Poor glycemic control and obesity exacerbate COVID-19 outcomes

JOsé O. Alemán, MD, PhD, assistant professor of endocrinology at NYU Langone Health, discovered an unknown potential when the 2019 coronavirus disease (COVID-19) pandemic began attacking New York in March and April. “It became very clear that the experience in New York would be different from the experience in China and Italy,” he recalls, the difficult experience of facing a deadly disease. Doctor german, VA NY Caring for the patient in the COVID-19 ward on the Manhattan campus of the Harbor Healthcare System.

Awkward links to obesity and hyperglycemia

In China and Italy, COVID-19 is already aging as a prognostic risk factor for hospitalization, emergency care and death. However, in a more diverse patient population in New York, Dr. Alleman soon realized another observation. A body mass index (BMI) of over 30 was likely to pose a higher risk to younger patients. To make matters worse, he and his colleagues started diagnosing new episodes Diabetes Among multiple patients with COVID-19 obesity..

Multiple research groups at NYU Langone. Leora Horwitz, MD, Associate Professor of Medicine and Population Health, and Jennifer L. Reiter, MD, Associate Professor of Pediatrics, and Michael S. Phillips, MD, The main epidemiologists in the hospital, raced to study case reports of interest. In a large, retrospective study of 6,585 patients treated with COVID-19 across the VA health care system across the country, Dr. Alemán and colleagues identified a major risk factor for poor age outcomes. Factors that have been identified and reconfirmed in previous studies as important additional information about the findings of male gender and obesity. However, by investigating the extensive medical records of veterans seeking care with the VA system, Dr. Alleman’s group found another major risk factor that was previously undocumented.

“In veteran populations, poor glycemic control measured by hemoglobin A1c levels is a stronger risk factor for poor COVID-19 outcomes than BMI when compared head to head,” he says. The data in his group suggest that, in fact, at all outcome levels, high hemoglobin A1c counts are three to four times more predictable than high BMI. Together, the two factors seem to have a synergistic effect. “We are in the process of establishing how much it is, but it’s more than an additive effect,” Dr. Allemann said.

Overlapping epidemics

The obesity epidemic in the United States was created decades ago and was caused in part by lack of access to both nutritious foods and good health care, he says. There’s a long-standing epidemic that overlaps with a new pandemic called the “reveler,” says Alleman. In particular, underserved minority communities may have worse baseline health and may be more susceptible to COVID-19 than white communities. “Most of our population is significantly more morbid than they think, due to underlying excess weight and related complications that have not been investigated, and COVID-19 reveals it. Yes,” said Dr. Alleman.

It is unclear exactly how obesity and glycemic control exacerbate the risk. But more than a decade ago, researchers found that about 70% of obese patients had an excessive number of macrophage cells in adipose tissue. Macrophages, which are primarily responsible for clearing infections and cell debris, play an important role in regulating inflammation. Dr. Alleman and others have begun to consider obesity as a chronic inflammatory condition, assuming that inflammation begins in dysfunctional adipose tissue for unknown reasons and propagates into the circulatory system. Researchers observe that obese patients have elevated levels of markers of circulating inflammation, and Dr. Alleman is investigating how reversible this low degree of inflammation is.

2017 clinical weight loss study His group found that postmenopausal obese female patients on a low-calorie diet all had improved levels of insulin, glucose, leptin, and inflammatory markers. However, unexpectedly, the researchers saw increased macrophage infiltration into the patient’s adipose tissue during the early stages of weight loss.

Animal studies in other laboratories suggest that such infiltration is transient during continued weight loss, but Dr. Alleman said it was an important risk factor for obesity complications. I am assuming there is. Based on his ongoing and clinical research, he believes that doctors may be able to treat inflammation separately from achieving weight loss in patients with chronic obesity. “That means it could reduce some of the excess weight complications we think are associated with inflammation, such as diabetes, cardiovascular disease, and now COVID-19.” He says.

Examine the consequences of inflammation

By measuring systemic inflammation markers, Dr. Allemann and colleagues hope to understand whether patients with obese and dysfunctional adipose tissue will not be protected by the upcoming COVID-19 vaccine .. If so, this study will help identify patients with a higher risk of poor prognosis and less likely to benefit from standard vaccination.

The treatment exam helps provide additional answers. Initial trials of inhibitors of the inflammatory cytokine IL-6 do not suggest a clear benefit of COVID-19 for critically ill patients, but trials with the corticosteroid dexamethasone show more promise. The result is obtained. “It lends credence to the idea that steroids may be beneficial in suppressing the widespread inflammation,” says Alleman.

To further elicit a potential relevance, he wants to compare metabolic and inflammatory changes in diabetic and nondiabetic patients undergoing bariatric surgery and those diagnosed with COVID-19. While many questions remain unanswered, a new link between COVID-19, obesity, and glycemic control suggests that obesity represents multiple diseases, a particular type characterized by dysfunctional adipose tissue and inflammation. Supports the idea that may lead to more serious COVID-19 complications.