Moderator of 1 Session
Presenter of 3 Presentations
Introducing MR antagonists in diabetic kidney disease
The danger of hyperglycemia during COVID-19
Abstract
Abstract Body
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA beta-coronavirus responsible for the coronavirus disease 2019 (COVID-19). COVID-19 encompasses a large range of disease severity, from mild symptoms to severe forms with Intensive Care Unit admission and eventually death. The severe forms of COVID-19 are usually observed in high-risk patients, as those with type two diabetes mellitus. Acute hyperglycemia at hospital admission represents a risk factor for poor COVID-19 prognosis in patients with and without diabetes. Acute and chronic glycemic control are both emerging as major determinants of vaccination efficacy, disease severity, and mortality rate in COVID-19 patients. Mechanistically, it has been proposed that hyperglycemia might be a disease-modifier for COVID-19 through multiple mechanisms: 1- induction of glycation and oligomerization of ACE2, the main receptor of SARS-CoV-2; 2- increased expression of the serine protease TMPRSS2, responsible for S protein priming; 3- impairment of the function of innate and adaptive immunity despite the induction of higher pro-inflammatory responses, both local and systemic. Consistently, managing acute hyperglycemia through insulin infusion has been suggested to improve clinical outcomes while implementing chronic glycemic control positively affects the immune response following vaccination. Here, we review the available evidence linking acute and chronic hyperglycemia to COVID-19 outcomes, describing also the putative mediators of such interactions and proposing glycemic control as a potential route to optimize disease prevention and management.
THE MEANING OF GLUCOSE CONTROL IN DIABETES TODAY: IT`S TIME FOR A PARADIGM SWITCH
Abstract
Abstract Body
Glycated haemoglobin (HbA1c) is the most used parameter to assess glycaemic control. However, recent evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA1c levels as soon as possible, but to obtain this result by reducing postprandial hyperglycaemia, glycaemic variability and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved avoiding hypoglycaemia and, if this happens, hypoglycaemia should be reverted to normoglycaemia. Modern technology, i.e. intermittently-scanned glucose monitoring and continuous glucose monitoring together with the new available drug therapies (e.g. ultra-fast insulin, SGLT-2i, and GLP-1RAs) may help to change the paradigm of glycaemia management based on HbA1c in favour of a holistic approach considering all the different aspects of this commonly oversimplified pathological feature of diabetes.