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International Journal of Diabetes in Developing Countries

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01-09-2020 | Insulins | Review Article

COVID-19 and type 1 diabetes: dealing with the difficult duo

Authors: Subhankar Chowdhury, Soumik Goswami

Published in: International Journal of Diabetes in Developing Countries | Issue 3/2020

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.

Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199–207.CrossRef

Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. For the China Medical Treatment Expert Group for Covid-19. N Engl J Med. 2020;382:1708–20.CrossRef

Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan [published online ahead of print, 2020 Apr 12]. J Allergy Clin Immunol. 2020;S0091-6749(20):30495–4. https://doi.org/10.1016/j.jaci.2020.04.006.CrossRef

Abate SM, Checkol YA, Mantedafro B, Basu B. Prevalence and risk factors of mortality among hospitalized patients with COVID-19: a systematic review and meta-analysis.[Submitted]. Bull World Health Organ. 2020. https://doi.org/10.2471/BLT.20.260737.

Du RH, Liang LR, Yang CQ, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524. Published 2020 May 7. https://doi.org/10.1183/13993003.00524-2020.CrossRefPubMedPubMedCentral

Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829–38. https://doi.org/10.1016/j.kint.2020.03.005.CrossRefPubMedPubMedCentral

DIAMOND Project Group. Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Diabetic Medicine. 2006;23:857–66. https://doi.org/10.1111/j.1464-5491.2006.01925.x.CrossRef

Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Derek G. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Cook Diabetes Care Mar. 2018;41(3):513–21. https://doi.org/10.2337/dc17-213.CrossRef

Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: a review of pathogenesis. Indian J Endocrinol Metab. 2012;16(Suppl 1(Suppl1)):S27–36. https://doi.org/10.4103/2230-8210.94253.CrossRefPubMedPubMedCentral

10.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. COVID-19 Lombardy. ICU network baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020. https://doi.org/10.1001/jama.2020.5394 [Epub ahead of print].

11.

Wu Z, McGoogan. Characteristic of and important lessons from the Coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020. https://doi.org/10.1001/jama.2020.2648.

12.

Fadini GP, Morieri ML, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest. 2020. https://doi.org/10.1007/s40618-020-01236-2 [Epub ahead of print].

13.

Pitocco D, Tartaglione L, Viti L, Di Leo M, Manto A, Caputo S, et al. Lack of type 1 diabetes involvement in SARS-COV-2 population: Only a particular coincidence? Diabetes Research and Clinical Practice. 2020. https://doi.org/10.1016/j.diabres.2020.108220.

14.

https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf. Accessed on 28^th May 2020.

15.

https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf. Accessed on 28^th May 2020.

16.

Kiselar JG, Wang X, Dubyak GR, El Sanadi C, Ghosh SK, Lundberg K, et al. Modification of-defensin-2 by dicarbonyls methylglyoxal and glyoxal inhibits antibacterial and chemotactic function in vitro. PLoS ONE. 2015;10.

17.

Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8:546–50.CrossRef

18.

Caruso P, Longo M, Esposito K, Ida Maiorino M. Type 1 Diabetes triggered by covid-19 pandemic: A Potential outbreak? Diabetes Res Clin Pract. 2020. https://doi.org/10.1016/j.diabres.2020.108219.

19.

Lönnrot M, Lynch KF, Elding Larsson H, et al. Respiratory infections are temporally associated with initiation of type 1 diabetes autoimmunity: the TEDDY study. Diabetologia. 2017;60:1931–40. https://doi.org/10.1007/s00125-017-4365-5.CrossRefPubMedPubMedCentral

20.

Op de Beeck A, Eizirik DL. Viral infections in type 1 diabetes mellitus--why the β cells? Nat Rev Endocrinol. 2016;12:263–73. https://doi.org/10.1038/nrendo.2016.30.CrossRefPubMedCentral

21.

Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection. Clinical Gastroenterology and Hepatology. 2020. https://doi.org/10.1016/j.cgh.2020.04.040.

22.

Diabetes Metab. 2020;S1262-3636(20):30081-1. https://doi.org/10.1016/j.diabet.2020.05.004.

23.

Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547. Published 2020 May 14. https://doi.org/10.1183/13993003.00547-2020.CrossRefPubMedPubMedCentral

24.

https://www.touchendocrinology.com/insight/covid-19-infection-in-people-with-diabetes/. Accessed on 30^th May 2020.

25.

Brufsky A. Hyperglycemia, hydroxychloroquine, and the COVID-19 pandemic. J Med Virol. 2020:6.

26.

Goyal V, Bordia A. The hypoglycemic effect of chloroquine. J Assoc Physicians India. 1995;43(1):17–8.PubMed

27.

Salman PM, Quevedo I, Arias M, et al. Hypoglycemia due to hydroxychloroquine, an uncommon association but to keep in mind, case report and review of literature. J Diabetes Metab Disord Control. 2020;7(1):6–7. https://doi.org/10.15406/jdmdc.2020.07.00193.CrossRef

28.

Halaby MJ, Kastein BK, Yang DQ. Chloroquine stimulates glucose uptake and glycogen synthase in muscle cells through activation of Akt. Biochem Biophys Res Commun. 2013;435(4):708–13. https://doi.org/10.1016/j.bbrc.2013.05.047.CrossRefPubMed

29.

Baretić M. Case report of chloroquine therapy and hypoglycemia in type 1 diabetes: what should we have in mind during the COVID-19 pandemic? [published online ahead of print, 2020 Apr 13]. Diabetes Metab Syndr. 2020;14(4):355–6. https://doi.org/10.1016/j.dsx.2020.04.014.CrossRefPubMedPubMedCentral

30.

Brazendale K, Beets MW, Weaver RG, et al. Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act. 2017;14:100.CrossRef

31.

MacMillan F, Kirk A, Mutrie N, et al. A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes: study characteristics, intervention design, and efficacy. Pediatr Diabetes. 2014;15:175–89.CrossRef

32.

Bonora BM, Boscari F, Avogaro A, Bruttomesso D, Fadini GP. Glycemic control among people with type 1 diabetes during lockdown for the SARS-CoV-2 outbreak in Italy [published online ahead of print, 2020 May 11]. Diabetes Ther. 2020:1–11. https://doi.org/10.1007/s13300-020-00829-7.

33.

Tornese G, Ceconi V, Monasta L, Carletti C, Faleschini E, Barbi E. Glycemic control in type 1 diabetes mellitus during COVID-19 quarantine and the role of in-home physical activity [published online ahead of print, 2020 May 21]. Diabetes Technol Ther. 2020. https://doi.org/10.1089/dia.2020.0169.

34.

Beato-Víbora PI. No deleterious effect of lockdown due to COVID-19 pandemic on glycemic control, measured by glucose monitoring, in adults with type 1 diabetes [published online ahead of print, 2020 May 12]. Diabetes Technol Ther. 2020. https://doi.org/10.1089/dia.2020.0184.

35.

Chen P, Mao L, Nassis GP, et al. Coronavirus disease (COVID-19): the need to maintain regular physical activity while taking precautions. J Sport Health Sci. 2020;9:103–4.CrossRef

36.

Peluso MA, Guerra de Andrade LH. Physical activity and mental health: the association between exercise and mood. Clinics (Sao Paulo). 2005;60:61–70.CrossRef

37.

Cherubini V, Gohil A, Addala A, et al. Unintended consequences of COVID-19: remember general pediatrics [published online ahead of print, 2020 May 8]. J Pediatr. 2020;S0022-3476(20):30578-3. https://doi.org/10.1016/j.jpeds.2020.05.004.CrossRef

38.

Laffel LM, Limbert C, Phelan H, Virmani A, Wood J, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: sick day management in children and adolescents with diabetes. Pediatr Diabetes. 2018;19(Suppl 27):193–204. https://doi.org/10.1111/pedi.12741.CrossRefPubMed

39.

https://cdn.ymaws.com/www.ispad.org/resource/resmgr/covid19/covid-19_role_of_subcutaneou.pdf. Accessed on 1^st June 2020.

40.

Swan KL, Weinzimer SA, Dziura JD, et al. Effect of puberty on the pharmacodynamic and pharmacokinetic properties of insulin pump therapy of youth with Type 1 diabetes. Diabetes Care. Jan 2008;31(1):44–6.CrossRef

41.

Cohen M, Leibovitz N, Shilo S, Zuckerman-Levin N, Shavit I, Shehadeh N. Subcutaneous regular insulin for the treatment of diabetic ketoacidosis in children. Pediatr Diabetes. June 2017;18(4):290–6.CrossRef

42.

Fisher JN, Shahshahani MN, Kitabchi AE. Diabetic ketoacidosis: low-dose insulin therapy by various routes. N Engl J Med. 1977;297(5):238–41.CrossRef

43.

Joensen LE, Madsen KP, Holm L, et al. 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? [published online ahead of print, 2020 May 11]. Diabet Med. 2020. https://doi.org/10.1111/dme.14319.

44.

Espinoza J, Shah P, Raymond J. Integrating continuous glucose monitor data directly into the electronic health record: proof of concept [published online ahead of print, 2020 Jan 6]. Diabetes Technol Ther. 2020. https://doi.org/10.1089/dia.2019.0377.

45.

Garg SK, Rodbard D, Hirsch IB, Forlenza GP. Managing new-onset type 1 diabetes during the COVID-19 pandemic: challenges and opportunities [published online ahead of print, 2020 Apr 17]. Diabetes Technol Ther. 2020. https://doi.org/10.1089/dia.2020.0161.

46.

Castle JR, Rocha L, Ahmann A. How COVID-19 Rapidly transformed clinical practice at the Harold Schnitzer Diabetes Health Center now and for the future [published online ahead of print, 2020 May 22]. J Diabetes Sci Technol. 2020:1932296820929368. https://doi.org/10.1177/1932296820929368.

Title: COVID-19 and type 1 diabetes: dealing with the difficult duo
Authors: Subhankar Chowdhury
Soumik Goswami
Publication date: 01-09-2020
Publisher: Springer India
Keywords: Insulins
SARS-CoV-2
COVID-19
Ketoacidosis
Insulins
Type 1 Diabetes
Published in: International Journal of Diabetes in Developing Countries / Issue 3/2020
Print ISSN: 0973-3930
Electronic ISSN: 1998-3832
DOI: https://doi.org/10.1007/s13410-020-00846-z

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