Stabilizing blood sugar within the appropriate range will improve clinical outcomes in patients with COVID-19 combined T2DM

Ong Jianpingunit: China University of Science and Technology affiliated with the first hospitalthe current new coronavirus pneumonia (COVID-19) epidemic is still spreading around the world, is the international community focused on public health emergenciesAfter months of unremitting efforts from all walks of life in the country to fight the epidemic, China's Wuhan City, Hubei Province as the center of the local epidemic epidemic has basically ended, the epidemic prevention and control tend to become normalAccording to data released by theInternational Diabetes Alliance in 2019, there are 116 million people with diabetes in ChinaIn this extraordinary period, how to help COVID-19 co-diabetes patients to do a good job of blood glucose management, and what degree of medical intervention is a hot issue of health care, scholarsGiven that high blood sugar may affect lung ventilation and alveoli dispersion function through inflammatory pathways and stimulation of free radicals, and that infection may enhance the body's stress response leading to greater blood glucose fluctuations, health care providers urgently need to take root in clinical research data to analyze the relationship between blood glucose control and death and other adverse events in COVID-19 patients to implement more effective medical interventionsMay 1, 2020, Professor Li Hongliang of Wuhan University,in cell-metabolism magazine reported 7337 CASES OF COVID-19 admitted to 19 hospitals in Hubei Province from December 30, 2019 to March 20, 2020Epidemiological, clinical, imaging, laboratory and demographic statistics of cases and a group review of 952 cases of type 2 diabetes (T2DM) (13.0% of the total number of cases, similar to 10.9% of the prevalence rate of T2DM nationwide) and 6385 cases without T2DMCompared to non-combined T2DM patients, COVID-19 cases of combined T2DM were older (median age 62 and 53 years old respectively), had higher rates of clinical symptoms such as breathing difficulties (20.5% and 15.4%, respectively), and were prone to combined underlying diseases (including 53.4% and 19.7% coronary blood pressure, 13.7%, and 3.7%, and cerebrovascular disease s5.6% and 1.5%, respectively)Related:Cell Metab: Professor Li Hongliang found that diabetes combined with new coronary pneumonia patients blood glucose control levels and mortality diabetes patients can be due to high blood sugar status in the body can lead to low immunity, in the team reported 952 cases of COVID-19 combined T2DM, the proportion of peripheral blood lymphocyte reduction was significantly higher than the proportion of patients with non-tithastal 44.5% and 32.6%), while the increase in serum markers indicating inflammatory response and high coagulation status was also significantly higher than that of the non-T2DM group (C-reactive protein 57.0% and 42.4%, calcitonin was 33.3% and 20.3%, d-dipolymers were 50.5% and 33.3%, respectively, This confirms that the adverse effects of high blood sugar on the body's immune system may make patients with COVID-19 more likely to develop adverse events such as infections, inflammatory reactions and thromboembolism In addition, the author noted that of the 7337 patients reported by the team, the T2DM group had a higher incidence of blood oxygen saturation below 95% when admitted to hospital (18.8% and 13.2%, respectively), and were more likely to develop adult respiratory distress syndrome (16.9% and 7%, respectively) 2%), therefore, the use of various respiratory support measures (including oxygen absorption 76.9% and 61.2%, non-invasive ventilation was 10.2% and 3.9%, respectively, invasive ventilation was 3.6% and 0.7%) Although patients with COVID-19 who were combined with T2DM received higher-intensity comprehensive treatment, the proportion of adverse prognosis was not reduced (infectious shock was 3.8% and 1.0%, respectively, and diffuse intravascular coagulation was 0.5% and 0, respectively 2% mortality rate, 8.4% and 2.8%, adjusted risk ratio of 1.49), indicating that coVID-19 individuals with T2DM needed more medical intervention than non-diabetic individuals, with higher mortality rates and more pronounced multi-organ injuries what kind of blood sugar control strategy should we adopt and what degree of blood sugar control goals should be set? The team the by analyzing 282 patients in the queue with good blood sugar control (with a range of 3.9 to 10.0 mmol/L, median age of 62 years, male 136 patients, 48.2%), and 528 patients with poor blood sugar control (with a maximum of 10.0 mmol/L, median age of 63 years, 298 males, or 56.) 4%), found that patients with good blood sugar control had lower blood oxygen saturation (12.6% and 22.7%, respectively) compared to coVID-19 patients with poor blood sugar control, and had a lower incidence of lymphocyte reduction (30.5% and 49.6%, respectively), suggesting that better blood sugar control might help improve the oxygenation and immunity of the lungs of COVID-19 patients, and therefore needed to support breathing at a lower rate (including 5.50 percent) Non-invasive ventilation was 4.6% and 11.9%, respectively, and invasive ventilation was 0.0% and 4.2%, respectively) It should also be noted that while the medical input required by patients with good blood sugar control has decreased significantly (the proportion of antiviral drugs used is 62.8% and 71.2%, respectively, the proportion of immunoglobulin infusions is 15.3% and 26.5%, respectively), the proportion of adverse events during hospitalization is significantly lower (adult respiratory Embarrassment syndrome was 7.1% and 21.4%, infectious shock was 0.0% and 4.7%, respectively, and diffuse intravascular coagulation was 0.0% and 0.6%, respectively, with lower mortality rates (1.1% and 11%, respectively) This shows that the control of blood glucose in patients with COVID-19 combined T2DM is a feasible auxiliary treatment, which is more conducive to the protection of important organ functions this finding provides sufficient evidence to improve the blood glucose status and clinical prognosis of COVID-19 patients with T2DM, and also clearly suggests that important risk factors for COVID-19 progression and adverse endpoints such as T2DM, and that stabilizing blood sugar within the appropriate range (3.9 to 10.0 mmol/L) can help reduce the incidence and mortality of adverse events and mortality in such patients and improve their clinical outcomes References Int J Mol Sci, 2017, 18 (3): E563 DOI: 10.3390/ijms18030563 Wang Baoli, Hu Lunyang, Jiang Yong, etc Research progress in stress hyperglycemia therapy in ICU patients J/CD Chinese Journal of Critical Illness Medicine (electronic version), 2019, 12 (4):276-280 DOI: 10.3877/cma.j.issn.1674-6880.2019.04.014 Zhu LH, She ZG, Cheng X, et al Association of the blood money money control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes Cell Metab, 2020, 31 (1) DOI: 10.1016/j.cmet.2020.04.021 Ong Jianping Source: , Chinese Diabetes Journal