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A thread on #diabetes and #COVID19 Last week @SilvermanOmar and me talked about diabetes and COVID19 on the @GDiabetesJC #GDJC. Our starting point was this review (link) in @DiabetologiaJnl. Hereâs some of main points from that talk.. 1/n
We know that people with diabetes are among those at increased risk of poor outcomes, if they get infected. Several studies have shown that among those who die of COVID-19, more people have diabetes; like, 35.5% had diabetes in this Italien study ( https://bit.ly/35MI3wp ) 2/n
Whether diabetes in itself causes poor outcomes is not known. This Chinese cohort ( https://bit.ly/35M8G4A ) found that having diabetes was associated with a higher risk of poor outcomes, after adjusting for age and smoking. But this is not conclusive. 3/n
Getting closer at a causal interpretation is complicated (see this great thread by @EpiEllie discussing results from a recent pre-print using UK data ( https://bit.ly/2YPM4yH )) 4/n
Hypotheses about the role of ectopic fat in the pathogenesis of COVID-19 in people with obesity is also emerging - here a perspective from Obesity ( https://bit.ly/2WLljZo ) and an interesting suggestion from @sorahill ( https://bit.ly/2A8LKka ). 5/n
Social distancing and hygiene are essential to prevent getting infected, as for everybody. Whether a healthy lifestyle, diet, exercise, no smoking and low stress lowers risk of infection or poor outcomes in people with diabetes is unknown. Probably not a bad idea though⊠6/n
Poor glycemic control is suggested to be associated with poor outcomes in people with diabetes (see previous tweet ( https://bit.ly/3fAhTS7 ) about a recent paper in @Cell_Metabolism ), but we do not know if better glycemic control improves outcomes. 7/n
Establishing ways of delivering care outside hospitals and clinics (like telemedicine and delivering drugs) is essential but can be challenging in some settings. 8/n
A lot of discussions about the role of ACEi/ARBs, drugs important to treat hypertension, heart failure and nephropathy. There is currently no clear evidence for stopping before or while infected, recommendation is to continue. 9/n
The race to find a drug that improves outcomes in people with COVID-19 infection is on. Some of the early âtrialsâ have been very poorly conducted. Any sign of positive results have been overhyped. No drug has robust evidence on antiviral efficacy on clinical outcomes. 10/n
For some practical recommendations for the management of diabetes in patients with COVID-19, we liked this paper ( https://bit.ly/2YQ4ijG ) in @TheLancetEndo from @kamleshkhunti and many other great diabetologists. 11/n
With many countries transisitioning into the next phase of the epidemic, starting to open up their societies after lockdowns, we need to be particularly mindful of the needs and safety of our vulnerable populations. That was all. 12/n
