationship or rather shows that the severity of illness in a given individual with diabetes leads to both higher blood glucose concentration and greater likelihood of mortality. 3 Specific hospitalized patient data sets, however, do not show that prior glycemic control, as reflected in HbA1c, are associated with different likelihood of adverse outcome among persons with diabetes.


id: cord-305405-me4gebvm
author: Conway, J.
date: 2020-09-21
txt: ./txt/cord-305405-me4gebvm.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32971153/
doi: 10.1016/j.diabres.2020.108460
summary:
  Other features of patients with diabetes and COVID-19 infection included long duration of diabetes, less tight glycaemic control and common use of ACE inhibitors, ARBs and NSAIDs. In December 2019, a pneumonia like illness was first reported in Wuhan-China caused by a new coronavirus named corona virus disease-2019 (COVID-19) which then spread to cause a global pandemic. A meta-analysis of 8 Chinese studies to assess the prevalence of comorbidities in 46,248 infected patients with COVID-19, median age 46.0 years (51.6%) men, diabetes mellitus was the second most prevalent comorbidity (8%) after hypertension (17%) and higher than cardiovascular (5%) and respiratory diseases (2%). 4 In addition to the Chinese studies, subsequent international studies have demonstrated that diabetes was a frequent comorbidity and a risk factor for adverse outcomes of COVID-19 infection such as higher rates of ICU admissions and refractoriness to anti-viral and anti-inflammatory therapies.

title:
  Characteristics of patients with diabetes hospitalised for COVID-19 infection-a brief case series report

abstract:
  Objectives Diabetes has been shown to be a risk factor for corona virus disease-2019 (COVID-19) infection. The characteristics of patients with diabetes vulnerable to this infection are less specified. We aim to present the characteristics of patients with diabetes admitted to hospital with COVID-19. Design: A retrospective case series. Setting: A single clinical centre in the UK. Methods We have retrospectively collected the demographics, medical characteristics and outcome of all patients with diabetes admitted to hospital over two-week period with COVID-19 infection. All cases were diagnosed by a reverse transcription polymerase chain reaction (RT-PCR) of pharyngeal and nasal swabs. Results A total of 71 COVID-19 patients were admitted during the study period of whom 16 (22.5%) patients had diabetes and were included in this case series. There was no significant difference between patients with compared to those without diabetes regarding age, gender or clinical presentation. However, comorbidities were more common in patients with diabetes specially hypertension {75% v 36.4%, a difference of 38.6%, 95% confidence interval (CI) 6.5 to 58.3} and chronic kidney disease (37.5 v 5.5, a difference of 32% (1.6 to 51.6). Patients with diabetes were significantly more obese than those without diabetes (56.2% v 21.8% a difference of 34.4%, 95% CI 7.7 to 61.1). About one third (31.3%) of patients with diabetes were frail. Mean {standard deviation (SD)} duration of diabetes was 10 (2.8) years and mean (SD) HbA1c was 60.3 (15.6) mmol/mol. The use of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and non-steroidal anti-inflammatory drugs (NSAIDs) was common (37.5%, 25% and 18.8% respectively). There was no significant difference in the outcomes between patients with compared to those without diabetes. Conclusion Patients with diabetes hospitalised for COVID-19 were significantly more obese and had high prevalence of comorbidities than those without diabetes. Other features of patients with diabetes and COVID-19 infection included long duration of diabetes, less tight glycaemic control and common use of ACE inhibitors, ARBs and NSAIDs.


id: cord-306670-c2jm0g88
author: Zhang, Yan
date: 2020-05-22
txt: ./txt/cord-306670-c2jm0g88.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32446795/
doi: 10.1016/j.diabres.2020.108227
summary:
  COVID-19 patients with diabetes were more likely to develop severe or critical disease conditions with more complications, and had higher incidence rates of antibiotic therapy, non-invasive and invasive mechanical ventilation, and death (11.1% vs. In the current study, we retrospectively reviewed the clinical data of 258 patients with laboratory-confirmed COVID-19, and compared the differences in clinical characteristics, laboratory markers, treatment strategies, and short-term prognosis including death between patients with and without diabetes. We found that COVID-19 patients with diabetes were more likely to develop severely or critically ill subtypes, including more complications with ARDS, acute cardiac injury, resulting in receiving more antibiotic therapy and mechanical ventilation. Additionally, we found that COVID-19 patients with diabetes also had preexisting cardiovascular disease, and were more susceptible to having acute cardiac injury during hospitalization, which might increase the possibility of short-term poor prognosis in patients with diabetes after SARS-CoV-2 infection.

title:
  Association of Diabetes Mellitus with Disease Severity and Prognosis in COVID-19: A Retrospective Cohort Study

abstract:
  Abstract The 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China, and was characterized as a pandemic by the World Health Organization. Diabetes is an established risk associated with poor clinical outcomes, but the association of diabetes with COVID-19 has not been reported yet. Methods In this cohort study, we retrospectively reviewed 258 consecutive hospitalized COVID-19 patients with or without diabetes at the West Court of Union Hospital in Wuhan, China, recruited from January 29 to February 12, 2020. The clinical features, treatment strategies and prognosis data were collected and analyzed. Prognosis was followed up until March 12, 2020. Results Of the 258 hospitalized patients (63 with diabetes) with COVID-19, the median age was 64 years (range 23-91), and 138 (53.5%) were male. Common symptoms included fever (82.2%), dry cough (67.1%), polypnea (48.1%), and fatigue (38%). Patients with diabetes had significantly higher leucocyte and neutrophil counts, and higher levels of fasting blood glucose, serum creatinine, urea nitrogen and creatine kinase isoenzyme MB at admission compared with those without diabetes. COVID-19 patients with diabetes were more likely to develop severe or critical disease conditions with more complications, and had higher incidence rates of antibiotic therapy, non-invasive and invasive mechanical ventilation, and death (11.1% vs. 4.1%). Cox proportional hazard model showed that diabetes (adjusted hazard ratio [aHR]=3.64; 95% confidence interval [CI]: 1.09, 12.21) and fasting blood glucose (aHR=1.19; 95% CI: 1.08, 1.31) were associated with the fatality due to COVID-19, adjusting for potential confounders. Conclusions Diabetes mellitus is associated with increased disease severity and a higher risk of mortality in patients with COVID-19.


id: cord-309474-9h9w46eq
author: Schiaffini, Riccardo
date: 2020-07-03
txt: ./txt/cord-309474-9h9w46eq.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32623034/
doi: 10.1016/j.diabres.2020.108302
summary:
  We compared insulin and CGM data (TIR, TBR and TAR) of two periods: PRE-COV and IN-COV, in which children have transitioned from normal school attendance to the exclusive care of their parents. This is a real-life, retrospective, observational study aimed at evaluating how constant parental care compared to spending time outside home affected glycemic control in pre-school and school children with T1D utilizing Tandem Basal IQ system before and during the quarantine period due to pandemic COVID-19 infection. Our observational real-life study confirms the positive effect of parental care in T1D very young children and that, though new technologies can potentially improve diabetes outcomes also in this sub-population, maintenance of a good glucose control remains largely dependent on family competence and education 10.

title:
  School and pre-school children with type 1 diabetes during covid-19 quarantine: the synergic effect of parental care and technology

abstract:
  Abstract Introduction Management of Type 1 Diabetes (T1D) poses numerous challenges, especially for young children and their families. Parental care positively influencesthe outcomesofchildren with T1D, while there are often criticisms in school environment. The COVID-19 pandemic has forced children and parents to spend many hours at home and diabetes care has returned mainly in the hands of parents. Aim of the study To evaluate the effectiveness of exclusive return to parental care in pre-school and school children with T1D treated with Tandem Basal IQ system during the COVID-19 pandemic. Patients and methods 22 children (M:F = 14:8) with T1D have been evaluated. We compared insulin and CGM data (TIR, TBR and TAR) of two periods: PRE-COV and IN-COV, in which children have transitioned from normal school attendance to the exclusive care of their parents. Results During the IN-COV period a significantly (p < 0.001) higher median value of TIR (66,41%) was observed as compared to PRE-COV period (61,45%). Patients also showed a statistically significant difference (p < 0.002) between the IN-COV period and the PRE-COV period as concerning the TAR metric: respectively 29,86 ± 10,6 % vs 34,73 ± 12,8 %. The difference between the bolus insulin doses was statistically significant (PRE-COV 5,3 IU/day, IN-COV 7,9 IU/day – p<0.05). Conclusion Our observational real-life study confirms the positive effect of parental care in T1D very young children and demonstrates that during the COVID-19 pandemic it was possible to obtain a good glycometabolic compensation despite the significant change in lifestyle.


id: cord-309795-2kozsv4z
title: Metabolic liver disease in diabetes – from mechanisms to clinical trials
author: Dewidar, Bedair
date: 2020-06-20
txt: ./txt/cord-309795-2kozsv4z.txt
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url: https://www.sciencedirect.com/science/article/pii/S0026049520301633?v=s5
doi: 10.1016/j.metabol.2020.154299
summary:
  NAFLD, which affects about 25% of the population [3] , comprises a broad range of abnormalities ranging from simple fatty liver (steatosis) to non-alcoholic steatohepatitis (NASH), characterized by inflammation, necrosis, and hepatocellular ballooning, and progression to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) [2] . In general, both hyperglycemia and toxic lipids such as ceramides, DAG, FFA, and cholesterol can induce deleterious effects on liver cells (glucolipotoxicity), which might initiate NAFLD progression from simple steatosis to NASH and fibrosis via various mechanisms, including cell death, oxidative stress, endoplasmic reticulum (ER) stress and mitochondrial disorders [46] . BL, baseline; CCR2/5, C-C chemokine receptors type 2 and type 5; FXR, farnesoid X receptor; HbA 1c , glycated haemoglobin; LXR, Liver X receptor; MPC, mitochondrial pyruvate carrier; NA, data not available; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score; PPAR, peroxisome proliferator-activated receptor; NASH, non-alcoholic steatohepatitis; SCD, stearoyl-CoA desaturase; SGLT, sodium-glucose cotransporter; THR, thyroid hormone receptor; T2DM, type 2 diabetes. Potential Nexus of Non-alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: Insulin Resistance Between Hepatic and Peripheral Tissues

abstract:
  Abstract Non-alcoholic fatty liver disease (NAFLD) comprises fatty liver (steatosis), non-alcoholic steatohepatitis (NASH) and fibrosis/cirrhosis and may lead to end-stage liver failure or hepatocellular carcinoma. NAFLD is tightly associated with the most frequent metabolic disorders, such as obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). Both multisystem diseases share several common mechanisms. Alterations of tissue communications include excessive lipid and later cytokine release by dysfunctional adipose tissue, intestinal dysbiosis and ectopic fat deposition in skeletal muscle. On the hepatocellular level, this leads to insulin resistance due to abnormal lipid handling and mitochondrial function. Over time, cellular oxidative stress and activation of inflammatory pathways, again supported by multiorgan crosstalk, determine NAFLD progression. Recent studies show that particularly the severe insulin resistant diabetes (SIRD) subgroup (cluster) associates with NAFLD and its accelerated progression and increases the risk of diabetes-related cardiovascular and kidney diseases, underpinning the critical role of insulin resistance. Consequently, lifestyle modification and certain drug classes used to treat T2DM have demonstrated effectiveness for treating NAFLD, but also some novel therapeutic concepts may be beneficial for both NAFLD and T2DM. This review addresses the bidirectional relationship between mechanisms underlying T2DM and NAFLD, the relevance of novel biomarkers for improving the diagnostic modalities and the identification of subgroups at specific risk of disease progression. Also, the role of metabolism-related drugs in NAFLD is discussed in light of the recent clinical trials. Finally, this review highlights some challenges to be addressed by future studies on NAFLD in the context of T2DM.


id: cord-309799-fhkbcp7z
title: Diabetes and COVID-19: IDF perspective in the Western Pacific Region
author: Hwang, Yerin
date: 2020-06-25
txt: ./txt/cord-309799-fhkbcp7z.txt
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url: https://www.sciencedirect.com/science/article/pii/S0168822720305301?v=s5
doi: 10.1016/j.diabres.2020.108278
summary:
  -Setting up separate inpatient COVID-19 screening "hot" wards that were separate from "cold" wards -Setting up special "fever" clinics, initially attached to a hospital but separate from other services, particularly emergency departments -Novel screening pathways with initially more than less restrictive criteria for screening: an on-line self-registration and self-screening tool, drive-through screening and rapid throughput screening, to allow hospital workers with mild symptoms to be screened and get back to work in 24 hours -Securing adequate personal protective equipment (PPE), including from pre-existing national medical resources stockpiles and providing training on specialized techniques for urgent/safe gowning up -Suspension of non-urgent surgery and procedures in both public and private hospitals with graded reintroduction -Arrangements between State governments and private hospitals for the latter to take COVID and non-COVID patients, if and when required -Upskilling and education of appropriate staff in best practice in procedures such as intubation to minimize risk to health professionals -Call-up of, and short-term registration of, recently retired healthcare professionals and senior medical students -Limitation or suspension of face-face non-urgent medical ambulatory or outpatient services (including outpatient adult and pediatric endocrinology/diabetes services), with a provision of telehealth services that would prevent emergency department presentations/admissions.

abstract:
  Abstract The World Health Organization (WHO) declared a pandemic, the highest risk level in the infectious disease alert phase, on 11 March 2020. In the Western Pacific Region (WPR), 192,016 confirmed cases with 7,125 deaths had been reported as of 8 June 2020. In people with diabetes COVID-19 can be more difficult to treat due to the wide fluctuations in blood glucose levels or presence of comorbidities such as diabetes complications, including cardiovascular disease and renal damage, which are recognized risks for adverse outcomes. National diabetes associations and governments have established guidelines for subjects with diabetes in relation to COVID-19, and are trying to supply emergency and their regularly required medical products for them. The WPR is so large and composed of such diverse countries and COVID-19 situations, no one conclusion or program applies. Instead we could see a diverse COVID-19 pandemic profile in the WPR, and several creative diagnostic and therapeutic measures undertaken. This includes drive-through screening facilities, high-speed RT-PCR technologies, convalescent patients’ plasma therapy, which potentially had some positive contributions in combatting COVID-19 in the WPR as well as globally. Although the numbers of confirmed cases are currently decreasing in the region, the COVID-19 pandemic is not over, and many experts are recommending to prepare measures for potential second or third waves of COVID-19.


id: cord-310159-l9hfmmbc
title: COVID-19 and type 1 diabetes: dealing with the difficult duo
author: Chowdhury, Subhankar
date: 2020-07-14
txt: ./txt/cord-310159-l9hfmmbc.txt
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mime: text/plain
url: https://doi.org/10.1007/s13410-020-00846-z
doi: 10.1007/s13410-020-00846-z
summary:
  Since there are a significant number of patients with type 1 diabetes (T1D) with unique concerns and challenges during the ongoing COVID-19 pandemic, we reviewed existing literature, relevant websites, and related guidelines to form this narrative review to help address key questions in this area. While T2D and its associated comorbidities have established themselves as risk factors for increased hospitalisation, requirement of intensive care, and mortality with COVID-19, early anecdotal reports from global infection hotspots suggested that children with diabetes had a similar disease pattern compared with children without diabetes (less severe manifestations than adults) [23, 24] . On the contrary, a large population cohort study assessing the risk of in-hospital death for individuals registered with a General Practice in England showed that people with T1D had 3•50 (3•15-3•89) odds of dying in hospital with COVID-19 compared with those without diabetes which was attenuated to 2•86 when also adjusted for previous hospital admissions with coronary heart disease, cerebrovascular disease, or heart failure [14] .

abstract:
  BACKGROUND: Coronavirus disease 2019 (COVID-19) has aroused global health concerns, particularly in relation to diabetes where it has been associated with poorer outcomes. The bulk of the evolving evidence in diabetes and COVID-19 relates to type 2 diabetes (T2D). Since there are a significant number of patients with type 1 diabetes (T1D) with unique concerns and challenges during the ongoing COVID-19 pandemic, we reviewed existing literature, relevant websites, and related guidelines to form this narrative review to help address key questions in this area. METHODS: We systematically searched the PubMed database up to May 31, 2020, and retrieved all the articles published on T1D and COVID-19. RESULTS: We found 18 relevant articles, each of which carried a part of the evidence regarding the risk of contracting COVID-19 in patients with T1D, effect of COVID-19 on development of T1D, outcomes in T1D with COVID-19, and special management issues in T1D in the light of COVID-19. These have been documented in the present review. CONCLUSION: COVID-19 with T1D presents special challenges. While the available evidence does shed some light, we need more evidence to deal with this difficult duo.


id: cord-310650-8lhkiw9p
title: The Challenges of COVID-19 for People Living With Diabetes: Considerations for Digital Health
author: Gamble, Anissa
date: 2020-05-15
txt: ./txt/cord-310650-8lhkiw9p.txt
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mime: text/plain
url: https://doi.org/10.2196/19581
doi: 10.2196/19581
summary:
  The coronavirus disease (COVID-19) is a global pandemic that significantly impacts people living with diabetes. Diabetes-related factors of glycemic control, medication pharmacodynamics, and insulin access can impact the severity of a COVID-19 infection. For those living with diabetes, digital health presents the opportunity to access care with greater convenience while not having to expose themselves to infection in an in-person clinic. The coronavirus disease (COVID-19) is a global pandemic and significantly impacts individuals living with diabetes. If the use of virtual visits continues after the pandemic eases-as they are expected to [38] -it opens up a great opportunity to provide more timely access to not only physician care but services that are often scarce for those living with diabetes [39] . Figure 1 presents a summary of the challenges of COVID-19 for people living with diabetes and the opportunities of diabetes digital health to support them in this time of need.

abstract:
  The coronavirus disease (COVID-19) is a global pandemic that significantly impacts people living with diabetes. Diabetes-related factors of glycemic control, medication pharmacodynamics, and insulin access can impact the severity of a COVID-19 infection. In this commentary, we explore how digital health can support the diabetes community through the pandemic. For those living with diabetes, digital health presents the opportunity to access care with greater convenience while not having to expose themselves to infection in an in-person clinic. Digital diabetes apps can increase agency in self-care and produce clinically significant improvement in glycemic control through facilitating the capture of diabetes device data. However, the ability to share these data back to the clinic to inform virtual care and enhance diabetes coaching and guidance remains a challenge. In the end, it requires an unnecessarily high level of technical sophistication on the clinic’s part and on those living with diabetes to routinely use their diabetes device data in clinic visits, virtual or otherwise. As the world comes together to fight the COVID-19 pandemic, close collaboration among the global diabetes community is critical to understand and manage the sustained impact of the pandemic on people living with diabetes.


id: cord-312875-gn6hg6oc
author: Infante, Marco
date: 2020-05-13
txt: ./txt/cord-312875-gn6hg6oc.txt
cache: ./cache/cord-312875-gn6hg6oc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32401405/
doi: 10.1111/1753-0407.13053
summary:
  (3) Although the exact mechanisms of action underlying the glucose-lowering properties of HCQ are still not entirely clear and may differ between patients with and without diabetes, pre-clinical and clinical data suggest that HCQ could exert multifaceted effects on glucose homeostasis, namely: improvement of insulin sensitivity, increase of insulin secretion, reduction of hepatic insulin clearance and intracellular insulin and insulin-receptor complex degradation, increase of adiponectin levels, reduction of systemic inflammation, and/or reduction of inflammation-induced insulin resistance in adipocytes and skeletal muscle cells. (13) More recently, a 24-week prospective randomized trial (14) and two real-world, prospective observational studies of short duration (up to 24-48 weeks) (5, 15) conducted in India have shown that the use of HCQ (400 mg/day) as an add-on treatment in patients with T2D uncontrolled on a combination of two or more oral hypoglycemic agents (including metformin, sulfonylureas, pioglitazone, DPP-4 inhibitors, SGLT2 inhibitors, and alpha-glucosidase inhibitors) was welltolerated and led to a significant improvement of glucose control (assessed by HbA1c, fasting-and postprandial blood glucose) from baseline (without occurrence of severe hypoglycemia).

title:
  Antihyperglycemic properties of hydroxychloroquine in patients with diabetes: risks and benefits at the time of COVID‐19 pandemic

abstract:
  The antimalarial drug hydroxychloroquine (HCQ) has long been used as a disease‐modifying antirheumatic drug for the treatment of several inflammatory rheumatic diseases. Over the last three decades, various studies have shown that HCQ plays also a role in the regulation of glucose homeostasis. Although the mechanisms of action underlying the glucose‐lowering properties of HCQ are still not entirely clear, evidence suggests that this drug may exert multifaceted effects on glucose regulation, including improvement of insulin sensitivity, increase of insulin secretion, reduction of hepatic insulin clearance and reduction of systemic inflammation. Preliminary studies have shown the safety and efficacy of HCQ (at a dose ranging from 400 to 600 mg/day) in patients with type 2 diabetes over a short‐term period. In 2014, HCQ has been approved in India as an add‐on hypoglycemic agent for patients with uncontrolled type 2 diabetes. However, large randomized controlled trials are needed to establish the safety and efficacy profile of HCQ in patients with type 2 diabetes over a long‐term period. With regard to the COVID‐19 pandemic, several medications (including HCQ) have been used as off‐label drugs due to the lack of proven effective therapies. However, emerging evidence shows limited benefit from HCQ use in COVID‐19 in general. The aim of this manuscript is to comprehensively summarize the current knowledge on the antihyperglycemic properties of HCQ and to critically evaluate the potential risks and benefits related to HCQ use in patients with diabetes, even in light of the current pandemic scenario. This article is protected by copyright. All rights reserved.


id: cord-313829-pjscmen8
title: COVID-19 in people living with diabetes: An international consensus
author: Caballero, A.E.
date: 2020-07-06
txt: ./txt/cord-313829-pjscmen8.txt
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mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1056872720304335
doi: 10.1016/j.jdiacomp.2020.107671
summary:
  The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. It is difficult to predict but some indicators are available from the model of Harpreet In summary, while overall mortality due to COVID-19 is lower in India than in other countries, the elderly population, where most patients with diabetes, hypertension and CVD are concentrated, remains at high risk. Although it is clear that this option of care is not available to most people around the world, exploring how to improve the communication between providers and patients and families at home, in their own communities facing day to day challenges, may prove to be a more effective approach to managing the disease well beyond the COVID pandemic.

abstract:
  The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care world-wide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.


id: cord-314500-89ovdnxl
title: The double burden of diabetes and global infection in low and middle-income countries
author: Dunachie, Susanna
date: 2018-12-04
txt: ./txt/cord-314500-89ovdnxl.txt
cache: ./cache/cord-314500-89ovdnxl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30517697/
doi: 10.1093/trstmh/try124
summary:
  Diabetes increases susceptibility to infection and worsens outcomes for some of the world''s major infectious diseases such as tuberculosis, melioidosis and dengue, but the relationship between diabetes and many neglected tropical diseases is yet to be accurately characterised. A greater understanding of the impact of diabetes on risks and outcomes for infections causing significant diseases in LMIC is essential in order to develop vaccines and therapies for the growing number of people with diabetes at risk of infection, and to prioritise research agendas, public health interventions and policy. In a metaanalysis of five case-control studies of acute dengue, diabetes was associated with an increased risk of a severe clinical presentation of dengue compared with either asymptomatic infection or non-severe acute dengue, 43 although given the limited data, the authors emphasised this was only suggestive of a link.

abstract:
  Four out of five people in the world with diabetes now live in low- and middle-income countries (LMIC), and the incidence of diabetes is accelerating in poorer communities. Diabetes increases susceptibility to infection and worsens outcomes for some of the world’s major infectious diseases such as tuberculosis, melioidosis and dengue, but the relationship between diabetes and many neglected tropical diseases is yet to be accurately characterised. There is some evidence that chronic viral infections such as hepatitis B and HIV may predispose to the development of type 2 diabetes by chronic inflammatory and immunometabolic mechanisms. Helminth infections such as schistosomiasis may be protective against the development of diabetes, and this finding opens up new territory for discovery of novel therapeutics for the prevention and treatment of diabetes. A greater understanding of the impact of diabetes on risks and outcomes for infections causing significant diseases in LMIC is essential in order to develop vaccines and therapies for the growing number of people with diabetes at risk of infection, and to prioritise research agendas, public health interventions and policy. This review seeks to give an overview of the current international diabetes burden, the evidence for interactions between diabetes and infection, immune mechanisms for the interaction, and potential interventions to tackle the dual burden of diabetes and infection.


id: cord-316943-ef3i96bo
title: The burden of type 2 diabetes pre-and during the COVID-19 pandemic – a review
author: Sciberras, Justine
date: 2020-10-19
txt: ./txt/cord-316943-ef3i96bo.txt
cache: ./cache/cord-316943-ef3i96bo.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33102262/
doi: 10.1007/s40200-020-00656-4
summary:
  Whilst people with diabetes are more susceptible to COVID-19, enforcing lockdown regulations set by the Public Health department to reduce risk of infection brought about its own challenges to T2DM management. The pathophysiology and the underlying risk factors have long been established, yet the incidence of diabetes is still on a progressive incline [7] The 2019 coronavirus SARS-COV2 pandemic has further increased the burden on the diabetes population, those at risk of dyglcyaemic changes as well as the healthcare services [8] . Additionally, reports from the Centres for Disease Control and Prevention stated that patients with diabetes and metabolic syndrome might be 10 times more likely to die due to COVID-19 [20] . Factors leading to high morbidity and mortality of COVID-19 in patients with type 2 diabetes Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

abstract:
  INTRODUCTION: Diabetes Mellitus is a chronic disease and a global epidemic. It is a known fact that co-morbidities, including Diabetes Mellitus, pose a higher risk of infection by COVID-19. Additionally, the outcomes following infection are far worse than in people without such co-morbities. Factors contributing to the development of type 2 diabetes mellitus (T2DM) have long been established, yet this disease still bestows a substantial global burden. The aim was to provide a comprehensive review of the burden of diabetes pre-COVID-19 and the additional impact sustained by the diabetes population and healthcare systems during the COVID-19 pandemic, while providing recommendations of how this burden can be subsided. METHODOLOGY: Literature searches were carried out on ‘Google Scholar’ and ‘PubMed’ to identify relevant articles for the scope of this review. Information was also collected from reliable sources such as the World Health Organisation and the International Diabetes Federation. RESULTS: T2DM presented with economic, social and health burdens prior to COVID-19 with an significant ‘Disability Adjusted Life Years’ impact. Whilst people with diabetes are more susceptible to COVID-19, enforcing lockdown regulations set by the Public Health department to reduce risk of infection brought about its own challenges to T2DM management. Through recommendations and adapting to new methods of management such as telehealth, these challenges and potential consequences of mismanagement are kept to a minimum whilst safeguarding the healthcare system. CONCLUSION: By understanding the challenges and burdens faced by this population both evident pre-covid and during, targeted healthcare can be provided during the COVID-19 pandemic. Furthermore, implementation of targeted action plans and recommendations ensures the care provided is done in a safe and effective environment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40200-020-00656-4) contains supplementary material, which is available to authorized users.


id: cord-333487-zem2d4y6
title: The Impact of COVID-19 on People with Diabetes in Brazil
author: Thomaz Ugliara Barone, Mark
date: 2020-07-03
txt: ./txt/cord-333487-zem2d4y6.txt
cache: ./cache/cord-333487-zem2d4y6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.diabres.2020.108304
doi: 10.1016/j.diabres.2020.108304
summary:
  Methods In a convenience sampling study, data were collected from 1701 individuals, aged 18 or above; 75.54% female participants; 60.73% T1D and 30.75% T2D, between April 22nd and May 4th, using an anonymous and untraceable survey containing 20 multiple choice questions (socio-demographic; health status and habits of life during COVID-19 pandemic). Conclusions This study provides a firsthand revelation of the severity of COVID-19 on individuals with diabetes in Brazil, altering their habits, which impacted their glycemia, potentially increasing their risk of poor outcomes if infected by SARS-CoV-2. This also harmed adjustments to continue the proper follow-up and management of other diseases, including both communicable and NCDs. For these reasons, the present study aims to investigate challenges encountered by people living with diabetes in Brazil during the COVID-19 pandemic.

abstract:
  Abstract The present study aims atidentifying main barriers faced by people living with diabetes in Brazil during the COVID-19 pandemic. Methods In a convenience sampling study, data were collected from 1701 individuals, aged 18 or above; 75.54% female participants; 60.73% T1D and 30.75% T2D, between April 22nd and May 4th, using an anonymous and untraceable survey containing 20 multiple choice questions (socio-demographic; health status and habits of life during COVID-19 pandemic). Relationship between variables was established using the multiple correspondence analysis technique. Results 95.1% of respondents reduced their frequency of going outside of their homes; among those who monitored blood glucose at home during the pandemic (91.5%), the majority (59.4%) experienced an increase, a decrease or a higher variability in glucose levels; 38.4% postponed their medical appointments and/or routine examinations; and 59.5% reduced their physical activity. T1D, the youngest group, was more susceptible to presenting COVID-19 symptoms despite not being testing; whilst the TD2 group had higher frequency of comorbidities that are additional risk factors for COVID-19 severity. Conclusions This study provides a firsthand revelation of the severity of COVID-19 on individuals with diabetes in Brazil, altering their habits, which impacted their glycemia, potentially increasing their risk of poor outcomes if infected by SARS-CoV-2.


id: cord-334582-ccg27nmf
author: Bonora, Benedetta Maria
date: 2020-05-11
txt: ./txt/cord-334582-ccg27nmf.txt
cache: ./cache/cord-334582-ccg27nmf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32395187/
doi: 10.1007/s13300-020-00829-7
summary:
  CONCLUSION: Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on T1D management, at least in the short term. Using data collected by remote monitoring of glucose sensors, we investigated whether glycaemic control in people with type 1 diabetes (T1D) during lockdown improved or worsened. None of the patients who continued to work showed improvement in any of the measures of glucose control during the lockdown period (period 2) compared to the 3 months or the week before the SARS-CoV-2 outbreak: average glucose, standard deviation, CV%, time in hypoglycaemia, time in range and time in hyperglycaemia remained unchanged (Table 2) , as did the number of scans per day.

title:
  Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy

abstract:
  INTRODUCTION: In late February 2020, due to the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Italian Government closed down all educational and sport activities. In March, it introduced further measures to stop the spread of coronavirus disease (COVID-19), placing the country in a state of almost complete lockdown. We report the impact of these restrictions on glucose control among people with type 1 diabetes (T1D). METHODS: Data were collected on 33 individuals with T1D who were monitoring their glucose levels using a flash glucose monitoring device and remotely connected to the diabetes clinic on a cloud platform. We retrieved information on average glucose, standard deviation and percentage time in hypoglycaemia (< 70 mg/dl), glucose range (70–180 mg/dl) and hyperglycaemia (> 180 mg/dl). We compared glycaemic measures collected during lockdown to those collected before the SARS-CoV-2 epidemic and to the periods immediately before lockdown. RESULTS: In 20 patients who had stopped working and were at home as a result of the lockdown, overall glycaemic control improved during the first 7 days of the lockdown as compared to the weeks before the spread of SARS-CoV-2. Average glucose declined from 177 ± 45 mg/dl (week before lockdown) to 160 ± 40 mg/dl (lockdown; p = 0.005) and the standard deviation improved significantly. Time in range increased from 54.4 to 65.2% (p = 0.010), and time in hyperglycaemia decreased from 42.3 to 31.6% (p = 0.016). The number of scans per day remained unchanged. In 13 patients who continued working, none of the measures of glycaemic control changed during lockdown. CONCLUSION: Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on T1D management, at least in the short term.


id: cord-334773-yw2qgv13
author: Lisco, Giuseppe
date: 2020-08-10
txt: ./txt/cord-334773-yw2qgv13.txt
cache: ./cache/cord-334773-yw2qgv13.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s12020-020-02444-9
doi: 10.1007/s12020-020-02444-9
summary:
  This concern has been further confirmed by the results of a cohort study among 85 fatal cases of COVID-19 in Wuhan, hence defining DM as a potentially harmful comorbidity predisposing to worse clinical course or death once SARS-CoV-2 infection occurred [49] . Different hypothesis should be considered for explaining this clinical phenomenon, including glucose control at baseline and during the infection course, pathophysiology and immune system response in SARS-CoV-2 infected patients with T2D, diabetes-related comorbidities and concomitant medications. In conclusion, diabetic patients especially elderly individuals and those with worse baseline glucose control may exhibit immune system dysregulation that predispose them to a less effective response against SARS-CoV-2 and to a dysfunctional inflammation that requires to be carefully monitored in confirmed cases of COVID-19, for preventing or avoiding a harmful progression of the disease. Immune response and systemic inflammation play a crucial role in SARS-CoV-2 infection, particularly in case of severe clinical course of the disease.

title:
  Hypothesized mechanisms explaining poor prognosis in type 2 diabetes patients with COVID-19: a review

abstract:
  PURPOSE: Epidemiological data suggest that comorbid patients, mostly those with type 2 diabetes (T2D), are predisposed to poor prognosis in Coronavirus disease 2019 (COVID-19), leading to serious healthcare concerns. The aim of the present manuscript is to review the main relevant mechanisms possibly contributing to worsen the clinical course of COVID-19 in T2D. RESULTS: Poor glucose control, high glycaemic variability and diabetes-related comorbidities at baseline, particularly cardiovascular diseases and obesity, contribute in worsening the prognosis in the above-mentioned cluster of patients. Moreover, both a lower efficient innate immune system response and cytokine dysregulation predispose patients with T2D to impaired viral clearance and more serious pulmonary and systemic inflammation once the SARS-CoV-2 infection occurred. Inconclusive data are currently available for specifically indicate or contraindicate concurrent medications for managing T2D and its comorbidities in infected patients. CONCLUSIONS: T2D individuals should be considered as more vulnerable to COVID-19 than general population, and thus require adequate advices about hygienic tips to protect themselves during the pandemic. A careful management of glucose levels and diabetes-related comorbidities remains essential for avoiding further complications, and patient monitoring during the pandemic should be performed also at distance by means of telemedicine. Further studies are needed to clarify whether medications normally used for managing T2D and its associated comorbidities could have a protective or detrimental effect on COVID-19 clinical course.


id: cord-335894-6m0nnufu
title: Issues for the management of people with diabetes and COVID-19 in ICU
author: Ceriello, Antonio
date: 2020-07-20
txt: ./txt/cord-335894-6m0nnufu.txt
cache: ./cache/cord-335894-6m0nnufu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s12933-020-01089-2
doi: 10.1186/s12933-020-01089-2
summary:
  Moreover, there are also several other conditions (described in the course of the article), commonly present in diabetes, which can expose people with diabetes Open Access Cardiovascular Diabetology *Correspondence: antonio.ceriello@hotmail.it 1 IRCCS MultiMedica, Via Gaudenzio Fantoli, 16/15, 20138 Milan, Italy Full list of author information is available at the end of the article and COVID-19 at high risk for complications. Furthermore, a large proportion of people with diabetes has asymptomatic coronary artery disease [45, 46] which can increase the risk of acute coronary syndrome, heart failure and arrhythmia during the COVID-19 due to proinflammatory process, hypercoagulability and sympathetic stimulation. In the case of COVID-19 people with diabetes are more exposed to cardiovascular complications, which may be more challenging to manage [74, 75] . Improved outcome of patients with diabetes mellitus with good glycemic control in the Cardiac Intensive Care Unit: a retrospective study

abstract:
  In the pandemic “Corona Virus Disease 2019” (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.


id: cord-336201-fl606l3b
title: The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System
author: Daryabor, Gholamreza
date: 2020-07-22
txt: ./txt/cord-336201-fl606l3b.txt
cache: ./cache/cord-336201-fl606l3b.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32793223/
doi: 10.3389/fimmu.2020.01582
summary:
  Obesity-related immune cell infiltration, inflammation, and increased oxidative stress promote metabolic impairments in the insulin-sensitive tissues and finally, insulin resistance, organ failure, and premature aging occur. T2DM, the most common form of diabetes (∼90%), is characterized by a systemic inflammatory disease accompanied by insulin resistance (IR) or decreased metabolic response to insulin in several tissues, including the adipose tissue, liver, and skeletal muscle, as well as by reduced insulin synthesis by pancreatic beta cells (4, 5) . During the progression of diabetes, hyperglycemia promotes mitochondrial dysfunction and induces the formation of reactive oxygen species (ROS) that cause oxidative stress in several tissues such as blood vessels and pancreatic beta cells (7) (8) (9) . In addition, the attachment of AGEs to their receptors [e.g., CD36, galectin-3, scavenger receptors types I (SR-A1), and II (SR-A2)] on the surfaces of immune cells in the circulation and tissues activates the expression of pro-inflammatory cytokines and increases free radical generation (18) .

abstract:
  Metabolic abnormalities such as dyslipidemia, hyperinsulinemia, or insulin resistance and obesity play key roles in the induction and progression of type 2 diabetes mellitus (T2DM). The field of immunometabolism implies a bidirectional link between the immune system and metabolism, in which inflammation plays an essential role in the promotion of metabolic abnormalities (e.g., obesity and T2DM), and metabolic factors, in turn, regulate immune cell functions. Obesity as the main inducer of a systemic low-level inflammation is a main susceptibility factor for T2DM. Obesity-related immune cell infiltration, inflammation, and increased oxidative stress promote metabolic impairments in the insulin-sensitive tissues and finally, insulin resistance, organ failure, and premature aging occur. Hyperglycemia and the subsequent inflammation are the main causes of micro- and macroangiopathies in the circulatory system. They also promote the gut microbiota dysbiosis, increased intestinal permeability, and fatty liver disease. The impaired immune system together with metabolic imbalance also increases the susceptibility of patients to several pathogenic agents such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, the need for a proper immunization protocol among such patients is granted. The focus of the current review is to explore metabolic and immunological abnormalities affecting several organs of T2DM patients and explain the mechanisms, whereby diabetic patients become more susceptible to infectious diseases.


id: cord-339637-hb6bsb6q
author: Khader, Mohammed Abdul
date: 2020-08-18
txt: ./txt/cord-339637-hb6bsb6q.txt
cache: ./cache/cord-339637-hb6bsb6q.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1871402120303143?v=s5
doi: 10.1016/j.dsx.2020.08.011
summary:
  A highly significant correlation (r = 0.89, p = 0.0145) was found between increasing age and reporting of higher BGLs. Conclusion: This study provides a firsthand evidence of major disruption in diabetes care activities during and after the lockdown phase in India and increased risk of poorer clinical outcomes, if infected by SARS-CoV-2. Inclusion criteria -People who are diagnosed with diabetes -Any gender -Age more than 18 years Exclusion criteria -Not able to provide informed consent for the study The questionnaire consisted of mainly 3 domains: A) socio-demographic details, e.g., subject''s age, gender, state, city, town, educational qualification, financial income; B) medical and social history, e.g., type of diabetes, comorbidities, smoking, and drinking habits; C) impact of COVID-19 outbreak on their medical and social life, e.g., frequency of clinic visits, changes in glycemic levels, digital glucometer at home, access to health care services, changes in the eating habits and physical activity, changes in drinking and smoking habits, online consultations, the reason for cancellation or postponement.

title:
  A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India

abstract:
  Background and aims: Uncontrolled diabetes has been associated with poorer clinical outcomes in COVID-19. We aimed to evaluate and assess the impact of COVID-19 pandemic on management of diabetes and challenges faced by people with diabetes in India during and after the lockdown phase. Methods: A cross-sectional study based on an online questionnaire survey was designed. The questions collected socio-demographic details, medical and social history, and impact of the pandemic on medical and social life from 1582 participants. Linear regression was employed to evaluate association of different parameters with the change in glycemic levels. Results: The frequency of clinical visits during the COVID-19 pandemic were reduced in 87.28% of participants. 92.45% of participants were able to monitor their blood glucose levels (BGLs) in which 78.42% (49.35%, 20.91%, and 8.16%) participants experienced an increase in BGL (mild, moderate, and severe respectively). Only 47.41% of participants possessed the digital glucometer at home. 69.07% of participants reported a decrease in physical activity while 46.88% reported an increase in food intake. 80.06% of participants were able to buy all medicines and 29.80% were gone for virtual consultations while 87.81% reported that they didn't have access to healthcare services. Overall, 89.47% participants experienced disruption in therapy. A highly significant correlation (r = 0.89, p = 0.0145) was found between increasing age and reporting of higher BGLs. Conclusion: This study provides a firsthand evidence of major disruption in diabetes care activities during and after the lockdown phase in India and increased risk of poorer clinical outcomes, if infected by SARS-CoV-2.


id: cord-345360-wlzgq7f9
author: Yan, Alice F.
date: 2020-07-22
txt: ./txt/cord-345360-wlzgq7f9.txt
cache: ./cache/cord-345360-wlzgq7f9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32710996/
doi: 10.1016/j.diabres.2020.108350
summary:
  AIMS: To examine perceived infection risk of COVID-19 and the health and related behavior changes among people with diabetes, compared with people without diabetes, and to examine factors associated with self-reported health during the national quarantine period in China. The objectives of this time-sensitive study are: 1) to examine perceived risk of COVID-19 and levels of worry among people with diabetes, and compare with the perceptions of those without diabetes; 2) to examine the health-related experiences and behaviors of people with diabetes when compared with those without diabetes, and 3) to examine factors associated with self-reported health status during the COVID-19 quarantine period in China. To our knowledge, no studies to date have reported findings related to perceived infection risks and the impacts of COVID-19 on a large sample of people with diabetes on health-related outcomes and lifestyle behavior changes in China, where COVID-19 was first reported, and many vigorous nationwide measures were taken to control its spread.

title:
  Perceived Risk, Behavior Changes and Health-related Outcomes During COVID-19 Pandemic: Findings among Adults with and without Diabetes in China

abstract:
  AIMS: To examine perceived infection risk of COVID-19 and the health and related behavior changes among people with diabetes, compared with people without diabetes, and to examine factors associated with self-reported health during the national quarantine period in China. METHODS: The 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media across China. A national sample of 10,545 adults in all 31 provinces in mainland China provided data on sociodemographic characteristics, awareness, attitudes towards COVID-19, lifestyle factors, and health outcomes during the quarantine. Regression models tested associations among study variables adjusting for covariates. RESULTS: Among the 9,016 total participants (42.6% men and 57.4% women), 585 reported having diagnosed diabetes and 8,431 had no diabetes. Participants with diabetes perceived themselves to be at higher risk and were more worried about being infected with COVID-19 when compared to non-diabetic individuals (p<.001). During the COVID-19 pandemic, participants with diabetes were more likely to experience food and drug shortages and to increase their physical activity, compared to their counterparts. Among diabetic respondents, a high proportion of current smokers (74.1%) and drinkers (68.5%) reported increased amounts of smoking and drinking. People with diabetes were 11% less likely to report excellent or very good health. Having 150 minutes/week physical activity was positively associated with excellent or very good health (prevalence ratio, PR=1.14, 95%CI 1.11-1.16). CONCLUSIONS: A high proportion of people with diabetes perceived risk of COVID-19 infection and increased their smoking and drinking during the pandemic.


id: cord-347207-1u4i6qmc
author: Almomani, Huda Y.
date: 2020-07-29
txt: ./txt/cord-347207-1u4i6qmc.txt
cache: ./cache/cord-347207-1u4i6qmc.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1551741120308354
doi: 10.1016/j.sapharm.2020.07.012
summary:
  title: Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (rose-adam): A study protocol Several studies have established the important positive role of educational interventions on achieving glycaemic control and other clinical outcomes, however, there is still a lack in studies that evaluate the impact of such type of interventions on hypoglycaemia risk in elderly patients with type 2 diabetes. The purpose of this research is to evaluate the effectiveness of pharmacist-led patient counselling on reducing hypoglycaemic attacks in older adults with type 2 diabetes mellitus. Participants who are elderly (age ≥ 65 years), diagnosed with type 2 diabetes mellitus, and taking insulin, sulfonylurea, or any three anti-diabetic medications will be randomly assigned to intervention (SUGAR Handshake) and control (usual care) groups.

title:
  Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (rose-adam): A study protocol

abstract:
  INTRODUCTION: Hypoglycaemia is one of the most serious adverse effects of diabetes treatment. Older adults are at the highest risk to develop hypoglycaemia. Several studies have established the important positive role of educational interventions on achieving glycaemic control and other clinical outcomes, however, there is still a lack in studies that evaluate the impact of such type of interventions on hypoglycaemia risk in elderly patients with type 2 diabetes. The purpose of this research is to evaluate the effectiveness of pharmacist-led patient counselling on reducing hypoglycaemic attacks in older adults with type 2 diabetes mellitus. METHODS: and analysis: This study is an open-label, parallel controlled randomised trial, which will be conducted in the outpatient clinics at the largest referral hospital in the north of Jordan. Participants who are elderly (age ≥ 65 years), diagnosed with type 2 diabetes mellitus, and taking insulin, sulfonylurea, or any three anti-diabetic medications will be randomly assigned to intervention (SUGAR Handshake) and control (usual care) groups. The SUGAR Handshake participants will have an interactive, individualised, medications-focused counselling session reinforced with a pictogram and a phone call at week six of enrolment. The primary outcome measure is the frequency of total hypoglycaemic events within 12 weeks of follow up. Secondary outcomes include the frequency of asymptomatic, symptomatic, and severe hypoglycaemic events, hypoglycaemia incidence, and time to the first hypoglycaemic attack. We will also conduct a nested qualitative study for process evaluation. ETHICS AND DISSEMINATION: The Human Research Ethics Committee of the University of Lincoln and the Institutional Review Board of King Abdullah University Hospital approved this protocol. The findings of this study will be presented in international conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: The study protocol has been registered with ClinicalTrials.gov, NCT04081766.


id: cord-350182-s10nong7
author: Milionis, Charalampos
date: 2020-07-20
txt: ./txt/cord-350182-s10nong7.txt
cache: ./cache/cord-350182-s10nong7.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s40200-020-00592-3
doi: 10.1007/s40200-020-00592-3
summary:
  Coronavirus disease 2019 (COVID-19) is a respiratory infection which is caused by a novel virus belonging to the Coronaviridae family [1] and is officially named SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The existence of diabetes is strongly associated with an increased risk of developing severe COVID-19 in case of infection with SARS-CoV-2 [24, 25] . The present article supports that heightened inflammatory processes constitute the main pathophysiologic factor for the severity of COVID-19 among patients with diabetes mellitus, whilst impairments in immune response and diabetic comorbidities contribute to the aggravated pathogenesis. Yet it remains unclear whether the innate immune response is vitally impaired in both types of diabetes mellitus and whether hyperglycaemia favours the initial virulence of SARS-CoV-2. Furthermore, patients with diabetes mellitus may present dysfunctional type IV (delayed) hypersensitivity reaction and abnormal complement activation [35] which may hinder the immune response. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

title:
  A brief analysis and hypotheses about the risk of COVID-19 for people with type 1 and type 2 diabetes mellitus

abstract:
  COVID-19 is an infectious respiratory disease which firstly occurred in Wuhan, China and evolved rapidly around the globe. The causative pathogen is a novel coronavirus called SARS-CoV-2 with genomic similarities with SARS-CoV and MERS-CoV. The disease is transmitted among humans either through direct contact or via droplets from sneeze or cough. Most infected persons remain asymptomatic or mildly symptomatic, but some patients may develop severe clinical features, including pneumonia, respiratory failure, sepsis and even death. People of advanced age and/or with underlying diseases (including diabetes mellitus) are at greater risk. The innate and adaptive immune system are responsible for protecting the body against viral infection. Nevertheless, it is assumed that SARS-CoV-2 interferes with the immune system through immunomodulating mechanisms which intensify its pathogenesis. A delayed or reduced response of the innate immune system is critical for the development of pathogenesis of the virus. People with diabetes are more likely to develop severe symptoms of COVID-19. The present article speculates that special aspects of the immune dysfunction caused by chronic hyperglycaemia is the main reason for this susceptibility.


id: cord-350373-dftdxzsm
author: Rayman, G.
date: 2020-08-02
txt: ./txt/cord-350373-dftdxzsm.txt
cache: ./cache/cord-350373-dftdxzsm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32740972/
doi: 10.1111/dme.14378
summary:
  title: Dexamethasone therapy in COVID‐19 patients: implications and guidance for the management of blood glucose in people with and without diabetes The guidance recommends giving correction doses of rapid-acting analogue insulin when capillary blood glucose > 12.0 mmol/l, with the dose calculated according to the patient''s weight or in those already treated with insulin, on their total daily insulin dose. Unlike the previous guidance, we do not recommend using the insulin correction ratios that some people with type 1 diabetes usually use as these may not be appropriate given the significant disturbance of glucose metabolism. Insulin resistance will fall when dexamethasone is stopped and so capillary blood glucose and insulin dose adjustment need careful monitoring to avoid hypoglycaemia. Where the total daily dose (TDD) of insulin is known follow the guidance in the Increase the long acting basal or NPH insulin by 20% but this may need rapid escalation by as much as 40% depending on response.

title:
  Dexamethasone therapy in COVID‐19 patients: implications and guidance for the management of blood glucose in people with and without diabetes

abstract:
  The RECOVERY (Randomised Evaluation of COVid‐19 thERapY) trial found that dexamethasone 6 mg once per day for 10 days reduced deaths by one‐third in ventilated patients and by one‐fifth in other patients, receiving oxygen therapy. This equates to the prevention of one death in around eight ventilated patients, or one in around 25 patients requiring oxygen.


id: cord-352544-7b6btzrx
title: The association of diabetes and the prognosis of COVID-19 patients: a retrospective study
author: Liu, Zhelong
date: 2020-08-25
txt: ./txt/cord-352544-7b6btzrx.txt
cache: ./cache/cord-352544-7b6btzrx.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0168822720306392
doi: 10.1016/j.diabres.2020.108386
summary:
  Abstract Aims This study evaluated the impact of previous glycemic control and in-hospital use of antidiabetic/antihypertensive drugs on the prognosis of COVID-19 patients with diabetes. Despite a few studies reported that COVID-19 patients with poorly controlled fasting blood glucose in hospital were associated with higher mortality [16] , there is still a lack of information on the impact of previous glycemic control on the prognosis of COVID-19 patients with diabetes. Model 1 explored the risk factors associated with worsening by a univariate analysis, which included HbA1c, maximum of the BG in-hospital, age, sex, smoking, comorbidities other than diabetes, white cell count, the percentage of neutrophils, lymphopenia, alanine aminotransferase, aspartate aminotransferase, γ -glutamyl transferase, creatinine, C-reactive protein (CRP), D-dimer, N-terminal brain natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), prothrombin time, total cholesterol, triglyceride, interleukin-6, tumor necrosis factor-α. Our study found that among COVID-19 patients, those with poor HbA1c control had a higher risk of disease worsening, with an optimal cut-off value of 8.6% (70 mmol/mol), demonstrating the importance of previous glycemic control.

abstract:
  Abstract Aims This study evaluated the impact of previous glycemic control and in-hospital use of antidiabetic/antihypertensive drugs on the prognosis of COVID-19 patients with diabetes. Methods In this retrospective cohort study, consecutive inpatients with laboratory confirmed COVID-19 were enrolled from Tongji Hospital (Wuhan, China). Patients without diabetes were matched to those with diabetes based on age, sex, and comorbidities. All patients were followed up to a clinical endpoint (discharge, worsening including transferring to ICU or immediate death). Data and outcomes were extracted from medical records and analyzed. Results 64 patients with pre-existing diabetes were included in this study, with 128 matched patients without diabetes included as a control group. Patients with diabetes had a higher rate of worsening (18.8% versus 7.8%, p=0.025). Multivariable regression showed increased odds of worsening associated with previous glycemic control reflected by HbA1c (odds ratio 3.29, 95% CI 1.19-9.13, p=0.022) and receiver-operating characteristics (ROC) curve identified HbA1c of 8.6% (70 mmol/mol) as the optimal cut-off value. Univariate analysis demonstrated the in-hospital use of antidiabetic/antihypertensive drugs were not associated with a higher risk of worsening. Conclusions COVID-19 patients with diabetes had a higher risk of worsening, especially those with poorly-controlled HbA1c, with an optimal cut-off value of 8.6%. The in-hospital use of antidiabetic/antihypertensive drugs were not associated with increased odds of worsening in patients with diabetes.


id: cord-353867-617f90wq
author: Ory, Marcia G.
date: 2020-08-30
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url: https://www.ncbi.nlm.nih.gov/pubmed/32872662/
doi: 10.3390/ijerph17176312
summary:
  This community-based initiative reached a large and diverse population, and statistically significant reductions in A1c levels (p < 0.01) were observed among participants with Type 2 diabetes at 3 months. The U.S.-Mexico border is impacted by extremely high disparities in income, education, and healthcare access, and these social determinants of health make this region among the nation''s Figure 1 illustrated the 27 counties formally included in the Healthy South Texas initiative [30] , and the counties in which the Diabetes Education Program was offered were marked with a red dot. Among participants with pre-diabetes or Type 1 diabetes, no statistically significant differences were observed based on baseline A1c level attending a follow-up session at any given time point (Table 2 ). From private and public sources, over USD 15,000,000 was identified in direct support and in-kind dollars for the Healthy South Texas initiative (including delivery of the Diabetes Education Program, as well as other disease prevention and health promotion activities) by governmental and nongovernmental entities.

title:
  Implementing a Diabetes Education Program to Reduce Health Disparities in South Texas: Application of the RE-AIM Framework for Planning and Evaluation

abstract:
  Health disparities in diabetes management and control are well-documented. The objective of this study is to describe one diabetes education program delivered in the United States in terms of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Planning and Evaluation Framework. Questionnaires, clinical data, and administrative records were analyzed from 8664 adults with diabetes living in South Texas, an area characterized by high health disparities. The Diabetes Education Program delivered was a professionally led 12-month program involving 8 h of in-person workshop education followed by quarterly follow-up sessions. Changes in average blood glucose levels over the past 3 months (e.g., A1c levels) were the primary clinical outcome. Descriptive and multiple generalized linear mixed models were performed. This community-based initiative reached a large and diverse population, and statistically significant reductions in A1c levels (p < 0.01) were observed among participants with Type 2 diabetes at 3 months. These reductions in A1c levels were sustained at 6-, 9-, and 12-month follow-up assessments (p < 0.01). However, considerable attrition over time at follow-up sessions indicate the need for more robust strategies to keep participants engaged. For this diabetes education program, the RE-AIM model was a useful framework to present study processes and outcomes.


