Glucose control in home-isolated adults with type 1 diabetes affected by COVID-19 using continuous glucose monitoring

J Endocrinol Invest. 2021 Sep 5. doi: 10.1007/s40618-021-01669-3. Online ahead of print.


PURPOSE: This study is aimed at evaluating changes in metrics of glucose control in home-isolated patients with type 1 diabetes and COVID-19 using a continuous glucose monitoring (CGM) system.

METHODS: We included adults aged 18-45 years with type 1 diabetes, using CGM, followed by telemedicine at a Southern Italian University Hospital. Thirty-two home-quarantined subjects with SARS-CoV-2 positive swab constituted the COVID-19 group. Thirty age-matched diabetic individuals without COVID-19 formed the control group. The effects of COVID-19 on glycemic control in patients infected were assessed at different time points [2 weeks before-COVID-19 (Time 1), 2 weeks during-COVID-19 (Time 2) and 2 weeks after COVID-19 (Time 3)] and compared with those without infection.

RESULTS: A significant reduction of TIR (Time 1 vs Time 2, %, 60.1 ± 16.6 vs 55.4 ± 19.2, P = 0.03), associated with a significant increase of TAR level 2 (10.1 ± 7.3 vs 16.7 ± 12.9, P < 0.001), GMI (7.1 ± 0.6 vs 7.5 ± 0.8, P < 0.001), CV (37.3 ± 7.1 vs 39.6 ± 7.0, P = 0.04), mean glucose values (mg/dL, 160.2 ± 26.5 vs 175.5 ± 32.6, P = 0.001) and standard deviation (59.2 ± 13.1 vs 68.6 ± 17.7, P = 0.001) was observed in patients with COVID-19. No significant change of glycemic metrics was found in the NO COVID-19 group across the time.

CONCLUSION: Young home-isolated patients with type 1 diabetes and COVID-19 showed a worsening of glucose control during COVID-19, as compared with age-matched diabetic subjects without the infection.

PMID:34482534 | DOI:10.1007/s40618-021-01669-3

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Time to resolution of respiratory and systemic COVID-19 symptoms in community setting

Clin Microbiol Infect. 2021 Sep 2:S1198-743X(21)00481-X. doi: 10.1016/j.cmi.2021.08.021. Online ahead of print.


OBJECTIVES: During the Coronavirus disease 2019 (COVID-19), symptom course among outpatients is not well known. Our aim was to assess the time to resolution of respiratory and systemic symptoms and their associated factors.

METHODS: Cohort study including adult outpatients, managed with Covidom, a telesurveillance solution, with RT-PCR confirmed diagnosis, from March 9th 2020 until February 23rd 2021. Follow-up was 30 days after symptom onset.

RESULTS: Among the 9,667 patients included, mean age was 43.2±14.0 years, and 67.5% were female (n=6,522). Median body mass index (BMI) (IQR) was 25.0 kg/m2 (22.1-28.8). Main comorbidities were: hypertension (12.9%; n=1247), asthma (11.0%; n=1063), and diabetes mellitus (5.5%; n=527). The most frequent symptom during follow-up was dyspnea (65.1%; n=6,296), followed by tachypnea (49.9%; n=4,821), shivers (45.6%; n=4,410), and fever (36.7%; n=3,550). Median time to resolution of systemic and respiratory symptoms were 3 days (95% CI: 2-4) and 7 days (95% CI: 6-8), respectively. Ultimately, 17.2% (95% CI: 15.7%-18.8%) still presented respiratory symptoms at day 30. Longer time to respiratory symptom resolution was associated with older age, increased BMI, chronic obstructive pulmonary disease (COPD), coronary artery disease, asthma, and heart failure. Regarding systemic symptoms, coronary artery disease, asthma, age above 40 years, and elevated BMI were associated with longer time to resolution.

CONCLUSIONS: Time to symptom resolution among outpatients with COVID-19 seemed shorter for systemic than respiratory symptoms. Prolonged respiratory symptoms were common at day 30. Risk factors associated with later resolution included age, cardiovascular and pulmonary diseases.

PMID:34481989 | DOI:10.1016/j.cmi.2021.08.021

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Safety of English ivy (Hedera helix) leaf extract during pregnancy: retrospective cohort study

Daru. 2021 Sep 4. doi: 10.1007/s40199-021-00415-7. Online ahead of print.


BACKGROUND: English ivy (Hedera helix) is commonly used to reduce productive cough symptoms by acting as expectorant therapy. The safety of Hedera helix extract during pregnancy was not established yet. This study aims to determine the safety of English ivy leaf extract on newborns.

OBJECTIVES: To determine the weight, APGAR (Activity-Pulse-Grimace-Appearance-Respiration) score, and health status of the newborns among the studied groups.

METHODS: A retrospective multicenter cohort study was conducted during the fourth quarter of 2020 on 245 pregnant women and their newborns in two hospitals located in Riyadh, Saudi Arabia. The women were divided into an exposed group (N = 165) who used English ivy leaf extract syrup during pregnancy, and a control group (N = 80) who were not using any natural-pharmaceutical product for cough.

RESULTS: The mean weight of the newborns in the exposed group was 3 kg compared to 2.8 kg in the control group (p-value < 0.05). The median APGAR score of the newborns in the exposed group was 8.5/10 compared to 8.0/10 in the control group (p-value > 0.05). There were no significant differences regarding the percentages of full-term and preterm newborns in the exposed and control groups (78.8% vs. 76.3%, and 21.0% vs. 24.0%, respectively, odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.45-1.63, p-value > 0.05). Regarding the newborns' health complications reported, there was no statistical difference in the percentages of full-term newborns diagnosed with at least one health complication between the exposed and control groups (0.6 vs. 3.8, OR = 0.15, 95% CI = 0.01-1.47, p-value > 0.05).

CONCLUSION: Hedera helix (English ivy) leaf extract syrup was safe to be used in short term during pregnancy for the fetus.

PMID:34482524 | DOI:10.1007/s40199-021-00415-7

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Increased Utilization of Virtual Visits and Electronic Approaches in Clinical Research During the COVID-19 Pandemic and Thereafter

Mayo Clin Proc. 2021 Sep;96(9):2332-2341. doi: 10.1016/j.mayocp.2021.06.022. Epub 2021 Jul 5.


OBJECTIVES: To assess the impact of the COVID-19 pandemic on clinical research and the use of electronic approaches to mitigate this impact.

METHODS: We compared the utilization of electronic consenting, remote visits, and remote monitoring by study monitors in all research studies conducted at Mayo Clinic sites (Arizona, Florida, and Minnesota) before and during the COVID-19 pandemic (ie, between May 1, 2019 and December 31, 2020). Participants are consented through a participant-tracking system linked to the electronic health record.

RESULTS: Between May 2019, and December 2020, there were 130,800 new consents across every modality (electronic and paper) to participate in a non-trial (107,176 [82%]) or a clinical trial (23,624 [18%]). New consents declined from 5741 in February 2020 to 913 in April 2020 but increased to 11,864 in November 2020. The mean (standard deviation [SD]) proportion of electronic consent increased from 22 (2%) before to 45 (20%) during the pandemic (P=.001). Mean (SD) remote electronic consenting increased from 0.3 (0.5%) to 29 (21%) (P<.001). The mean (SD) number of patients with virtual visits increased from 3.5 (2.4%) to 172 (135%) (P=.003) per month between pre-COVID (July 2019 to February 2020) and post-COVID (March to December 2020) periods. Virtual visits used telemedicine (68%) or video (32%). Requests for remote monitor access to complete visits increased from 44 (17%) per month between May 2019 and February 2020 to 111 (74%) per month between March and December 2020 (P=.10).

CONCLUSION: After a sharp early decline, the enrollment of new participants and ongoing study visits recovered during the COVID-19 pandemic. This recovery was accompanied by the increased use of electronic tools.

PMID:34481597 | DOI:10.1016/j.mayocp.2021.06.022

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