Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai

BACKGROUND Globally,patients with diabetes suffer from increased disease severity and mortality due to coronavirus disease 2019(COVID-19).Old age,high body mass index(BMI),comorbidities,and complications of diabetes are recognized as major risk factors for infection severity and mortality.AIM To investigate the risk and predictors of higher severity and mortality among inhospital patients with COVID-19 and type 2 diabetes(T2D)during the first wave of the pandemic in Dubai(March–September 2020).METHODS In this cross-sectional nested case-control study,a total of 1083 patients with COVID-19 were recruited.This study included 890 men and 193 women.Of these,427 had T2D and 656 were non-diabetic.The clinical,radiographic,and laboratory data of the patients with and without T2D were compared.Independent predictors of mortality in COVID-19 non-survivors were identified in patients with and without T2D.RESULTS T2D patients with COVID-19 were older and had higher BMI than those without T2D.They had higher rates of comorbidities such as hypertension,ischemic heart disease,heart failure,and more life-threatening complications.All laboratory parameters of disease severity were significantly higher than in those without T2D.Therefore,these patients had a longer hospital stay and a significantly higher mortality rate.They died from COVID-19 at a rate three times higher than patients without.Most laboratory and radiographic severity indices in non-survivors were high in patients with and without T2D.In the univariate analysis of the predictors of mortality among all COVID-19 non-survivors,significant associations were identified with old age,increased white blood cell count,lymphopenia,and elevated serum troponin levels.In multivariate analysis,only lymphopenia was identified as an independent predictor of mortality among T2D non-survivors.CONCLUSION Patients with COVID-19 and T2D were older with higher BMI,more comorbidities,higher disease severity indices,more severe proinflammatory state with cardiac involvement,and died from COVID-19 at three times the rate of patients without T2D.The identified mortality predictors will help healthcare workers prioritize the management of patients with COVID-19.

Management of nonalcoholic fatty liver disease in the Middle East

The prevalence of nonalcoholic fatty liver disease(NAFLD)in the Middle East is increasing in parallel to an increase in the prevalence of associated risk factors such as obesity,metabolic syndrome,and type 2 diabetes mellitus.About 20%to 30%of the patients progress to develop nonalcoholic steatohepatitis(NASH),a histological subtype of NAFLD,with features of hepatocyte injury such as hepatocyte ballooning.NASH can progress to fibrosis,cirrhosis,and even hepatocellular carcinoma.NAFLD thus causes a substantial burden on healthcare systems and it is imperative that appropriate strategies are discussed at a regional level to facilitate effective management tailored to the needs of the region.To fulfil this unmet need,expert gastroenterologists,hepatologists,and endocrinologists from the region came together in three advisory board meetings that were conducted in Saudi Arabia,United Arab Emirates,and Kuwait,to discuss current local challenges in NAFLD screening and diagnosis,and the different available management options.The experts discussed the disease burden of NAFLD/NASH in the Middle East;screening,diagnosis,and referral patterns in NAFLD;and available treatment options for NAFLD and NASH.This paper summarizes the discussions and opinion of the expert panel on the management of NAFLD/NASH and also presents an extensive literature review on the topic.