Thread by @DanielJDrucker

For those of you who could not attend the #ENDO2020 sessions this am, due to scheduling or technical challenges, a summary thread #Diabetes #COVID19

We enter the #COVID19 era with an unprecedented set of pharmacological tools that can be used wisely to achieve personalized goals for #T2D

How should we think about the complex interactions between ACE2, DPP4, cardiometabolic inflammation, and the management of #T2D Normally, enhanced ACE2 and reduced DPP4 activity are favorable in PPL with #diabetes

Physicians are familiar with the benefical roles of enhanced ACE2 and Ang(1-7) activity in the context of end organ damage, notably important for the heart, blood vessels, and even the endocrine pancreas. Yet know we must reconsider the role of ACE as a receptor for SARS-CoV-2

Unequivocal evidence from multiple labs demonstrates that ACE2, but not DPP4, is required for entry of SARS-CoV-2 into cells, whereas human DPP4 is a functional MERS-CoV receptor

DPP4, both membrane anchored and soluble forms, cleaves a large number of immunomodulatory chemokines and cytokines-yet the impact of DPP4 inhibition on inflammation in PPL with #T2D apppears modest when examined carefully

People with #T2D #CVD exhibit upregulation of meta-inflammation, thought to enhance risk of #atherosclerosis and related complications. Yet DPP4 inhibitors had no discernable effect on major outcomes in multiple large CVOTs of high risk individuals with known CVD

The immunomodulatory actions of DPP4i have been studied in normal subjects, PPL with #T2D #HIV and little perturbation of immune function, cellular immune subsets, or cytokine profiles, has been detected in RCTs

To date, little information has emerged to shed new light on the potential safety issues surrounding use of glucose-lowering drugs, including DPP4 inhibitors, in PPL with #COVID19

The CORONADO study will provide more drug-specific information on PPL with #Diabetes and SARS-CoV-2 infection-to date, the reporting on outcomes at 7 days highlights an association of #insulin with adverse outcomes. And yet...

We know that insulin use will be more common in PPL with long standing #Diabetes #T2D who have generally failed to achieve excellent control on oral agents alone. Hence one expects injectable therapy to associate with adverse outcomes #COVID19 but not due to causal relationships

Good two way dialogue and communication with PPL w #Diabetes can enhance health and prevention of disease, while optimizing outpatient outcomes

The hospital represents a unique environment, where careful regular monitoring of multiple organs and medical parameters is required to optimize outcomes for PPL with both #Diabetes and #COVID19

All of the medications used to Rx #T2D need careful appraisal both in the outpatient setting, and more importantly, in the hospital in PPL with #COVID19 infection. In some instances, meds may need to be scaled back or substituted/discontinued

The use of SGLT2i in hospital requires careful monitoring of hydration status, and acid base parameters. Some may elect to discontinue these drugs in ill hospitalized PPL, and the DARE19 study should provide useful answers to the safety and putative benefit of SGLT2i #COVID19

Currently #Insulin is the glucose-lowering agent of choice in the hospitalized severely ill person #COVID19 #diabetes. Glucose targets ideally in the 6-10 range, with careful glucose monitoring to avoid #hypoglycemia

Much of this information is summarized here #EndocrineReviews Open Access via @TheEndoSociety Stay tuned for the archived lectures #ENDO2020 academic.oup.com/edrv/article/4…

@threadreaderapp