COVID-19 and diabetes

Laura Orioli, Michel P. Hermans, Vanessa Preumont, Audrey Loumaye, Jean-Paul Thissen, Orsalia Alexopoulou, Raluca Furnica, Maria-Cristina Burlacu, Dominique Maiter, Jean-Cyr Yombi, Bernard Vandeleene Published in the journal : May 2020 Category : Diabétologie

Diabetes is one of the most commonly reported comorbidities in COVID-19-infected patients. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. However, diabetes is a risk factor for developing severe and critical COVID-19 forms, which often require intensive care unit admission and, eventually, invasive mechanical ventilation, which are associated with high mortality rates. The characteristics of COVID-19 diabetic patients and prognostic impact of diabetes on SARS-CoV-2 infection are currently under investigation. Obesity, the main risk factor for incident Type 2 diabetes, appears to be more common in patients with critical COVID-19 forms that require mechanical invasive ventilation. In diabetic patients, COVID-19 is associated with poor glycemic control and acute metabolic complications like ketoacidosis. At present, there are no recommendations in favor of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Owing to the risks of lactic acidosis and ketoacidosis, metformin and SGLT2 inhibitors should be discontinued in patients with severe COVID-19 forms. Finally, we advise a systematic screening for (pre)diabetes in patients with proven SARS-CoV-2 infection.

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Hyperglycemia in type 2 diabetes: a synthesis of the new therapeutic recommendations

Martin Buysschaert Published in the journal : April 2020 Category : Diabétologie

This paper sought to describe and discuss the new guidelines for the treatment of hyperglycemia in patients with Type 2 diabetes, published in 2020 by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). Besides lifestyle measures, metformin remains the first-line treatment. Additional antihyperglycemic agents are now selected depending of a past history of cardiovascular or renal diseases. Antidiabetic agents with proven cardiac and renal protection should be privileged, particularly in secondary prevention. These recommendations define a structured strategy, which must be implemented in each country, according to internal rules.

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New Type 2 diabetes treatments: cardiovascular safety/benefit and neproprotection

Martin Buysschaert, Benoit Buysschaert, Isabelle Paris, José Luis Medina, Michael Bergman, Vanessa Preumont Published in the journal : January 2020 Category : Diabétologie

Diabetic nephropathy is currently the leading cause of chronic end-stage renal disease, along with its clinical consequences. Its prevention implies multidisciplinary management based on strict control of blood glucose from diabetes onset, in addition to blood pressure control, primarily using ACE-I inhibitors or sartans. Recent clinical trials have demonstrated the cardiovascular security/benefits as well as nephroprotective effects of new classes of antihyperglycemic agents (DDP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors), in addition to their well-established antihyperglycemic effects.

This paper aims to review the state of the art of diabetes-related cardiovascular and renal complication management.

 

 

 

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Impact of Freestyle Libre flash glucose monitoring system on glycemic control and quality of life

Margarita Goula, Marie Strivay, Vincianne Thielen Published in the journal : December 2019 Category : Diabétologie

The self-monitoring of glucose values is deemed necessary in diabetic patients to achieve a better glycemic control while avoiding hypoglycemias. New technologies have been devel-oped, such as the Freestyle Libre (sFL), a flash glucose monitoring system whose impact on better glycemic control and improved quality of life must still be assessed. This study confirmed the significant rise in the frequency of self-monitored glucose tests performed when using the sFL, in comparison with baseline, thereby resulting in an improvement in glycemic control and various quality of life features. Larger studies are required to elucidate the potential benefits gained by using sFL in blood glucose self-monitoring by diabetic in a larger scale.

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Predictive factors of macroangiopathy in type 2 diabetic patients

Imen Sebai, Ibtissem Oueslati, Nadia Khessairi, Meriem Yazidi, Emna Talbi, Fatma Chaker Mélika Chihaoui Published in the journal : October 2019 Category : Diabétologie

Cardiovascular complications are the first cause of mortality in patients with type 2 diabetes mellitus. The aim of our study was to determine the risk factors related to diabetic macroangiopathy. To meet this purpose, we conducted a cross-sectional study among 71 patients with type 2 diabetes mellitus. Patients were divided into two groups according to presence or absence of macroangiopathy. The examination included full medical histories, somatic examination and laboratory tests, in particular brain natriuretic peptide (BNP) measurements. The univariate analysis showed a significant association between macroangiopathy and male gender (p = 0.029), HbA1c > 9.5% (p = 0.008), a cumulative number of cardiovascular risk factors>5 (p <10-3), hypertension, presence of microangiopathy (p <10-3) and BNP plasmatic level > 24 pg/mL (p=0.007). In multivariate analysis, predictor factors were a cumulative cardiovascular risk factors > 5 (OR=13.9 [95%CI:1.4 -137.6], p = 0.024), presence of microangiopathy (OR=22 [95%CI: 2.2 - 215.4], p = 0.008) and HbA1c>9.5% (OR = 36.6 [95%CI:2.6 - 505]; p = 0.007). Thus, cardiovascular diseases were the consequence of the entanglement of traditional risk factors with the involvement of chronic hyperglycemia.

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Is type 1 diabetes auto-immune disease?

Caroline Daems, Juliette Vanderroost, Philippe A. Lysy Published in the journal : April 2019 Category : Diabétologie

Type 1 diabetes (T1D) is a medical condition characterized by insulin secretion deficiency, inducing chronic hyperglycemia, and subsequent autoimmune destruction of insulin-producing pancreatic β cells. This destruction is primarily mediated by CD4+ helper T cells and CD8+ cytotoxic T lymphocytes that induce β cell death, also termed apoptosis. Recently, several research teams have challenged the purely autoimmune origin of the disease. Indeed, insulitis is not systematically found in all pancreatic samples analyzed, whereas immune therapies aimed to suppress autoimmunity and restore the immune tolerance have not always achieved the expected success. Inflammation, undeniably, plays a key role in the trigger and development of T1D, and in particular the pro-inflammatory cytokines IL-1β, IFN-γ, and TNF-α. By activating inflammatory cascades and endoplasmic reticulum stress in β cells, these cytokines ultimately lead to cellular apoptosis. The condition’s true cause, whether autoimmunity or inflammation, is, however, still unknown. In this review, we have summarized the different pathophysiological aspects of T1D, whether autoimmune or inflammatory.

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Suliqua®, a fixed-ratio combination of basal insulin glargine and lixisenatide: role in the management of type 2 diabetes

Martin Buysschaert, Vanessa Preumont (1) Published in the journal : January 2019 Category : Diabétologie

Suliqua® is a new fixed-ratio combination product of the basal insulin glargine 100U/mL and the GLP-1 receptor agonist lixisenatide. This article sought to analyze the recent literature to better identify the product’s potential advantages in general and more particularly, in comparison to basal insulin, and to clarify its precise place in the treatment algorithm for Type 2 diabetes in Belgium.

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Dapagliflozin and cardiovascular events in type 2 diabetes : the model of the DECLARE-TIMI 58 trial

Martin Buysschaert Published in the journal : January 2019 Category : Diabétologie

This paper aimed to review the clinical data on dapagliflozin (Forxiga®) treatment in the light of the recent DECLARE-TIMI 58 trial results. This study involving Type 2 diabetic patients, either with or without prior macroangiopathy, has demonstrated cardiovascular benefits in terms of the primary efficacy outcome, namely a composite of cardiovascular death and hospitalization for heart failure. Moreover, the study has revealed a lower risk for renal disease progression.

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XULTOPHY®, A COMBINATION OF BASAL INSULIN AND LIRAGLUTIDE: ROLE IN THE TREATMENT OF TYPE 2 DIABETES

Martin Buysschaert Published in the journal : September 2018 Category : Diabétologie

Xultophy® is a new combination product consisting of basal insulin (degludec) and a GLP-1 agonist (liraglutide). In this article, we analyzed recent literature in order to find out its potential advantages in general and compared to basal insulin in particular, as well as to clarify its role in the therapeutic management of insulinrequiring type 2 diabetes. 

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Glycemic self-monitoring: benefit-cost ratio

Vanessa Preumont, Stéphanie Rouhard Published in the journal : March 2018 Category : Diabétologie

The FreeStyle Libre® and Guardian Connect® glucose monitors are currently available in Belgium for patients with Type 1 diabetes and for subjects without residual insulin secretion. The FreeStyle Libre® device was designed to replace the recommended finger-stick glucose monitoring, without any need of calibration. Accuracy is comparable to that pertaining to currently available real-time continuous glucose monitoring. The system can be used in adults, children, and during pregnancy. In randomized trials, its use was reported associated with a reduction in hypoglycemia and, in observational studies, with an improvement in glycated hemoglobin levels. User satisfaction was proven high, with relatively few adverse events. Glucose data can be summarized as ambulatory profile in order to facilitate insulin dose adjustments. Further trials are needed in order to assess the long-term impact on both glycated hemoglobin and quality of life.

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