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      COVID-19 may increase the risk of insulin resistance in adult patients without diabetes: A 6-month prospective study

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          Abstract

          Objective

          During the coronavirus disease 2019 (COVID-19) pandemic, exploring insulin resistance and β-cell activity is important for understanding COVID-19-associated new-onset diabetes. This study aimed to assess insulin sensitivity and fasting insulin secretion in COVID-19 patients without diabetes on admission and at 3 and 6 months after discharge.

          Methods

          This 6-month prospective study assessed data from the records of 64 patients without diabetes diagnosed with COVID-19 at Wenzhou Central Hospital, China. Each patient was followed up for 3 and 6 months after discharge. Repeated measures analysis of variance was used to investigate differences in multiple measurements of the same variable at different times. Linear regression analysis was performed to analyze the contributor for changes in triglyceride-glucose (TyG) index.

          Results

          Fasting C-peptide levels in patients at baseline were lower than the normal range (1.1-4.4 μg/L). Compared with baseline, patients had significantly elevated fasting C-peptide levels (0.35±0.24 vs. 2.36±0.98 vs. 2.52±1.11 μg/L, P˂0.001), HOMA-CP (0.42, IQR 0.36–0.62 vs. 2.54, IQR 1.95-3.42 vs. 2.90, IQR 2.02-4.23, P˂0.001) and TyG indexes (8.57±0.47 vs. 8.73±0.60 vs. 8.82±0.62, P=0.006), and decreased fasting glucose levels (5.84±1.21 vs. 4.95±0.76 vs. 5.40±0.68 mmol/L, P=0.003) during the 3 and 6-month follow-up. Male gender [β (95%CI): -0.312 (-0.590, -0.034)], age [0.012 (0.001, 0.023)], interferon-alfa treatment during hospitalization [0.540 (0.029, 1.051)], and changes in TC [0.217 (0.069, 0.366)] and HDL [-0.477 (-0.881, -0.074)] levels were significantly associated with changes in the TyG index.

          Conclusions

          Our study provided the first evidence that COVID-19 may increase the risk of insulin resistance in patients without diabetes.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
            In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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              Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

              Nanshan Chen, Min Zhou, Xuan Dong … (2022)
              Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocr Pract
                Journal ID (iso-abbrev): Endocr Pract
                Title: Endocrine Practice
                Publisher: Published by Elsevier Inc. on behalf of the AACE.
                ISSN (Print): 1530-891X
                ISSN (Electronic): 1934-2403
                Publication date PMC-release: 19 April 2021
                Publication date (Electronic): 19 April 2021
                Affiliations
                [1 ]Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
                [2 ]Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
                [3 ]Departments of Infectious Disease, The Ding Li Clinical College of Wenzhou Medical University and Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang, China
                [4 ]Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, California 94305, USA
                [5 ]Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
                Author notes
                [† ] Co-Corresponding author: Chenchan Hu, M.D., 1 Qinzhong Road, Ouhai District, Wenzhou, 325000, Zhejiang Province, China; Tel. 0086-577-86718186; Fax. 0086577-86718337.
                [∗∗ ] Co-Corresponding author: Jue Li, M.D., Ph.D., 1239 Siping Road, Yangpu District, Shanghai, 200092, China; Tel. 0086-21-65986735; Fax. 008621-65987071.
                [# ]Shen Qu (Shen Qu will handle correspondence at all stages of refereeing and publication), M.D., Ph.D., 301 Yanchang Road, Jin’an District, Shanghai, 200072, China; Tel. 0086-21-66302531; Fax. 008621-66302531.
                [∗]

                Co-first authors: Mochuan Chen and Bing Zhu should be considered joint first author.

                Article
                Publisher Item ID: S1530-891X(21)00161-0
                DOI: 10.1016/j.eprac.2021.04.004
                PMC ID: 8054613
                PubMed ID: 33887468
                SO-VID: 2504f368-4d4b-4020-901a-27add4730655
                Copyright © © 2021 Published by Elsevier Inc. on behalf of the AACE.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 6 February 2021
                Date revision received : 2 April 2021
                Date accepted : 8 April 2021
                Categories
                Subject: Article

                Keywords: coronavirus disease 2019 (covid-19),insulin resistance,insulin secretion,triglyceride-glucose (tyg) index
                Data availability:
                Keywords: coronavirus disease 2019 (covid-19), insulin resistance, insulin secretion, triglyceride-glucose (tyg) index

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