In China, in the early days of the pandemic it was established that about 21% of (mostly elderly) admissions had a history of diabetes but a further c20% were diagnosed on admission.

Was Coronavirus precipitating diabetes or were these people with it previously but undiagnosed?
“The precise mechanisms for new-onset diabetes in people with COVID-19 are not known, but it is likely that a number of complex interrelated processes are involved”
These include
📌previously undiagnosed diabetes,
📌stress hyperglycemia,
📌steroid-induced hyperglycemia, and
📌direct or indirect effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the b-cell.
A number of studies have also reported that preexisting diabetes as well as newly diagnosed diabetes with a first glucose measurement on hospital admission are both associated with an increased risk of all-cause mortality in hospitalized patients with COVID-19.
Pre existing but undiagnosed and unmanaged diabetes cannot be ruled out as a factor, maybe induced in part to changes in lifestyle due to pandemic restrictions and effect on mental and physical health
But it is very striking that a study from London reported 30 children (aged 23 m to 16.8 years with new onset Type 1 diabetes .

This represented an 80% increase in new onset Type 1 diabetes compared with previous years

Further it see,s severity of presentation is increased
That, alone should be a warning flag with regard to the largely uncontrolled spread of Covid amongst children who could be left with a lifelong and serious condition.
However a German study found no such increase of incidence in Type 1 but DID find significant increases in Diabetic ketoacidosis and severe ketoacidosis at diagnosis.

See also Chinese and London studies re Type 2 diabetes

And this is associated with more severe organ injury
This paper goes on to review a large number of related studies and concludes

📌 There is an urgent need for research to help guide management pathways for these patients.
📌 In view of increased mortality in people with new-onset diabetes, hospital protocols should include efforts to recognize and manage acute hyperglycemia, including diabetic ketoacidosis, in people admitted to the hospital.
📌Whether new-onset diabetes is likely to remain permanent is not known, as the long-term follow-up of these patients is limited. Prospective studies of metabolism in the setting of postacute COVID-19 will be required to understand the etiology, prognosis& treatment opportunities
The link to the study itself is here

care.diabetesjournals.org/content/diacar…

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More from @fascinatorfun

12 Oct
I’ve been feeling pretty bloody awful the last week.

Is it a sense of impotence and shame watching Frost all set to break our word - and legal obligations again. And to NI disadvantage?
Is it the report and knowing that Johnson in his cowardly way hides….and voters will let him get away with it?

The collective shamelessness of the Tory Party

The ineffectual opposition.

The anniversary of my mother’s death (on Sunday) - her birthday today?
Watching deaths continue to pile up (over 200 (60 day) deaths today?

Wondering when and how it will all end?
Read 5 tweets
12 Oct
Well.

And what possible GOOD reason can there be for that instruction?

And who designed and signed off this policy?
“The policy says: “Instant messaging is provided to all staff and should be used in preference to email for routine communications where there is no need to retain a record of the communication.”
“Instant messages history in individual and group chats must be switched off and should not be retained once a session is finished.”
Read 5 tweets
12 Oct
Calls for inquiry as negative Covid PCR tests after positive lateral flow reported | Coronavirus | The Guardian

Prof ⁦@alanmcn1⁩ gives sensible interim advice whilst the issue is urgently investigated.
theguardian.com/world/2021/oct…
“There needs to be really clear and immediate messaging from government around which test [people should] act on. My very clear advice would be that if you have a respiratory infection, stay at home because you’re going to pass it on.”
“But if you’ve got symptoms of a respiratory infection and a lateral flow test that’s positive, I would be working on the assumption that it’s Covid-19 regardless of the PCR result at the moment.”
Read 9 tweets
12 Oct
Hard hard HARD agree with this.

The rotten decision making preceded the Covid pandemic…and countries like Singapore IMPLEMENTED OUR flu pandemic plan with far FAR greater success…imperfect but FAR better

Because they ACTED on it
And had resourced PH to do so..& gave it clout
But which of us thinks giving the likes of Jenny Harries MORE clout would have made a difference?

It wasn’t more clout she needed but a massive kick up the arse from a political leader who was going to put saving lives and health and well-being at the heart of the response
That was never going to be Johnson.

Oh no. Not trivial Johnson.

Clark Kent Johnson from Feb 2020
Read 12 tweets
12 Oct
This chapter makes sorry reading.

And quite something that in March it was thought that the intermittent lockdown approach might get deaths down to 100k even if no vaccination

Bad. But not as bad as the possible half a million.
Yet here we are 18 mnths later, post 3 lockdowns of sorts, Alpha then Delta variants increasing the risks & worsening the odds, 45 mill+ fully vaccinated
163,500 Covid deaths (by date of death): deaths & hospitalisations still piling up.
And a Government even sloppier than at the beginning.

The second and third/ fourth waves are unequivocally on Johnson. His choice against scientific advice.

How very Johnson to absent himself from the country when the Select Committee report is published.
Read 15 tweets
11 Oct
Notable that this 151 page report suggesting (correctly) our Covid response was one of the worst in history was lead by two ex Tory ministers
Having read part of the report, however, it seems to be pointing to a whitewash when it comes to the second wave on.

By then there was no excuse.

A terrible price had already been exacted.

We knew early and hard works far better than late and lax.
By 18 September 2020 we were not even at 42k deaths.

Still. We already knew that was over 20k more deaths than was Vallance had said would be a “good outcome”.

We knew that

Yet now we are at 120k MORE deaths.
Read 6 tweets

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