key: cord-0687402-3iqokwho authors: Bloomgarden, Zachary title: Is the type of diabetes treatment relevant to outcome of COVID‐19? date: 2020-04-30 journal: J Diabetes DOI: 10.1111/1753-0407.13047 sha: 672d23038dc227baf0fb3debaa1bffd63c1c4b6e doc_id: 687402 cord_uid: 3iqokwho nan An important aspect of the pathophysiology of the 2019 novel coronavirus infectious disease (COVID- 19) involves the development of diffuse pulmonary alveolar damage with extensive macrocyte infiltration ( 9 ). Based on this observation, the use of anti-inflammatory treatments has been proposed for COVID-19, with some recommendation for chloroquine and hydroxychloroquine ( 10 , 11 ), although two preliminary reports failed to show benefit ( 12 , 13 ). In addition, these can lead to QT interval prolongation with risk of ventricular arrhythmia, particularly when administered with azithromycin ( 14 ). The recent US National Institutes of Health treatment guidelines statement suggested that prophylactic use of hydroxychloroquine has no evidence of efficacy and recommended that the combination with azithromycin not be used ( 15 ) . Recently, the observation that severity of COVID-19 tracks with elevation in circulating inflammatory mediators ( 16 ), has led to the proposal that anti-inflammatory agents, corticosteroids, and immune suppressant treatments might be of benefit ( 17 ), although others argue against such approaches ( 18 ). Similarly, use of nonsteroidal anti-inflammatory agents has been recommended by some authors ( 19 ), while others suggest these drugs may worsen outcome of respiratory infections, and hence be inadvisable in COVID- 19 ( 20 ) , leaving at least some degree of doubt ( 21 ). The use of existing treatments for type 2 diabetes with recognized anti-inflammatory effects may have benefits both in early and in advanced COVID-19, without the potential harms of existing antiinflammatory agents. Furthermore, there is reason to think that the degree of glycemic control may influence outcome of COVID-19 ( 22 ) . Existing datasets give minimal information as to drivers of outcome among persons with diabetes, at best noting the presence or absence of diabetes ( 23 ). We need to know much more about the characteristics of people with diabetes with COVID-19, at all levels of severity, including their diabetes treatment regimen, measures of glycemic control, and measures associated with insulin resistance including body mass index, waist circumference, and triglyceride and HDL cholesterol levels, to ascertain factors which may be associated with differing prognosis of the infection, both in earlier/milder and later/more severe cases, and, ultimately, to design appropriate diabetes treatment approaches which may play a role in optimizing outcome. Inflammation and insulin resistance Inflammation and insulin resistance Inflammation as a Therapeutic Target for Diabetic Neuropathies Therapeutic approaches targeting inflammation for diabetes and associated cardiovascular risk Inflammation and thrombosis in diabetes Diabetic Kidney Disease: Challenges, Progress, and Possibilities Metabolic Inflammation-A Role for Hepatic Inflammatory Pathways as Drivers of Comorbidities in Nonalcoholic Fatty Liver Disease? Gastroenterology Glycemic control and the heart: it matters how you get there Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19 Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial Matthieu Mahevas Guidance On Minimizing Risk of Drug-Induced Ventricular Arrhythmia During Treatment of COVID-19: A Statement from the Canadian Heart Rhythm Society COVID-19) Treatment Guidelines High IL-6/IFN-γ ratio could be associated with severe disease in COVID-19 patients Associations between immunesuppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence. Ecancermedicalscience Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review Misguided drug advice for COVID-19 Non-steroidal anti-inflammatory drugs and covid-19 Safety of Ibuprofen in Patients With COVID-19; Causal or Confounded? Chest Hydroxychloroquine, and the COVID-19 Epidemic Epidemiological data from the COVID-19 outbreak, real-time case information. Sci Data