Title: Use of Insulin in treatment of COVID-19: A proposal to explore feasibility

Authors: Dr Jayesh G Kalbhande, Dr Vicky Kuldeep

 DOI: https://dx.doi.org/10.18535/jmscr/v8i7.103

Abstract

Introduction

It was December 2019, first case of Corona Virus Disease 2019 viz. Covid-19 was reported in Wuhan, China.(1) Initially the Chinese Centre of Disease Control and Prevention (CDC) named it as Severe Acute Respiratory Syndrome Coronavirus 2 which was later labelled as COVID-19 by WHO on February 11, 2020.(2) Soon COVID-19 was declared as Pandemic by WHO. COVID-19 symptoms include fever, dry cough, muscle pain, diarrhoea, fatigue, loss of smell and taste. It has been found that it can lead to sudden and rapid deterioration in general condition resulting in respiratory failure and septic shock in severe cases.(3)

COVID 19 has a major impact in European countries and in United States of America. Presently there are more than 15 million cases worldwide with a death toll of more than0.6 million.(4) Currently the number of COVID 19 positive cases is rapidly rising in India. As of today, there is no curative medication for COVID 19.Patients with mild symptoms recovers with supportive medication. Patients with moderate to severe symptoms, especially the elderly or with comorbidities may develop severe COVID 19. They are currently treated with number of experimental and repurposed medications. These patients may have high mortality rates.(5) We scrolled through the literature to analyse the role of Insulin in the treatment of COVID-19.

References

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;
  2. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–74.
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395 (10223):497–506.
  4. WHO official website [Internet]. Available from: https://covid19.who.int
  5. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061–9.
  6. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;
  7. Centre for Disease Control and Prevention [Internet]. Available from: https://www.cdc.gov/nchs/nvss/vsrr/COVID19/
  8. Chan JF-W, Kok K-H, Zhu Z, Chu H, To KK-W, Yuan S, et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. 2020;9(1):221–36.
  9. Organization WH. Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). World Health Organization; 2003.
  10. Pani LN, Korenda L, Meigs JB, Driver C, Chamany S, Fox CS, et al. Effect of aging on A1C levels in individuals without diabetes: evidence from the Framingham Offspring Study and the National Health and Nutrition Examination Survey 2001–2004. Diabetes Care. 2008;31(10):1991–6.
  11. Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2011;57(6):e1–47.
  12. Dubowitz N, Xue W, Long Q, Ownby JG, Olson DE, Barb D, et al. Aging is associated with increased HbA1c levels, independently of glucose levels and insulin resistance, and also with decreased HbA1c diagnostic specificity. Diabet Med. 2014;31(8):927–35.
  13. Saaddine JB, Fagot-Campagna A, Rolka D, Narayan KMV, Geiss L, Eberhardt M, et al. Distribution of HbA1c levels for children and young adults in the US: Third National Health and Nutrition Examination Survey. Diabetes Care. 2002;25(8):1326–30.
  14. Roth J, Müller N, Lehmann T, Heinemann L, Wolf G, Müller UA. HbA1c and age in non-diabetic subjects: an ignored association? Exp Clin Endocrinol Diabetes. 2016;124(10):637–42.
  15. Turner AJ, Hiscox JA, Hooper NM. ACE2: from vasopeptidase to SARS virus receptor. Trends Pharmacol Sci. 2004;25(6):291–4.
  16. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;
  17. Donoghue M, Hsieh F, Baronas E, Godbout K, Gosselin M, Stagliano N, et al. A novel angiotensin-converting enzyme–related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9. Circ Res. 2000;87(5):e1–9.
  18. Tikellis C, Bernardi S, Burns WC. Angiotensin-converting enzyme 2 is a key modulator of the renin–angiotensin system in cardiovascular and renal disease. Curr Opin Nephrol Hypertens. 2011;20(1):62–8.
  19. Patel VB, Mori J, McLean BA, Basu R, Das SK, Ramprasath T, et al. ACE2 deficiency worsens epicardial adipose tissue inflammation and cardiac dysfunction in response to diet-induced obesity. Diabetes. 2016;65(1):85–95.
  20. Riera Oliva M, Márquez E, Clotet S, Gimeno J, Roca-Ho H, Lloreta Trull J, et al. Effect of insulin on ACE2 activity and kidney function in the non-obese diabetic mouse (PLoS ONE (2014)). PLoS ONE 2014; 9 e84683. 2014;
  21. Soro-Paavonen A, Gordin D, Forsblom C, Rosengard-Barlund M, Waden J, Thorn L, et al. Circulating ACE2 activity is increased in patients with type 1 diabetes and vascular complications. J Hypertens. 2012;30(2):375–83.
  22. Salem ESB, Grobe N, Elased KM. Insulin treatment attenuates renal ADAM17 and ACE2 shedding in diabetic Akita mice. Am J Physiol Physiol. 2014;306(6):F629–39.
  23. Cristiani L, Mancino E, Matera L, Nenna R, Pierangeli A, Scagnolari C, et al. Will children reveal their secret? The coronavirus dilemma. Eur Respiratory Soc; 2020.
  24. Brufsky A. Hyperglycemia, hydroxychloroquine, and the COVID‐19 pandemic. J Med Virol. 2020;
  25. Ceriello A. Hyperglycemia and the worse prognosis of COVID-19. Why a fast blood glucose control should be mandatory. Diabetes Res Clin Pract. 2020;
  26. Zhou T, Hu Z, Yang S, Sun L, Yu Z, Wang G. Role of adaptive and innate immunity in type 2 diabetes mellitus. J Diabetes Res. 2018;2018.
  27. Geerlings SE, Hoepelman AIM. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26(3–4):259–65.
  28. Moutschen MP, Scheen AJ, Lefebvre PJ. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab. 1992;18(3):187.
  29. Tan JS, Anderson JL, Watanakunakorn C, Phair JP. Neutrophil dysfunction in diabetes mellitus. J Lab Clin Med. 1975;85(1):26–33.
  30. Gin H, Brottier E, Aubertin J. Influence of glycaemic normalisation by an artificial pancreas on phagocytic and bactericidal functions of granulocytes in insulin dependent diabetic patients. J Clin Pathol. 1984;37(9):1029–31.
  31. Mowat AG, Baum J. Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus. N Engl J Med. 1971;284(12):621–7.
  32. Sima AAF, O’Neill SJ, Naimark D, Yagihashi S, Klass D. Bacterial phagocytosis and intracellular killing by alveolar macrophages in BB rats. Diabetes. 1988;37(5):544–9.
  33. Nolan CM, Beaty HN, Bagdade JD. Further characterization of the impaired bactericidal function of granulocytes in patients with poorly controlled diabetes. Diabetes. 1978;27(9):889–94.
  34. Pozzilli P, Leslie RDG. Infections and diabetes: mechanisms and prospects for prevention. Diabet Med. 1994;11(10):935–41.
  35. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67(2):352–60.
  36. Sun Q, Li J, Gao F. New insights into insulin: The anti-inflammatory effect and its clinical relevance. World J Diabetes. 2014;5(2):89.
  37. Yorek MA, Dunlap JA. Effect of increased concentration of D-glucose or L-fucose on monocyte adhesion to endothelial cell monolayers and activation of nuclear factor-[kappa] B. Metab Exp. 2002;51(2):225–34.
  38. Nishikawa T, Edelstein D, Du XL, Yamagishi S, Matsumura T, Kaneda Y, et al. Normalizing mitochondrial superoxide production blocks three pathways of hyperglycaemic damage. Nature. 2000;404(6779):787–90.
  39. Morigi M, Angioletti S, Imberti B, Donadelli R, Micheletti G, Figliuzzi M, et al. Leukocyte-endothelial interaction is augmented by high glucose concentrations and hyperglycemia in a NF-kB-dependent fashion. J Clin Invest. 1998;101(9):1905–15.
  40. Aljada A, Saadeh R, Assian E, Ghanim H, Dandona P. Insulin inhibits the expression of intercellular adhesion molecule-1 by human aortic endothelial cells through stimulation of nitric oxide. J Clin Endocrinol Metab. 2000;85(7):2572–5.
  41. Dandona P, Aljada A, Mohanty P, Ghanim H, Hamouda W, Assian E, et al. Insulin inhibits intranuclear nuclear factor κB and stimulates IκB in mononuclear cells in obese subjects: evidence for an anti-inflammatory effect? J Clin Endocrinol Metab. 2001;86(7):3257–65.
  42. Aljada A, Ghanim H, Mohanty P, Kapur N, Dandona P. Insulin inhibits the pro-inflammatory transcription factor early growth response gene-1 (Egr)-1 expression in mononuclear cells (MNC) and reduces plasma tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1) concentrations. J Clin Endocrinol Metab. 2002;87(3):1419–22.
  43. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67.
  44. Investigators N-SS. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.
  45. Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA. Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. US Study Group of Insulin Glargine in Type 1 Diabetes. Diabetes Care. 2000;23(5):639–43.
  46. Nader ND, Hamishehkar H, Naghizadeh A, Shadvar K, Iranpour A, Sanaie S, et al. Effect of Adding Insulin Glargine on Glycemic Control in Critically Ill Patients Admitted to Intensive Care Units: A Prospective Randomized Controlled Study. Diabetes, Metab Syndr Obes Targets Ther. 2020;13:671.

Corresponding Author

Dr Jayesh G Kalbhande

Consultant Surgeon, BARC Hospital