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14 pages, 590 KiB

Open AccessArticle

The Impact of SARS-CoV-2 Infection on Glucose Homeostasis in Hospitalized Patients with Pulmonary Impairment

by Oana-Andreea Parlițeanu, Mara-Amalia Bălteanu, Dragoș Cosmin Zaharia, Tudor Constantinescu, Alexandra Maria Cristea, Ștefan Dumitrache-Rujinscki, Andra Elena Nica, Cristiana Voineag, Octavian Sabin Alexe, Emilia Tabacu, Alina Croitoru, Irina Strâmbu, Roxana Maria Nemeș and Beatrice Mahler

Diagnostics 2025, 15(5), 554; https://doi.org/10.3390/diagnostics15050554 - 25 Feb 2025

Viewed by 468

Abstract

Background and Objectives: We conducted a retrospective observational study to evaluate the impact of elevated blood glucose levels in patients with SARS-CoV-2 infection and a prior diagnosis of diabetes mellitus (DM) or newly diagnosed hyperglycemia. Materials and Methods: This study analyzed 6065 patients [...] Read more.

Background and Objectives: We conducted a retrospective observational study to evaluate the impact of elevated blood glucose levels in patients with SARS-CoV-2 infection and a prior diagnosis of diabetes mellitus (DM) or newly diagnosed hyperglycemia. Materials and Methods: This study analyzed 6065 patients admitted to the COVID-19 departments of the “Marius Nasta” National Institute of Pulmonology in Bucharest, Romania, between 26 October 2020 and 5 January 2023. Of these, 813 patients (13.40%) were selected for analysis due to either a pre-existing diagnosis of DM or hyperglycemia at the time of hospital admission. Results: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were elevated in patients with blood glucose levels exceeding 300 mg/dL. These elevations correlated with the presence of respiratory failure and increased mortality rates. Additionally, oxygen requirements were significantly higher at elevated blood glucose levels (p < 0.001), with a direct relationship between glycemia and oxygen demand. This was accompanied by lower oxygen saturation levels (p < 0.001). Maximum blood glucose levels were associated with the severity of respiratory failure (AUC 0.6, 95% CI: 0.56–0.63, p < 0.001). We identified cut-off values for blood glucose at admission (217.5 mg/dL) and maximum blood glucose during hospitalization (257.5 mg/dL), both of which were associated with disease severity and identified as risk factors for increased mortality. Conclusions: High blood glucose levels, both at admission and during hospitalization, were identified as risk factors for poor prognosis and increased mortality in patients with SARS-CoV-2 infection, regardless of whether the hyperglycemia was due to a prior diagnosis of DM or was newly developed during the hospital stay. These findings underscore the importance of glycemic control in the management of hospitalized COVID-19 patients. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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11 pages, 511 KiB

Open AccessArticle

Association of Positive Airway Pressure Adherence with Clinical Outcomes in Patients with Type 2 Diabetes and Obstructive Sleep Apnea

by Izolde Bouloukaki, George Stathakis, Violeta Moniaki, Eleni Mavroudi, Ioanna Tsiligianni and Sophia Schiza

Diagnostics 2024, 14(24), 2781; https://doi.org/10.3390/diagnostics14242781 - 11 Dec 2024

Viewed by 696

Abstract

Background/Objectives: There are controversies regarding the effect of obstructive sleep apnea (OSA) treatment with positive airway pressure (PAP) on diabetes-related outcomes. Therefore, we aimed to explore the association of PAP adherence with diabetes-related outcomes in patients with type 2 diabetes mellitus (T2DM) and [...] Read more.

Background/Objectives: There are controversies regarding the effect of obstructive sleep apnea (OSA) treatment with positive airway pressure (PAP) on diabetes-related outcomes. Therefore, we aimed to explore the association of PAP adherence with diabetes-related outcomes in patients with type 2 diabetes mellitus (T2DM) and OSA. Methods: In this prospective study, we included T2DM patients diagnosed with OSA during an 8-year period (2015–2023). PAP adherence (optimal usage for > 6 h/night for ≥ 70% of nights), hemoglobin A1c (HbA1c), body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), daytime sleepiness (Epworth Sleepiness Scale—ESS) and cardiovascular (CVD) events were recorded. Comparisons of the change in diabetes-related outcomes (follow-up to baseline) in the adherent and non-adherent groups were assessed by analysis of covariance to adjust for relevant confounders. Results: Of the 355 patients included, 199 (56%) were PAP adherent. The mean follow-up period was 5.5 years. At the end of the follow up period, the PAP adherent group achieved a greater decrease in HbA1c levels (−1.4 vs. −0.3), SBP (−10.1 vs. −5.5), DBP (−2.9 vs. −0.55) and ESS (−5.9 vs. −4.2) compared to the non-adherent groups. Conclusions: Achieving optimal PAP adherence in patients with T2DM and OSA was associated with improved diabetes-related outcomes. Therefore, current practices need to be modified to incorporate systematic assessment and treatment of OSA in these patients. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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Review

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13 pages, 466 KiB

Open AccessReview

Hyperglycemia and Lung Cancer—A Possible Relationship

by Spasoje Popevic, Nikola Maric, Branislav Ilic, Slobodan Belic, Ivana Sekulovic Radovanovic, Sanja Dimic-Janjic and Mihailo Stjepanovic

Diagnostics 2025, 15(6), 651; https://doi.org/10.3390/diagnostics15060651 - 7 Mar 2025

Viewed by 555

Abstract

Glucose is the main source of energy in human cells. Elevated levels of glucose are one of the most common metabolic disorders, and it has been shown to have a significant, mostly negative, effect on multiple chronic and acute diseases. Lung cancer remains [...] Read more.

Glucose is the main source of energy in human cells. Elevated levels of glucose are one of the most common metabolic disorders, and it has been shown to have a significant, mostly negative, effect on multiple chronic and acute diseases. Lung cancer remains one of the biggest challenges for treatment in modern medicine, with a high prevalence, incidence and mortality. Hyperglycemia is not uncommon in patients with lung cancer; however, it is usually overlooked. Patients with unregulated glycemia and lung cancer have been shown to have worse outcomes, reduced therapeutic effect and more complications during treatment. Studies have identified multiple molecular pathways common in both hyperglycemia and lung cancer; however, no clear correlation has been identified. By understanding these signaling pathways, we can influence the outcome therapeutically and thereby improve the survival of patients with lung cancer. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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12 pages, 261 KiB

Open AccessReview

The Complex Relationship Between Tuberculosis and Hyperglycemia

by Michelle Byers and Elizabeth Guy

Diagnostics 2024, 14(22), 2539; https://doi.org/10.3390/diagnostics14222539 - 13 Nov 2024

Cited by 1 | Viewed by 1089

Abstract

Hyperglycemia and tuberculosis are dual global pandemics. Each has a propulsive and amplifying effect on the other, and, because of this, we must consider hyperglycemia and tuberculosis together. Hyperglycemia is immunosuppressive and increases the risk of tuberculosis by threefold. It also leads to [...] Read more.

Hyperglycemia and tuberculosis are dual global pandemics. Each has a propulsive and amplifying effect on the other, and, because of this, we must consider hyperglycemia and tuberculosis together. Hyperglycemia is immunosuppressive and increases the risk of tuberculosis by threefold. It also leads to a more advanced presentation of pulmonary tuberculosis, thus increasing the likelihood of being smear positive and having cavitating lesions, and it impacts the duration and outcomes of treatment, with an increased one year mortality seen in patients with tuberculosis and diabetes. Additionally, any degree of hyperglycemia can have an impact on susceptibility to tuberculosis, and this effect is not limited to poorly controlled diabetes. Conversely, tuberculosis itself is associated with hyperglycemia and worsens hyperglycemia in those with diabetes mellitus. The impact of this relationship varies based on the base rates of each disease in different regions of the world. In order to successfully achieve the World Health Organization’s goals of tuberculosis eradication and adequate glycemic control, we must improve our understanding, co-management, and screening of hyperglycemia and tuberculosis. This review aims to explore the current research investigating the relationship between tuberculosis and diabetes, including the changes in disease susceptibility, presentation, geographic distribution, and effects on treatment. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

12 pages, 1377 KiB

Open AccessReview

Hyperglycemia and Venous Thromboembolism

by Neha Panchagnula and William Philip Brasher

Diagnostics 2024, 14(17), 1994; https://doi.org/10.3390/diagnostics14171994 - 9 Sep 2024

Cited by 1 | Viewed by 1725

Abstract

Patients with diabetes mellitus (DM) have chronically increased blood glucose and multiple physiologic alterations that place them at elevated risk for vascular disease. Traditionally, this vascular risk has mainly referred to chronic atherosclerosis and embolic arterial disease. Retrospective studies have suggested an increased [...] Read more.

Patients with diabetes mellitus (DM) have chronically increased blood glucose and multiple physiologic alterations that place them at elevated risk for vascular disease. Traditionally, this vascular risk has mainly referred to chronic atherosclerosis and embolic arterial disease. Retrospective studies have suggested an increased risk of a pulmonary embolism (PE) and deep vein thrombosis (DVT), collectively termed venous thromboembolism (VTE), in patients with DM, but this association has been difficult to demonstrate with comorbidities such as obesity in meta-analysis. Clinical studies have demonstrated worse outcomes for patients with DM who suffer from VTE. In vitro studies show multiple physiologic abnormalities with chronic inflammation, endothelial dysfunction, dysfunction in the coagulation cascade, as well as other changes that drive a vicious cycle of hypercoagulability. Aggressive medical management of DM can improve vascular outcomes, and some anti-hyperglycemic therapies may modify VTE risk as well. Anticoagulation strategies are similar for patients with DM, but with some added considerations, such as high rates of comorbid renal dysfunction. More research is needed to definitively categorize DM as a risk factor for VTE and elucidate specific therapeutic strategies. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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12 pages, 1001 KiB

Open AccessReview

Asthma and Hyperglycemia: Exploring the Interconnected Pathways

by Dharani K. Narendra and Sandhya Khurana

Diagnostics 2024, 14(17), 1869; https://doi.org/10.3390/diagnostics14171869 - 26 Aug 2024

Cited by 3 | Viewed by 2079

Abstract

The interplay between asthma and glucose metabolism disorders, such as hyperglycemia, has gained increasing attention due to the potential exacerbation of asthma symptoms and severity. This review explores the complex relationship between hyperglycemia and asthma, emphasizing the pathophysiological links, the impact of glucose [...] Read more.

The interplay between asthma and glucose metabolism disorders, such as hyperglycemia, has gained increasing attention due to the potential exacerbation of asthma symptoms and severity. This review explores the complex relationship between hyperglycemia and asthma, emphasizing the pathophysiological links, the impact of glucose metabolism disorders on asthma, and the effects of asthma medications on glucose levels. Hyperglycemia, often induced by asthma treatments like corticosteroids, has been associated with an increased risk of asthma exacerbations. This review delves into the pathophysiology underlying this association, highlighting the role of insulin resistance, metabolic syndrome, and obesity in both the development and management of asthma. Metabolic syndrome, characterized by abdominal obesity and hyperglycemia, independently increases the risk of worsening respiratory symptoms and asthma. Furthermore, this review examines the influence of various antidiabetic medications on asthma outcomes. Biguanides, like metformin, have shown promise in improving asthma outcomes in patients with type 2 diabetes mellitus and asthma. However, other medications have mixed results regarding their impact on asthma control and lung function. Considering these findings, this review advocates for further research into the role of metabolic pathways in asthma management. It calls for comparative studies and the inclusion of asthma-related outcomes in clinical trials of antidiabetic drugs to better understand their potential benefits for individuals with obesity and concurrent asthma. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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12 pages, 505 KiB

Open AccessEditor’s ChoiceReview

Pulmonary Hypertension and Hyperglycemia—Not a Sweet Combination

by Or Bruck and L. M. Pandit

Diagnostics 2024, 14(11), 1119; https://doi.org/10.3390/diagnostics14111119 - 28 May 2024

Cited by 1 | Viewed by 1909

Abstract

Hyperglycemia and pulmonary hypertension (PH) share common pathological pathways that lead to vascular dysfunction and resultant cardiovascular complications. These shared pathologic pathways involve endothelial dysfunction, inflammation, oxidative stress, and hormonal imbalances. Individuals with hyperglycemia or pulmonary hypertension also possess shared clinical factors that [...] Read more.

Hyperglycemia and pulmonary hypertension (PH) share common pathological pathways that lead to vascular dysfunction and resultant cardiovascular complications. These shared pathologic pathways involve endothelial dysfunction, inflammation, oxidative stress, and hormonal imbalances. Individuals with hyperglycemia or pulmonary hypertension also possess shared clinical factors that contribute to increased morbidity from both diseases. This review aims to explore the relationship between PH and hyperglycemia, highlighting the mechanisms underlying their association and discussing the clinical implications. Understanding these common pathologic and clinical factors will enable early detection for those at-risk for complications from both diseases, paving the way for improved research and targeted therapeutics. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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14 pages, 3776 KiB

Open AccessReview

Diabetes Mellitus and Pneumococcal Pneumonia

by Catia Cilloniz and Antoni Torres

Diagnostics 2024, 14(8), 859; https://doi.org/10.3390/diagnostics14080859 - 22 Apr 2024

Cited by 3 | Viewed by 4296

Abstract

Currently, there are more than 500 million people suffering from diabetes around the world. People aged 65 years or older are the most affected by this disease, and it is estimated that approximately 96% of diabetes cases worldwide are type 2 diabetes. People [...] Read more.

Currently, there are more than 500 million people suffering from diabetes around the world. People aged 65 years or older are the most affected by this disease, and it is estimated that approximately 96% of diabetes cases worldwide are type 2 diabetes. People with diabetes mellitus are at an increased risk of infections such as pneumonia, due to a series of factors that may contribute to immune dysfunction, including hyperglycemia, inhibition of neutrophil chemotaxis, impaired cytokine production, phagocytic cell dysfunction, altered T cell-mediated immune responses and the co-existence of chronic comorbidities. Rates of infection, hospitalization and mortality in diabetic patients are reported to be higher than in the general population. Research into the risk of infectious diseases such as pneumonia in these patients is very important because it will help improve their management and treatment. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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13 pages, 314 KiB

Open AccessReview

Hyperglycaemia and Chronic Obstructive Pulmonary Disease

by Mario Cazzola, Paola Rogliani, Josuel Ora, Luigino Calzetta, Davide Lauro and Maria Gabriella Matera

Diagnostics 2023, 13(21), 3362; https://doi.org/10.3390/diagnostics13213362 - 1 Nov 2023

Cited by 8 | Viewed by 4337

Abstract

Chronic obstructive pulmonary disease (COPD) may coexist with type 2 diabetes mellitus (T2DM). Patients with COPD have an increased risk of developing T2DM compared with a control but, on the other side, hyperglycaemia and DM have been associated with reduced predicted levels of [...] Read more.

Chronic obstructive pulmonary disease (COPD) may coexist with type 2 diabetes mellitus (T2DM). Patients with COPD have an increased risk of developing T2DM compared with a control but, on the other side, hyperglycaemia and DM have been associated with reduced predicted levels of lung function. The mechanistic relationships between these two diseases are complicated, multifaceted, and little understood, yet they can impact treatment strategy. The potential risks and benefits for patients with T2DM treated with pulmonary drugs and the potential pulmonary risks and benefits for patients with COPD when taking antidiabetic drugs should always be considered. The interaction between the presence and/or treatment of COPD, risk of infection, presence and/or treatment of T2DM and risk of acute exacerbations of COPD (AECOPDs) can be represented as a vicious circle; however, several strategies may help to break this circle. The most effective approach to simultaneously treating T2DM and COPD is to interfere with the shared inflammatory substrate, thus targeting both lung inflammation (COPD) and vascular inflammation (DM). In any case, it is always crucial to establish glycaemic management since the reduction in lung function found in people with diabetes might decrease the threshold for clinical manifestations of COPD. In this article, we examine possible connections between COPD and T2DM as well as pharmacological strategies that could focus on these connections. Full article

(This article belongs to the Special Issue Hyperglycemia in Respiratory Diseases—Impact and Challenges)

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