COVID-19 and diabetes mellitus: from pathophysiology to clinical management.
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TLDR
Evidence suggests that insulin and dipeptidyl peptidase 4 inhibitors can be used safely in patients with diabetes mellitus and COVID-19; metformin and sodium–glucose cotransporter 2 inhibitors might need to be withdrawn in patients at high risk of severe disease.Abstract:
Initial studies found increased severity of coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals to hyperglycaemia. Interacting with other risk factors, hyperglycaemia might modulate immune and inflammatory responses, thus predisposing patients to severe COVID-19 and possible lethal outcomes. Angiotensin-converting enzyme 2 (ACE2), which is part of the renin-angiotensin-aldosterone system (RAAS), is the main entry receptor for SARS-CoV-2; although dipeptidyl peptidase 4 (DPP4) might also act as a binding target. Preliminary data, however, do not suggest a notable effect of glucose-lowering DPP4 inhibitors on SARS-CoV-2 susceptibility. Owing to their pharmacological characteristics, sodium-glucose cotransporter 2 (SGLT2) inhibitors might cause adverse effects in patients with COVID-19 and so cannot be recommended. Currently, insulin should be the main approach to the control of acute glycaemia. Most available evidence does not distinguish between the major types of diabetes mellitus and is related to type 2 diabetes mellitus owing to its high prevalence. However, some limited evidence is now available on type 1 diabetes mellitus and COVID-19. Most of these conclusions are preliminary, and further investigation of the optimal management in patients with diabetes mellitus is warranted.read more
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TL;DR: The crystal structure of the receptor binding domain of the MERS-CoV spike protein, both free and bound to the receptor, was presented in this article, which revealed a core subdomain homologous to that of the SARS-coV spike proteins, and a unique strand-dominated external receptor binding motif that recognizes blades IV and V of the CD26 β-propeller.
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Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS
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TL;DR: This study aims to investigate the relationships between a known history of diabetes and ambient fasting plasma glucose levels with death and morbidity rates in patients with severe acute respiratory syndrome (SARS).
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Inflammation and Thrombosis The Clot Thickens
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