This study examined a cohort of patients who died or were discharged from January 1, 2020–March 3, 2020.
Overall mortality in this cohort was 9.7%. The median age was 57.5, 45.1% were male and 6.4% of patients presented with ketosis. The patients presenting with ketosis were younger (47 years), and had higher rates of pre-existing diabetes (diabetes (35.7% vs 18.5%, P=0.007). Fifteen of the 42 total patients who had ketosis also had diabetes.
The discussion of this paper states that COVID-19 caused ketosis and ketoacidosis in patients with diabetes. The following 4 points raise serious questions about this assertion of causality and the overall validity of the authors conclusions:
Overall, this paper has several errors, missing data and misconceptions regarding ketosis
Peer reviewed and published in Diabetes Metabolism Research and Reviews. Commentary and Hypothesis as to why obesity may lead to poor outcomes after COVID-19 infection.
Summary of COVID/Obesity publications at time of paper.
Possible links with obesity and worsening COVID
Letter to the Editor of Obesity.
This letter was written in response to a previously published study in Obesity which found a very high rate of obesity in COVID patients who required mechanical ventilation. The authors raise the question of generalizability of the study as 1. There is no standard as to when mechanical ventilation should be applied in worsening COVID, and 2. The rate of obesity in the surrounding community may be a significant factor. They report on outcomes from Lyon University Hospital, France, from 291 consecutive patients admitted to ICU for SARS-CoV-2 between February 27th and April 8th 2020. In the Lyon community the rate of obesity was much lower (11.3 %) compared to the community of the previous study (28.2%) and the requirement for mechanical ventilation was lower 58.4% versus 68.6%. They hypothesize the difference may be due to differing obesity rates or an increased use of high-flow oxygen delivery by opti-flow. **the rate of non-mechanical ventilation interventions for either site were not reported. Despite differing numbers, both studies did find that obesity was a risk for mechanical ventilation use.
Peer reviewed and published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Narrative review.
Concern is raised that chronic diabetes care is imperative during the current pandemic as diabetes is a significant risk factor for poor outcomes with COVID-19 and that improved glycemic control would help boost the innate immune system.
A study from China found worsening glycemic control in elderly patients with diabetes during the pandemic. This was postulated to occur due to change in nutrition due to access, decreased physical activity due to lockdowns and social distancing, decreased access to medication and testing supplies, increased stress and decreased access to diabetes care providers.
Recommendations for improved glycemic control are given. These recommendations are made for the population in India. Barriers to the implementation of recommendations are also made.