Endocrinology and Metabolism

Brief Report

Diabetes, obesity and metabolism
Impact of Diabetes on COVID-19 Susceptibility: A Nationwide Propensity Score Matching Study: Han Na Jang, Sun Joon Moon, Jin Hyung Jung, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2024;39(5):813-818. Published online August 28, 2024; DOI: https://doi.org/10.3803/EnM.2024.2014

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Abstract PDF Supplementary Material PubReader ePub: Prior research has highlighted poor clinical outcomes in coronavirus disease 2019 (COVID-19)-infected patients with diabetes; however, susceptibility to COVID-19 infection in patients with diabetes has not been extensively studied. Participants aged ≥30 years who underwent COVID-19 testing from December 2019 to April 2020 were analyzed using the National Health Insurance Service data in South Korea. In a cohort comprising 29,433 1:1 propensity score-matched participants, COVID-19 positivity was significantly higher in participants with diabetes than in those without diabetes (512 [3.5%] vs. 395 [2.7%], P<0.001). Logistic regression analysis indicated that diabetes significantly increased the risk of COVID-19 test positivity (odds ratio, 1.307; 95% confidence interval, 1.144 to 1.493; P<0.001). Patients with diabetes exhibited heightened COVID-19 infection rates compared to individuals without diabetes, and diabetes increased the susceptibility to COVID-19, reinforcing the need for heightened preventive measures, particularly considering the poor clinical outcomes in this group.

Original Articles

Diabetes, obesity and metabolism
Impact of Antidiabetic Drugs on Clinical Outcomes of COVID-19: A Nationwide Population-Based Study: Han Na Jang, Sun Joon Moon, Jin Hyung Jung, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2024;39(3):479-488. Published online January 29, 2024; DOI: https://doi.org/10.3803/EnM.2023.1857

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Background
Inconsistent results have been reported regarding the association between the use of antidiabetic drugs and the clinical outcomes of coronavirus disease 2019 (COVID-19). This study aimed to investigate the effect of antidiabetic drugs on COVID-19 outcomes in patients with diabetes using data from the National Health Insurance Service (NHIS) in South Korea.
Methods
We analyzed the NHIS data of patients aged ≥20 years who tested positive for COVID-19 and were taking antidiabetic drugs between December 2019 and June 2020. Multiple logistic regression analysis was performed to analyze the clinical outcomes of COVID-19 based on the use of antidiabetic drugs.
Results
A total of 556 patients taking antidiabetic drugs tested positive for COVID-19, including 271 male (48.7%), most of whom were in their sixties. Of all patients, 433 (77.9%) were hospitalized, 119 (21.4%) received oxygen treatment, 87 (15.6%) were admitted to the intensive care unit, 31 (5.6%) required mechanical ventilation, and 61 (11.0%) died. Metformin was significantly associated with the lower risks of mechanical ventilation (odds ratio [OR], 0.281; 95% confidence interval [CI], 0.109 to 0.720; P=0.008), and death (OR, 0.395; 95% CI, 0.182 to 0.854; P=0.018). Dipeptidylpeptidase-4 inhibitor (DPP-4i) were significantly associated with the lower risks of oxygen treatment (OR, 0.565; 95% CI, 0.356 to 0.895; P=0.015) and death (OR, 0.454; 95% CI, 0.217 to 0.949; P=0.036). Sulfonylurea was significantly associated with the higher risk of mechanical ventilation (OR, 2.579; 95% CI, 1.004 to 6.626; P=0.049).
Conclusion
In patients with diabetes and COVID-19, metformin exhibited reduced risks of mechanical ventilation and death, DPP- 4i was linked with lower risks of oxygen treatment and death, while sulfonylurea was related to the increased risk of mechanical ventilation.

Citations

Citations to this article as recorded by

Innovative Lipid-Lowering Strategies: RNA-Based, Small Molecule, and Protein-Based Therapies
Youngwoo Jang, Eun-Jung Rhee, Sung Hee Choi
Endocrinology and Metabolism.2025; 40(5): 668. CrossRef

Thyroid
Beyond Acute COVID-19: Investigating the Incidence of Subacute Thyroiditis in Long COVID-19 in Korea: Jeongmin Lee, Gi Hyeon Seo, Keeho Song; Endocrinol Metab. 2023;38(4):455-461. Published online August 8, 2023; DOI: https://doi.org/10.3803/EnM.2023.1711

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Background
The correlation between acute coronavirus disease 2019 (COVID-19) and subacute thyroiditis (SAT) has not been clearly investigated in “long COVID” patients. We aimed to investigate the incidence of SAT during convalescence and after the acute phase of COVID-19, comparing with that of the general population.
Methods
Data from a total of 422,779 COVID-19 patients and a control group of 2,113,895 individuals were analyzed. The index date was defined as the date 3 months after confirmation of COVID-19. The incidence rate (IR) of SAT and hazard ratios (HRs) were calculated per 100,000 persons. Subgroup analysis included analysis of HRs 90–179 and 180 days post-COVID-19 diagnosis; and additional analysis was conducted according to hospitalization status, sex, and age group.
Results
The IR of SAT was 17.28 per 100,000 persons (95% confidence interval [CI], 12.56 to 23.20) in the COVID-19 group and 8.63 (95% CI, 6.37 to 11.45) in the control group. The HR of COVID-19 patients was 1.76 (95% CI, 1.01 to 3.06; P=0.045). The HR of SAT was 1.39 (95% CI, 0.82 to 2.34; P=0.220) up to 6 months after the index date and 2.30 (95% CI, 1.60 to 3.30; P<0.001) beyond 6 months. The HR for SAT among COVID-19 patients was 2.00 (95% CI, 1.41 to 2.83) in hospitalized patients and 1.76 (95% CI, 1.01 to 3.06) in non-hospitalized patients compared to the control group. The IR of SAT was 27.09 (95% CI, 20.04 to 35.82) for females and 6.47 (95% CI, 3.34 to 11.30) for males. In the 19 to 64 age group, the IR of SAT was 18.19 (95% CI, 13.70 to 23.67), while the IR was 9.18 (95% CI, 7.72 to 10.84) in the 65 to 69 age group.
Conclusion
SAT could be a potential long-term complication of COVID-19. Long-term surveillance for thyroid dysfunction is needed especially in hospitalized, female and young-aged subjects.

Citations

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Subacute thyroiditis in pregnancy: a narrative review
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Thyroid dysfunction in COVID-19
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Nature Reviews Endocrinology.2024; 20(6): 336. CrossRef
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Hwa Young Ahn
Endocrinology and Metabolism.2024; 39(1): 186. CrossRef
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Yasuhiro Nakano, Naruhiko Sunada, Kazuki Tokumasu, Hiroyuki Honda, Yuki Otsuka, Yasue Sakurada, Yui Matsuda, Toru Hasegawa, Daisuke Omura, Kanako Ochi, Miho Yasuda, Hideharu Hagiya, Keigo Ueda, Fumio Otsuka
Scientific Reports.2024;[Epub] CrossRef
Risk of Incident Thyroid Dysfunction in the Post-Acute Phase of COVID-19: A Population-Based Cohort Study in Hong Kong
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Endocrine Practice.2024; 30(6): 528. CrossRef
Subacute Thyroiditis Following COVID-19: A Case of Diagnostic Challenge in the Absence of Neck Pain
Kan Sakai, Tadahiro Yonaha, Takashi Shinzato, Takahiro Taira
Cureus.2024;[Epub] CrossRef
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Jennifer Lizcano Ramírez, Jaritza Lissette Delgado Gonzales, Milton Isaac Delgado Contreras, Jenrry Fredy Chávez-Arizala
SCT Proceedings in Interdisciplinary Insights and Innovations.2024; 2: 328. CrossRef

Diabetes, obesity and metabolism Big Data Articles (National Health Insurance Service Database)
Risk for Newly Diagnosed Type 2 Diabetes Mellitus after COVID-19 among Korean Adults: A Nationwide Matched Cohort Study: Jong Han Choi, Kyoung Min Kim, Keeho Song, Gi Hyeon Seo; Endocrinol Metab. 2023;38(2):245-252. Published online April 5, 2023; DOI: https://doi.org/10.3803/EnM.2023.1662

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Background
Coronavirus disease 2019 (COVID-19) can cause various extrapulmonary sequelae, including diabetes. However, it is unclear whether these effects persist 30 days after diagnosis. Hence, we investigated the incidence of newly diagnosed type 2 diabetes mellitus (T2DM) in the post-acute phase of COVID-19.
Methods
This cohort study used data from the Health Insurance Review and Assessment Service, a representative national healthcare database in Korea. We established a cohort of 348,180 individuals diagnosed with COVID-19 without a history of diabetes between January 2020 and September 2021. The control group consisted of sex- and age-matched individuals with neither a history of diabetes nor COVID-19. We assessed the hazard ratios (HR) of newly diagnosed T2DM patients with COVID-19 compared to controls, adjusted for age, sex, and the presence of hypertension and dyslipidemia.
Results
In the post-acute phase, patients with COVID-19 had an increased risk of newly diagnosed T2DM compared to those without COVID-19 (adjusted HR, 1.30; 95% confidence interval [CI], 1.27 to 1.33). The adjusted HRs of non-hospitalized, hospitalized, and intensive care unit-admitted patients were 1.14 (95% CI, 1.08 to 1.19), 1.34 (95% CI, 1.30 to 1.38), and 1.78 (95% CI, 1.59 to 1.99), respectively. The risk of T2DM in patients who were not administered glucocorticoids also increased (adjusted HR, 1.29; 95% CI, 1.25 to 1.32).
Conclusion
COVID-19 may increase the risk of developing T2DM beyond the acute period. The higher the severity of COVID-19 in the acute phase, the higher the risk of newly diagnosed T2DM. Therefore, T2DM should be included as a component of managing long-term COVID-19.

Citations

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Freya Tyrer, Safoora Gharibzadeh, Clare Gillies, Claire Lawson, Ash Routen, Nazrul Islam, Cameron Razieh, Francesco Zaccardi, Tom Yates, Melanie J. Davies, Christopher E. Brightling, James D. Chalmers, Annemarie B. Docherty, Omer Elneima, Rachael A. Evans
Diabetes, Obesity and Metabolism.2025; 27(2): 767. CrossRef
Comparison of incidence trends of early-onset and late-onset type 2 diabetes in the Asia-Pacific region, 1990-2021: a join point regression analysis based on the global burden of disease study 2021
Chenying Lin, Haohua An, Jingna Lin, Yuejuan Cao, Zhen Yang
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New onset of type 1 and type 2 diabetes post-COVID-19 infection: a systematic review
Ahmed El-Naas, Omar Hamad, Siddhant Nair, Bushra Alfakhri, Shadi Mahmoud, Aliyaa Haji, Lina Ahmed, Ahamed Lebbe, Ali Aboulwafa, Farha Shaikh, Imane Bouhali, Dalia Zakaria
Emerging Microbes & Infections.2025;[Epub] CrossRef
Aspirin reduces the risk of type 2 diabetes associated with COVID-19
Valentina Trimarco, Raffaele Izzo, Daniela Pacella, Maria Virginia Manzi, Stanislovas S. Jankauskas, Paola Gallo, Francesco Rozza, Giuseppe Giugliano, Alessandra Spinelli, Giovanni Esposito, Roberto Piccinocchi, Gaetano Piccinocchi, Carmine Morisco, Maria
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Patricia FIERRO, David MARTÍN, Emilio PARIENTE-RODRIGO, Stefanie F. PINI, Héctor BASTERRECHEA, Marian TOBALINA, Benedetta PETITTA, Camila BIANCONI, Sara DÍAZ-SALAZAR, Merelyn BONOME, Carmen RAMOS-BARRÓN, José L. HERNÁNDEZ-HERNÁNDEZ
Minerva Endocrinology.2025;[Epub] CrossRef
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Emma Cocking, Joseph Daher, Majid Alabbood
Diabetes Research and Clinical Practice.2025; 227: 112417. CrossRef
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Campbell Systematic Reviews.2025;[Epub] CrossRef
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Diabetes Therapy.2024; 15(1): 33. CrossRef
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Walter Vena, Stella Pigni, Nazarena Betella, Annalisa Navarra, Marco Mirani, Gherardo Mazziotti, Andrea G. Lania, Antonio C. Bossi
Human Vaccines & Immunotherapeutics.2024;[Epub] CrossRef
Association of COVID-19 infection and the risk of new incident diabetes: a systematic review and meta-analysis
Jingye Zhou, Yuzhu Wang, Ruolan Xu
Frontiers in Endocrinology.2024;[Epub] CrossRef
Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people
Kurt Taylor, Sophie Eastwood, Venexia Walker, Genevieve Cezard, Rochelle Knight, Marwa Al Arab, Yinghui Wei, Elsie M F Horne, Lucy Teece, Harriet Forbes, Alex Walker, Louis Fisher, Jon Massey, Lisa E M Hopcroft, Tom Palmer, Jose Cuitun Coronado, Samantha
The Lancet Diabetes & Endocrinology.2024; 12(8): 558. CrossRef
A Prospective 1-Year Follow-up of Glycemic Status and C-Peptide Levels of COVID-19 Survivors with Dysglycemia in Acute COVID-19 Infection
David Tak Wai Lui, Chi Ho Lee, Ying Wong, Carol Ho Yi Fong, Kimberly Hang Tsoi, Yu Cho Woo, Kathryn Choon Beng Tan
Diabetes & Metabolism Journal.2024; 48(4): 763. CrossRef
Commentary on "New-onset diabetes in children during the COVID-19 Pandemic: an assessment of biomarkers and psychosocial risk factors at play in Mississippi"
Se Young Kim
Annals of Pediatric Endocrinology & Metabolism.2024; 29(4): 209. CrossRef
Elevated risk of pre-diabetes and diabetes in people with past history of COVID-19 in northeastern Nigeria
Roland I. Stephen, Jennifer A. Tyndall, Hsing-yu Hsu, Jing Sun, Nura Umaru, Jamiu S. Olumoh, Oyelola A. Adegboye, Olah U. Owobi, Todd T. Brown
BMC Public Health.2024;[Epub] CrossRef
Changes in the Epidemiological Landscape of Diabetes in South Korea: Trends in Prevalence, Incidence, and Healthcare Expenditures
Kyoung Hwa Ha, Dae Jung Kim
Endocrinology and Metabolism.2024; 39(5): 669. CrossRef
Pituitary Diseases and COVID-19 Outcomes in South Korea: A Nationwide Cohort Study
Jeonghoon Ha, Kyoung Min Kim, Dong-Jun Lim, Keeho Song, Gi Hyeon Seo
Journal of Clinical Medicine.2023; 12(14): 4799. CrossRef

Adrenal gland Big Data Articles (National Health Insurance Service Database)
Mortality and Severity of Coronavirus Disease 2019 in Patients with Long-Term Glucocorticoid Therapy: A Korean Nationwide Cohort Study: Eu Jeong Ku, Keeho Song, Kyoung Min Kim, Gi Hyeon Seo, Soon Jib Yoo; Endocrinol Metab. 2023;38(2):253-259. Published online March 21, 2023; DOI: https://doi.org/10.3803/EnM.2022.1607

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Background
The severity of coronavirus disease 2019 (COVID-19) among patients with long-term glucocorticoid treatment (LTGT) has not been established. We aimed to evaluate the association between LTGT and COVID-19 prognosis.
Methods
A Korean nationwide cohort database of COVID-19 patients between January 2019 and September 2021 was used. LTGT was defined as exposure to at least 150 mg of prednisolone (≥5 mg/day and ≥30 days) or equivalent glucocorticoids 180 days before COVID-19 infection. The outcome measurements were mortality, hospitalization, intensive care unit (ICU) admission, length of stay, and mechanical ventilation.
Results
Among confirmed patients with COVID-19, the LTGT group (n=12,794) was older and had a higher proportion of comorbidities than the control (n=359,013). The LTGT group showed higher in-hospital, 30-day, and 90-day mortality rates than the control (14.0% vs. 2.3%, 5.9% vs. 1.1%, and 9.9% vs. 1.8%, respectively; all P<0.001). Except for the hospitalization rate, the length of stay, ICU admission, and mechanical ventilation proportions were significantly higher in the LTGT group than in the control (all P<0.001). Overall mortality was higher in the LTGT group than in the control group, and the significance remained in the fully adjusted model (odds ratio [OR], 5.75; 95% confidence interval [CI], 5.31 to 6.23) (adjusted OR, 1.82; 95% CI, 1.67 to 2.00). The LTGT group showed a higher mortality rate than the control within the same comorbidity score category.
Conclusion
Long-term exposure to glucocorticoids increased the mortality and severity of COVID-19. Prevention and early proactive measures are inevitable in the high-risk LTGT group with many comorbidities.

Citations

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Aliya Yskak, Yevgeniy Sokharev, Kuanysh Zhumalynov, Elizaveta Koneva, Natalia Afanasyeva, Dmitri Borodulin, Dmitrii Babaskin, Almabek Nugmanov, Murat Nurushev, Vadim Chashkov, Gianmarco Ferrara
Scientifica.2025;[Epub] CrossRef
Outpatient glucocorticoid use and COVID-19 outcomes: a population-based study
Almudena Rodríguez-Fernández, Irene Visos-Varela, Maruxa Zapata-Cachafeiro, Samuel Pintos-Rodríguez, Rosa M. García-Álvarez, Teresa M. Herdeiro, María Piñeiro-Lamas, Adolfo Figueiras, Ángel Salgado-Barreira, Rosendo Bugarín-González, Eduardo Carracedo-Mar
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Endocrinology and Metabolism.2023; 38(2): 223. CrossRef
Pituitary Diseases and COVID-19 Outcomes in South Korea: A Nationwide Cohort Study
Jeonghoon Ha, Kyoung Min Kim, Dong-Jun Lim, Keeho Song, Gi Hyeon Seo
Journal of Clinical Medicine.2023; 12(14): 4799. CrossRef

Review Article

Mineral, Bone & Muscle
Interplay of Vitamin D and CYP3A4 Polymorphisms in Endocrine Disorders and Cancer: Siva Swapna Kasarla, Vannuruswamy Garikapati, Yashwant Kumar, Sujatha Dodoala; Endocrinol Metab. 2022;37(3):392-407. Published online June 3, 2022; DOI: https://doi.org/10.3803/EnM.2021.1349

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Vitamin D has received considerable optimistic attention as a potentially important factor in many pathological states over the past few decades. However, the proportion of the active form of vitamin D metabolites responsible for biological activity is highly questionable in disease states due to flexible alterations in the enzymes responsible for their metabolism. For instance, CYP3A4 plays a crucial role in the biotransformation of vitamin D and other drug substances. Food-drug and/or drug-drug interactions, the disease state, genetic polymorphism, age, sex, diet, and environmental factors all influence CYP3A4 activity. Genetic polymorphisms in CYP450-encoding genes have received considerable attention in the past few decades due to their extensive impact on the pharmacokinetic and dynamic properties of drugs and endogenous substances. In this review, we focused on CYP3A4 polymorphisms and their interplay with vitamin D metabolism and summarized the role of vitamin D in calcium homeostasis, bone diseases, diabetes, cancer, other diseases, and drug substances. We also reviewed clinical observations pertaining to CYP3A4 polymorphisms among the aforementioned disease conditions. In addition, we highlighted the future perspectives of studying the pharmacogenetics of CYP3A4, which may have potential clinical significance for developing novel diagnostic genetic markers that will ascertain disease risk and progression.

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Brief Report

Diabetes, Obesity and Metabolism
Year-Long Trend in Glycated Hemoglobin Levels in Patients with Type 2 Diabetes during the COVID-19 Pandemic: Jonghwa Jin, Seong Wook Lee, Won-Ki Lee, Jae-Han Jeon, Jung-Guk Kim, In-Kyu Lee, Yeon-Kyung Choi, Keun-Gyu Park; Endocrinol Metab. 2021;36(5):1142-1146. Published online October 21, 2021; DOI: https://doi.org/10.3803/EnM.2021.1154

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It has been suggested that the coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on glycemic control in patients with type 2 diabetes mellitus (T2DM). However, no study has examined yearly trends in glycated hemoglobin (HbA1c) levels after the start of the COVID-19 outbreak. Here, we performed a retrospective analysis of HbA1c concentrations during the early period of the COVID-19 outbreak (COVID-19 cohort) and then compared the yearly trend in the mean HbA1c level, along with fluctuations in HbA1c levels, with those during previous years (non-COVID-19 cohorts). We observed that the mean HbA1c level in patients with T2DM increased during the first 6 months of the COVID-19 outbreak. After 6 months, HbA1c levels in the COVID-19 cohort returned to levels seen in the non-COVID-19 cohorts. The data suggest that vulnerable patients with T2DM should be monitored closely during the early period of a pandemic to ensure they receive appropriate care.

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Tabinda Azim, Amer Hayat Khan, Fouzia Sadiq, Syed Azhar Syed Sulaiman, Dzul Azri Mohamed Noor, Umar Wahab, Osama Ishtiaq
Diabetes Research and Clinical Practice.2025; 226: 112316. CrossRef
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Original Articles

Thyroid
Thyroid Hormone Profile and Its Prognostic Impact on the Coronavirus Disease 2019 in Korean Patients: Jiyeon Ahn, Min Kyung Lee, Jae Hyuk Lee, Seo Young Sohn; Endocrinol Metab. 2021;36(4):769-777. Published online August 27, 2021; DOI: https://doi.org/10.3803/EnM.2021.1109

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Background
Data on the association between coronavirus disease 2019 (COVID-19) and thyroid have been reported, including overt thyrotoxicosis and suppression of thyroid function. We aimed to evaluate the thyroid hormone profile and its association with the prognosis of COVID-19 in Korean patients.
Methods
The clinical data of 119 patients with COVID-19, admitted in the Myongji Hospital, Goyang, South Korea, were retrospectively evaluated. The thyroid hormone profiles were analyzed and compared based on disease severity (non-severe disease vs. severe to critical disease). Clinical outcomes were analyzed according to the tertiles of thyroid hormones.
Results
Of the 119 patients, 76 (63.9%) were euthyroid, and none presented with overt thyroid dysfunction. Non-thyroidal illness syndrome was the most common manifestation (18.5%), followed by subclinical thyrotoxicosis (14.3%) among patients with thyroid dysfunction. Thyroid stimulating hormone (TSH) and triiodothyronine (T3) levels were significantly lower in patients with severe to critical disease than in those with non-severe disease (P<0.05). Patients in the lowest T3 tertile (<0.77 ng/mL) had higher rates of mechanical ventilation, intensive care unit admission, and death than those in the middle and highest (>1.00 ng/mL) T3 tertiles (P<0.05). COVID-19 patients in the lowest T3 tertile were independently associated with mortality (hazard ratio, 5.27; 95% confidence interval, 1.09 to 25.32; P=0.038) compared with those in the highest T3 tertile.
Conclusion
Thyroid dysfunction is common in COVID-19 patients. Changes in serum TSH and T3 levels may be important markers of disease severity in COVID-19. Decreased T3 levels may have a prognostic significance in COVID-19 related outcome.

Citations

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Thyroid function during COVID-19 and post-COVID complications in adults: a systematic review
Anisha Panesar, Palma Gharanei, Natasha Khovanova, Lawrence Young, Dimitris Grammatopoulos
Frontiers in Endocrinology.2025;[Epub] CrossRef
Prevalence and Evolution of Thyroid Dysfunction in COVID-19: A Retrospective Study
Shourya Tadisina, Sobrina Mohammed, Reda Asad, Tatiana Tselovalnikova, Bong Nguyen, Phani V Akella, Maha Abu Kishk
Cureus.2025;[Epub] CrossRef
The prevalence of thyroid disorders in COVID-19 patients: a systematic review and meta-analysis
Sadra Ashrafi, Hossein Hatami, Razieh Bidhendi-Yarandi, Mohammad Hossein Panahi
BMC Endocrine Disorders.2024;[Epub] CrossRef
Thyroid Stimulating Hormone as a Possible Additional COVID-19 Outcome Marker
Anamarija Zrilic Vrkljan, Ana Majic Tengg, Tanja Palaversa, Srecko Marusic, Lana Ruzic, Ines Bilic-Curcic, Maja Cigrovski Berkovic
Medicina.2024; 60(2): 314. CrossRef
Effect of Hypothalamic Adrenal Axis and Thyroid Function Alterations on Prognosis of Critically Ill COVID-19 Patients
Muhammet KORKUSUZ, Sulbiye KARABURGU, Tayfun ET, Rafet YARIMOĞLU, Nuh KUMRU
Namık Kemal Tıp Dergisi.2024; 12(1): 17. CrossRef
Patterns of thyroid gland dysfunction among hospitalized patients with COVID-19 pneumonia
Fatima Al Taher Taha Morsi, Marwan Elgohary, Ahmed A. Abdelmoaty, Maha E. Alsadik, Samah M. Shehata, Mohamed Ahmed EL Maghawry
The Egyptian Journal of Bronchology.2024;[Epub] CrossRef
Association between thyroid function and prognosis of severe COVID-19 among patients with SARS-CoV-2 infection: a retrospective cohort study in China
Yaling Yang, Lifang Qian, Chenwei Wu, Xinyue Xu, Duoduo Qu, Lihua Zhou, Jia Liu, Qin Zhu, Chunhong Wang, Xiaolong Zhao
Frontiers in Endocrinology.2024;[Epub] CrossRef
Thyroid Function in the Time of COVID-19: A Systematic Review of Disease Progression and Vaccination Effect
Maryam Zarkesh, Maryam Sanoie, Shabnam Heydarzadeh, Raziyeh Abooshahab, Afsoon Daneshafrooz, Farhad Hosseinpanah, Mehdi Hedayati
International Journal of Endocrinology and Metabolism.2024;[Epub] CrossRef
Thyroxine changes in COVID-19 pandemic: A systematic review and meta-analysis
Ziqi Li, Pengwei Hou, Shuwen Mu, Renzhi Wang, Hui Miao, Ming Feng, He Wang, Wentai Zhang, Yihao Chen, Tianshun Feng, Shousen Wang, Yi Fang
Frontiers in Endocrinology.2023;[Epub] CrossRef
The Influence of SARS-CoV-2 Infection on the Thyroid Gland
Aleksandra Piekarska, Marta Góral, Marta Kozula, Aleksandra Jawiarczyk-Przybyłowska, Katarzyna Zawadzka, Marek Bolanowski
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Thyroid Function Abnormalities and Outcomes in Hospitalized Patients with COVID-19 Infection: A Cross-Sectional Study
Deepika Patel, Dukhabandhu Naik, Sadishkumar Kamalanathan, Kadhiravan Tamilarasu, Jayaprakash Sahoo, Ayan Roy, Chandhana Merugu, Varun Suryadevara
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Mingyao Zhong, Yue Gao, Hongling Hu, Xuan Zhu, Lulu Gan, Ling Li, Cheng Xiang, Yimin Yan, Zhe Dai
Frontiers in Endocrinology.2023;[Epub] CrossRef
Affectation of the thyroid gland post SARS-CoV-2
João Pedro Souto Silva, Erico Gerardo Laube
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The Association Between COVID-19 and Thyroxine Levels: A Meta-Analysis
Yiru Chen, Xiuneng Li, Yu Dai, Jingjing Zhang
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The New Entity of Subacute Thyroiditis amid the COVID-19 Pandemic: From Infection to Vaccine
Mihaela Popescu, Adina Ghemigian, Corina Maria Vasile, Andrei Costache, Mara Carsote, Alice Elena Ghenea
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Stephani C. Wang, Fengmin Zhang, Hui Zhu, Haipeng Yang, Yang Liu, Ping Wang, Vladimir Parpura, Yu-Feng Wang
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The Association Between FT3 With the Outcome and Inflammation/Coagulopathy/Fibrinolysis of COVID-19
Jiayi Deng, Siye Zhang, Fei Peng, Quan Zhang, Yi Li, Yanjun Zhong
Frontiers in Endocrinology.2022;[Epub] CrossRef
Primary hypothyroidism with an episode of ventricular tachycardia in a patient with COVID-19
Pin-Hsu Liao, Yu-Cheng Cheng, Po-Yu Liu, I-Te Lee
Medicine.2022; 101(25): e29243. CrossRef
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Huijun Chen, Minjie Xu, Yezhi Huang, Jincai He, Wenwei Ren
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Mohammad Darvishi, Mohammad Reza Nazer, Hamze Shahali, Majid Nouri
Frontiers in Endocrinology.2022;[Epub] CrossRef
The prognostic utility of serum thyrotropin in hospitalized Covid-19 patients: statistical and machine learning approaches
E. Pappa, P. Gourna, G. Galatas, M. Manti, A. Romiou, L. Panagiotou, R. Chatzikyriakou, N. Trakas, G. Feretzakis, C. Christopoulos
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Thyrotropin Levels in Patients with Coronavirus Disease 2019: Assessment during Hospitalization and in the Medium Term after Discharge
Abdallah Al-Salameh, Noémie Scherman, Imane Adda, Juliette André, Yoann Zerbib, Julien Maizel, Jean-Daniel Lalau, Etienne Brochot, Claire Andrejak, Rachel Desailloud
Life.2022; 12(12): 2014. CrossRef
COVID-19 and thyroid function: What do we know so far?
Camila Lüdke Rossetti, Juliana Cazarin, Fabio Hecht, Fabyan Esberard de Lima Beltrão, Andrea Cláudia Freitas Ferreira, Rodrigo Soares Fortunato, Helton Estrela Ramos, Denise Pires de Carvalho
Frontiers in Endocrinology.2022;[Epub] CrossRef

Diabetes, Obesity and Metabolism
High Fibrosis-4 Index Is Related with Worse Clinical Outcome in Patients with Coronavirus Disease 2019 and Diabetes Mellitus: A Multicenter Observational Study: Sung-Woo Kim, Jae-Han Jeon, Jun Sung Moon, Mi Kyung Kim; Endocrinol Metab. 2021;36(4):800-809. Published online August 20, 2021; DOI: https://doi.org/10.3803/EnM.2021.1040

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Background
Based on recent evidence on the importance of the presence of diabetes mellitus (DM) and fibrosis-4 (FIB-4) index in coronavirus disease 2019 (COVID-19) mortality, we analyzed whether these factors could additively predict such mortality.
Methods
This multicenter observational study included 1,019 adult inpatients admitted to university hospitals in Daegu. The demographic and laboratory findings, mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM and/or a high FIB-4 index. The mortality risk and corresponding hazard ratio (HR) were analyzed using the Kaplan-Meier method and Cox proportional hazard models.
Results
The patients with DM (n=217) exhibited significantly higher FIB-4 index and mortality compared to those without DM. Although DM (HR, 2.66; 95% confidence interval [CI], 1.63 to 4.33) and a high FIB-4 index (HR, 4.20; 95% CI, 2.21 to 7.99) were separately identified as risk factors for COVID-19 mortality, the patients with both DM and high FIB-4 index had a significantly higher mortality (HR, 9.54; 95% CI, 4.11 to 22.15). Higher FIB-4 indices were associated with higher mortality regardless of DM. A high FIB-4 index with DM was more significantly associated with a severe clinical course with mortality (odds ratio, 11.24; 95% CI, 5.90 to 21.41) than a low FIB-4 index without DM, followed by a high FIB-4 index alone and DM alone. The duration of quarantine and hospital stay also tended to be longer in those with both DM and high FIB-4 index.
Conclusion
Both DM and high FIB-4 index are independent and additive risk factors for COVID-19 mortality.

Citations

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Frontiers in Neurology.2022;[Epub] CrossRef

Special Article

Miscellaneous
COVID-19 Vaccination for Endocrine Patients: A Position Statement from the Korean Endocrine Society: Cheol Ryong Ku, Kyong Yeun Jung, Chang Ho Ahn, Jun Sung Moon, Ju Hee Lee, Eun Heui Kim, Hyemi Kwon, Hee Kyung Kim, Sunghwan Suh, Sangmo Hong, Jeonghoon Ha, Eun Roh, Jin Hwa Kim, Mi-kyung Kim, the Committee of Clinical Practice Guideline of the Korean Endocrine Society; Endocrinol Metab. 2021;36(4):757-765. Published online August 17, 2021; DOI: https://doi.org/10.3803/EnM.2021.404

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Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccine against COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and their side effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients’ health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medical backgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements made by clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetes mellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.

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Brief Report

Diabetes, Obesity and Metabolism
Dipeptidyl Peptidase-4 Inhibitors and COVID-19-Related Deaths among Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Observational Studies: Dimitrios Patoulias, Michael Doumas; Endocrinol Metab. 2021;36(4):904-908. Published online July 27, 2021; DOI: https://doi.org/10.3803/EnM.2021.1048

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The coronavirus disease 2019 (COVID-19) pandemic remains an unbeaten enemy. Unfortunately, no targeted treatment option is available. Patients with type 2 diabetes mellitus (T2DM) have increased odds for severe or fatal disease, as demonstrated in recent observational studies. There is an ongoing discussion regarding the impact of different antidiabetic drug classes on outcomes of interest among affected subjects. Dipeptidyl peptidase-4 (DPP-4) inhibitors have been placed at the epicenter, since the DPP-4 enzyme seems to be implicated in the disease pathogenesis. Herein we present an updated meta-analysis of observational studies addressing the risk of COVID-19 death among patients with T2DM on prior DPP-4 inhibitor treatment. We pooled data from 10 observational studies, showing that DPP-4 inhibitors produce a non-significant decrease in the risk for COVID-19-related death. However, when administered in the inpatient setting, DPP-4 inhibitors decrease the risk for COVID-19-related death by 50%. Ongoing randomized controlled trials will shed further light.

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Original Article

Thyroid
Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors: David Tak Wai Lui, Chi Ho Lee, Wing Sun Chow, Alan Chun Hong Lee, Anthony Raymond Tam, Carol Ho Yi Fong, Chun Yiu Law, Eunice Ka Hong Leung, Kelvin Kai Wang To, Kathryn Choon Beng Tan, Yu Cho Woo, Ching Wan Lam, Ivan Fan Ngai Hung, Karen Siu Ling Lam; Endocrinol Metab. 2021;36(3):582-589. Published online June 8, 2021; DOI: https://doi.org/10.3803/EnM.2021.983

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Background
The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors.
Methods
We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months.
Results
In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer.
Conclusion
Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

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Review Articles

Diabetes
Continuous Glucose Monitoring in the Hospital: M. Citlalli Perez-Guzman, Trisha Shang, Jennifer Y. Zhang, Donna Jornsay, David C. Klonoff; Endocrinol Metab. 2021;36(2):240-255. Published online March 31, 2021; DOI: https://doi.org/10.3803/EnM.2021.201

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Continuous glucose monitors (CGMs) have suddenly become part of routine care in many hospitals. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. The use of CGMs to automatically and remotely supplement or replace assisted monitoring of blood glucose by bedside nurses can decrease: the amount of necessary nursing exposure to COVID-19 patients with diabetes; the amount of time required for obtaining blood glucose measurements, and the amount of personal protective equipment necessary for interacting with patients during the blood glucose testing. The United States Food and Drug Administration (FDA) is now exercising enforcement discretion and not objecting to certain factory-calibrated CGMs being used in a hospital setting, both to facilitate patient care and to obtain performance data that can be used for future regulatory submissions. CGMs can be used in the hospital to decrease the frequency of fingerstick point of care capillary blood glucose testing, decrease hyperglycemic episodes, and decrease hypoglycemic episodes. Most of the research on CGMs in the hospital has focused on their accuracy and only recently outcomes data has been reported. A hospital CGM program requires cooperation of physicians, bedside nurses, diabetes educators, and hospital administrators to appropriately select and manage patients. Processes for collecting, reviewing, storing, and responding to CGM data must be established for such a program to be successful. CGM technology is advancing and we expect that CGMs will be increasingly used in the hospital for patients with diabetes.

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Richard M. Bergenstal, Gregg D. Simonson, Lutz Heinemann
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Chikara Gothong, Lakshmi G. Singh, Medha Satyarengga, Elias K. Spanakis
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Breakthrough technology for in-hospital glucose monitoring
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The Role of the Diabetes Care and Education Specialist in the Hospital Setting

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Real-Time Monitoring of Blood Parameters in the Intensive Care Unit: State-of-the-Art and Perspectives
Rebecca Bockholt, Shaleen Paschke, Lars Heubner, Bergoi Ibarlucea, Alexander Laupp, Željko Janićijević, Stephanie Klinghammer, Sascha Balakin, Manfred F. Maitz, Carsten Werner, Gianaurelio Cuniberti, Larysa Baraban, Peter Markus Spieth
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Frontiers in Endocrinology.2022;[Epub] CrossRef
Stress-Induced Hyperglycemia: Consequences and Management
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Hospital Diabetes Meeting 2022
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Thyroid
Best Achievements in Clinical Thyroidology in 2020: Eun Kyung Lee, Young Joo Park; Endocrinol Metab. 2021;36(1):30-35. Published online February 24, 2021; DOI: https://doi.org/10.3803/EnM.2021.103

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This review highlights the most interesting research in thyroidology conducted in 2020. The publications of interest discussed below dealt with the following topics: thyroid dysfunction, risk of thyroid cancer, molecular diagnostics and new therapeutics for thyroid cancer, and thyroid disease in the coronavirus disease 2019 pandemic era.

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Compensation for iodine deficiency conditions with drugs based on duckweed substrate
M. Kh. Sadulaev, M. I. Usmanova, T. T. Tataev, A. M. Inderbiev, A. S.-A. Zhamalullayla, A. Salamova
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Use of long non-coding RNAs for the molecular diagnosis of papillary thyroid cancer
Daham Kim, Juyeon Yu, Jiwon Kim, Yoon-a Hwang, Jin Kyong Kim, Cheol Ryong Ku, Jung Hyun Yoon, Jin Young Kwak, Kee-Hyun Nam, Eun Jig Lee
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Ultrasound-Guided Fine-Needle Aspiration with or without Negative Pressure for Different Types of Thyroid Nodules
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Brief Report

Obesity and Metabolism
Overweight and Obesity are Risk Factors for Coronavirus Disease 2019: A Propensity Score-Matched Case-Control Study: Wonjun Ji, Rugyeom Lee, Kyungmin Huh, Minsun Kang, In Cheol Hwang, Munkhzul Radnaabaatar, Dae Ho Lee, Jaehun Jung; Endocrinol Metab. 2021;36(1):196-200. Published online February 24, 2021; DOI: https://doi.org/10.3803/EnM.2020.856

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Although obesity is a risk factor for infection, whether it has the same effect on coronavirus disease 2019 (COVID-19) need confirming. We conducted a retrospective propensity score matched case-control study to examine the association between obesity and COVID-19. This study included data from the Nationwide COVID-19 Registry and the Biennial Health Checkup database, until May 30, 2020. We identified 2,231 patients with confirmed COVID-19 and 10-fold-matched negative test controls. Overweight (body mass index [BMI] 23 to 24.9 kg/m²; adjusted odds ratio [aOR], 1.16; 95% confidence interval [CI], 1.1.03 to 1.30) and class 1 obesity (BMI 25 to 29.9 kg/m²; aOR, 1.27; 95% CI, 1.14 to 1.42) had significantly increased COVID-19 risk, while classes 2 and 3 obesity (BMI ≥30 kg/m²) showed similar but non-significant trend. Females and those <50 years had more robust association pattern. Overweight and obesity are possible risk factors of COVID-19.

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Association between being underweight and excess body weight before SARS coronavirus type 2 infection and clinical outcomes of coronavirus disease 2019: Multicenter study
João Araújo Barros-Neto, Carolina Santos Mello, Sandra Mary Lima Vasconcelos, Gabriel Soares Bádue, Raphaela Costa Ferreira, Maria Izabel Siqueira de Andrade, Carlos Queiroz do Nascimento, Mateus de Lima Macena, José Adailton da Silva, Heleni Aires Clemen
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Impact of COVID-19 Lockdown on Non-Alcoholic Fatty Liver Disease and Insulin Resistance in Adults: A before and after Pandemic Lockdown Longitudinal Study
Ángel Arturo López-González, Bárbara Altisench Jané, Luis Masmiquel Comas, Sebastiana Arroyo Bote, Hilda María González San Miguel, José Ignacio Ramírez Manent
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Original Articles

Clinical Study
Clinical Outcomes of COVID-19 Patients with Type 2 Diabetes: A Population-Based Study in Korea: Ji Hong You, Sang Ah Lee, Sung-Youn Chun, Sun Ok Song, Byung-Wan Lee, Dae Jung Kim, Edward J. Boyko; Endocrinol Metab. 2020;35(4):901-908. Published online December 10, 2020; DOI: https://doi.org/10.3803/EnM.2020.787

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Background
The aim of this study was to evaluate clinical outcomes in coronavirus disease 2019 (COVID-19) positive patients with type 2 diabetes compared to those without diabetes in Korea.
Methods
We extracted claims data for patients diagnosed with COVID-19 from the National Health Insurance Service database in Korea from January 20, 2020 to March 31, 2020. We followed up this cohort until death from COVID-19 or discharge from hospital.
Results
A total of 5,473 patients diagnosed with COVID-19 were analyzed, including 495 with type 2 diabetes and 4,978 without diabetes. Patients with type 2 diabetes were more likely to be treated in the intensive care unit (ICU) (P<0.0001). The incidence of inhospital mortality was higher in patients with type 2 diabetes (P<0.0001). After adjustment for age, sex, insurance status, and comorbidities, odds of ICU admission (adjusted odds ratio [OR], 1.59; 95% confidence interval [CI], 1.02 to 2.49; P=0.0416) and in-hospital mortality (adjusted OR, 1.90; 95% CI, 1.13 to 3.21; P=0.0161) among patients with COVID-19 infection were significantly higher in those with type 2 diabetes. However, there was no significant difference between patients with and without type 2 diabetes in ventilator, oxygen therapy, antibiotics, antiviral drugs, antipyretics, and the incidence of pneumonia after adjustment.
Conclusion
COVID-19 positive patients with type 2 diabetes had poorer clinical outcomes with higher risk of ICU admission and in-hospital mortality than those without diabetes. Therefore, medical providers need to consider this more serious clinical course when planning and delivering care to type 2 diabetes patients with COVID-19 infection.

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Ru Ying Fong, Annie Lee, Fei Gao, Jonathan Jiunn Liang Yap, Khung Keong Yeo
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Clinical Study
Fasting Plasma Glucose Level Independently Predicts the Mortality of Patients with Coronavirus Disease 2019 Infection: A Multicenter, Retrospective Cohort Study: Min Cheol Chang, Jong-Moon Hwang, Jae-Han Jeon, Sang Gyu Kwak, Donghwi Park, Jun Sung Moon; Endocrinol Metab. 2020;35(3):595-601. Published online August 26, 2020; DOI: https://doi.org/10.3803/EnM.2020.719

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Background
Coronavirus disease 2019 (COVID-19) has become a global pandemic, which prompts a consensus for the necessity to seek risk factors for this critical disease. Risk factors affecting mortality of the disease remain elusive. Diabetes and hyperglycemia are known to negatively affect a host’s antiviral immunity. We evaluated the relationship between a history of diabetes, fasting plasma glucose (FPG) levels and mortality among severely ill patients with COVID-19.
Methods
This was a retrospective cohort study that assessed 106 adult inpatients (aged ≥18 years) from two tertiary hospitals in Daegu, South Korea. The participants were transferred to tertiary hospitals because their medical condition required immediate intensive care. The demographic and laboratory data were compared between COVID-19 patients who survived and those who did not.
Results
Compared with the survivor group, age, and the proportions of diabetes, chronic lung disease and FPG were significantly higher in the deceased group. In the Cox proportional hazards regression model for survival analysis, FPG level and age were identified as significant predictors of mortality (P<0.05). The threshold values for predicting high mortality were age >68 years and FPG of 168 mg/dL, respectively. Among those without diabetes, high FPG remained a significant predictor of mortality (P<0.04).
Conclusion
High FPG levels significantly predicted mortality in COVID-19, regardless of a known history of diabetes. These results suggest intensive monitoring should be provided to COVID-19 patients who have a high FPG level.

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Review Article

Miscellaneous
Encountering COVID-19 as Endocrinologists: Eun-Jung Rhee, Jung Hee Kim, Sun Joon Moon, Won-Young Lee; Endocrinol Metab. 2020;35(2):197-205. Published online June 23, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.197

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The world is entering an era of disaster and chaos due to coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2. Since its first emergence in December 2019 in Wuhan, China, COVID-19 has swept through Asia and propagated throughout the world to Europe and North America. As of April 13, 1,773,084 people were infected and 111,652 people had died from COVID-19 globally, and new record levels of infection are being reported every day. Based on the data that have been amassed so far, the primary risk factors for a severe disease course or even mortality from COVID-19 are underlying diseases such as diabetes and hypertension. As the global prevalence of diabetes continues to increase, patients with endocrine diseases such as diabetes mellitus and those who are on long-term corticosteroid therapy due to adrenal insufficiency or hypopituitarism are at risk for a poor prognosis of COVID-19. As endocrinologists, we would like to briefly review the current knowledge about the relationship between COVID-19 and endocrine diseases and to discuss what we can do for the safety and health of our patients with endocrine diseases in this globally threatening situation.

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