Effective Response to DPP-4 Inhibitors in Patients of COVID – 19 Triggered Uncontrolled Type 2 DM – A Case Report

Introduction: A bidirectional relationship exist between the COVID -19 diagnosed & recovered patient and Type 2 Diabetes Mellitus. As per the various article available in public domain it has been proved that entry of COVID – 19 virus can lead to a series of pathological changes into a patient’s body which may lead to the development of insulin resistance and damage to the pancreas. The patient in our case was a COVID – 19 survivor which was diagnosed with type 2 DM during the treatment. The patient was started with the Glargine insulin when she was undergoing her treatment in the hospital for COVID – 19 Symptoms. Her fasting and postprandial blood sugar level was controlled with the insulin. After her discharged she was started with the Metformin 500 mg twice a day but her blood sugar was not controlled with the Metformin monotherapy, so we started with the triple drug combination Metformin + Glimepiride + Pioglitazone. After 1 month of follow-up, it was seen that the blood sugar level was not controlled, so the Pioglitazone was replaced with the DPP-4 inhibitor drug Vildagliptin and again the patient was asked to come for follow-up after 15 days, it was seen in this follow-up that the patients’ blood sugar was dramatically controlled. Conclusion: COVID – 19 triggered Type 2 DM is the result of cytokine storm develop during the disease. Metformin and DPP – 4 inhibitors reduce the insulin resistance in type 2 diabetes patients and helps to achieve the euglycemic goal of the patient.

Type 2 Diabetes control and Complications and it Relation to the Serum Magnesium Level

IntroductionType 2 Diabetes (T2D) is a growing health problem nationally and worldwide. Magnesium (Mg) is an important mineral for a wide range of metabolic reactions. Here, our primary goal was to determine the prevalence of hypomagnesemia and its relationship to glycemic control, cardiovascular markers, and T2D-related complications.Material and methodsA cross-sectional study from September 2015 to March 2017 including patients with T2D who attended the Diabetes Center, Taif, Saudi Arabia. Those with known hypomagnesemia, type 1 diabetes, gestational diabetes, end-stage renal disease, and those on magnesium supplementations were excluded. Those with a serum magnesium level < 0.7 mmol/L were considered to have hypomagnesemia.ResultsA total of 285 patients with a mean age of 59.4 ± 12.7 years were enrolled. The majority of patients were female, with long-standing T2D, with a mean body mass index in the obesity category, and most of them had comorbid conditions. Twenty-eight percent of the screened T2D patients had hypomagnesemia and this group were more likely to have a bachelor degree (P = 0.034), to be on metformin, statin, and Glargine insulin (all P < 0.05), have worse glycemic control (P < 0.05), and a higher pulse rate (P = 0.039), but were less likely to be on diet control (P = 0.034) when compared to those with a normal Mg level.ConclusionsAlmost one-third of the screened T2D patients have hypomagnesemia. Hypomagnesemia was associated with the treatment modalities, worse glycemic control, and with peripheral artery disease.