Pharmacological Management of Obese Patients with Type 2 Diabetes amid COVID-19 Pandemic

Excerpt

The hypothesis put forward by Iannelli et al. [1] to suggest that obesity is the missing piece accounting for the variation in the severity of coronavirus disease 2019 (COVID-19) in their discussion entitled “Obesity and COVID-19: ACE 2, the Missing Tile” has been of our great interest. The authors described the association of obesity with an imbalance in the renal-angiotensin-aldosterone system, where angiotensin-converting enzyme 2, the entry receptor of severe acute respiratory syndrome coronavirus 2, is largely expressed in adipose tissue. Therefore, obese individuals may develop a more overwhelming inflammatory response compared with non-obese individuals upon acquisition of COVID-19. The hypothesis has somewhat been confirmed in the recent CORONADO study [2], a nationwide multicenter observational study among diabetic patients hospitalized for COVID-19 in 53 French centers which reported body mass index (BMI) as the only independent pre-admission predictor associated with the primary outcome of combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission in a multivariable analysis that included characteristics before admission (adjusted odds ratio = 1.28; 95% confidence interval 1.10–1.47). In fact, in an earlier retrospective study [3] to determine the clinical outcomes of diabetic patients with COVID-19 in association with glucose-lowering medications, it was reported that long-term insulin usage, which may lead to weight gain, was associated with progression to severe or critical illness or in-hospital death (adjusted odds ratio = 3.58; 95% confidence interval 1.37–9.35). …