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A widely used diabetes treatment drug has a low probability in patients with novel coronavirus infection (Corona 19), but it can cause complications, a study found.
On the 1st, researchers at the Briham Women’s Hospital affiliated with Harvard University in Boston, USA, said that if a diabetic patient suspects of being infected with Corona 19, the use of the sodium-glucose cotransporter 2 inhibitor (SGLT-2i) should be stopped. Diabetes is one of the representative chronic diseases belonging to the high risk group for Corona 19
The researchers found that the incidence of euDAK, a type of diabetic ketoacidosis (DKA), increased when patients taking SGLT-2i inhibitors, which are prescribed as one of the blood sugar enhancers, were infected with COVID-19. The results of the study were recently published in an overseas academic journal,’AACE, Clinical Case Reports’.
When people with diabetes lack the supply of glucose, which serves as energy for their cells, the body burns fat instead. At this time, ketone, a chemical substance, is produced as fat is decomposed. This ketone starts as it accumulates in the blood and can progress to a complication called DKA. DKA can lead to diabetic coma or even death.
The researchers explained that euDKA differs from general DKA in that it has a low blood sugar level and is difficult to diagnose.
SGLT-2i has a mechanism to control blood sugar by excreting glucose through urine. For this reason, it is called a so-called fat-loss diabetes drug and is in high demand in the diabetes treatment market. However, these mechanisms may increase the risk of DKA and euDKA.
The researchers analyzed diabetes patients hospitalized in the spring of 2020, when the corona19 epidemic peaked in Boston. Of the hospitalized patients, euDKA was observed in five COVID-19 patients taking SGLT-2i. This is very high compared to the less than 10 euDKA cases reported in the last two years.
Three out of five were moved to a rehabilitation facility after treatment, and one was discharged. One 52-year-old man with acute respiratory distress syndrome died during treatment.
“SGLT2 inhibitors can cause DKA and euDKA,” said Naomi Fisher, professor of Endocrinology at Briham Women’s Hospital. “If the patient is sick, loses appetite, or does not eat, stop medication and eat properly until a healthy diet. Treatment) should not be resumed.”
Specifically, the researchers hypothesized that COVID-19 would exacerbate the euDKA risk. After the Corona 19 virus infects a patient, it can penetrate and affect insulin-producing pancreatic cells. In fact, several studies conducted on the early Acute Respiratory Syndrome (SARS) virus found that blood sugar increased in several infected patients.
“Other test models have shown that the virus can destroy insulin-producing cells,” Fisher said.
In addition, cytokines, an immune protein that can cause hyperimmune reactions in patients with COVID-19, have also been shown to increase the risk of DKA.
“High levels of cytokine reactions can also be seen in DKA,” Fisher said. “The pathways that lead to inflammation can interact.”
He said, “I hope that no more euDKA cases will come out even in the situation where the Corona 19 infection is rapidly increasing by informing patients and medical staff.”
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