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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Response to COVID -19 and Diabetes: Can DPP4 Inhibition Play a Role? – GLP-1 Might Play One Too</title><author><name sortKey="Morin, Nathaniel" sort="Morin, Nathaniel" uniqKey="Morin N" first="Nathaniel" last="Morin">Nathaniel Morin</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32333969</idno><idno type="pmc">7175913</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175913</idno><idno type="RBID">PMC:7175913</idno><idno type="doi">10.1016/j.diabres.2020.108160</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000455</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000455</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Response to COVID -19 and Diabetes: Can DPP4 Inhibition Play a Role? – GLP-1 Might Play One Too</title><author><name sortKey="Morin, Nathaniel" sort="Morin, Nathaniel" uniqKey="Morin N" first="Nathaniel" last="Morin">Nathaniel Morin</name></author></analytic><series><title level="j">Diabetes Research and Clinical Practice</title><idno type="ISSN">0168-8227</idno><idno type="eISSN">1872-8227</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Iacobellis, Gianluca" uniqKey="Iacobellis G">Gianluca Iacobellis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Terwari, N" uniqKey="Terwari N">N. Terwari</name></author><author><name sortKey="Awad, S" uniqKey="Awad S">S. Awad</name></author><author><name sortKey="Duska, F" uniqKey="Duska F">F. Duska</name></author><author><name sortKey="Williams, J P" uniqKey="Williams J">J.P. Williams</name></author><author><name sortKey="Bennett, A" uniqKey="Bennett A">A. Bennett</name></author><author><name sortKey="Macdonald, I A" uniqKey="Macdonald I">I.A. Macdonald</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Duggan, E W" uniqKey="Duggan E">E.W. Duggan</name></author><author><name sortKey="Carlson, K" uniqKey="Carlson K">K. Carlson</name></author><author><name sortKey="Umpierrez, G" uniqKey="Umpierrez G">G. Umpierrez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Labherz, C" uniqKey="Labherz C">C. Labherz</name></author><author><name sortKey="Kahles, F" uniqKey="Kahles F">F. Kahles</name></author><author><name sortKey="Piotrowski, K" uniqKey="Piotrowski K">K. Piotrowski</name></author><author><name sortKey="Vogeser, M" uniqKey="Vogeser M">M. Vogeser</name></author><author><name sortKey="Foldenauer, A C" uniqKey="Foldenauer A">A.C. Foldenauer</name></author><author><name sortKey="Nassau, K" uniqKey="Nassau K">K. Nassau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hulst, A H" uniqKey="Hulst A">A.H. Hulst</name></author><author><name sortKey="Visscher, M J" uniqKey="Visscher M">M.J. Visscher</name></author><author><name sortKey="Godfried, M B" uniqKey="Godfried M">M.B. Godfried</name></author><author><name sortKey="Thiel, B" uniqKey="Thiel B">B. Thiel</name></author><author><name sortKey="Gerritse, B M" uniqKey="Gerritse B">B.M. Gerritse</name></author><author><name sortKey="Scohy, T V" uniqKey="Scohy T">T.V. Scohy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kaneko, S" uniqKey="Kaneko S">S. Kaneko</name></author><author><name sortKey="Ueda, Y" uniqKey="Ueda Y">Y. Ueda</name></author><author><name sortKey="Tahara, Y" uniqKey="Tahara Y">Y. Tahara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Katagiri, N" uniqKey="Katagiri N">N. Katagiri</name></author><author><name sortKey="Kigawa, I" uniqKey="Kigawa I">I. Kigawa</name></author><author><name sortKey="Yahara, Y" uniqKey="Yahara Y">Y. Yahara</name></author><author><name sortKey="Ueda, Y" uniqKey="Ueda Y">Y. Ueda</name></author><author><name sortKey="Hamano, K" uniqKey="Hamano K">K. Hamano</name></author><author><name sortKey="Kaneko, S" uniqKey="Kaneko S">S. Kaneko</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vellanki, P" uniqKey="Vellanki P">P. Vellanki</name></author><author><name sortKey="Rasouli, N" uniqKey="Rasouli N">N. Rasouli</name></author><author><name sortKey="Baldwin, D" uniqKey="Baldwin D">D. Baldwin</name></author><author><name sortKey="Alexanian, S" uniqKey="Alexanian S">S. Alexanian</name></author><author><name sortKey="Anzola, I" uniqKey="Anzola I">I. Anzola</name></author><author><name sortKey="Cardona, Urrutia M" uniqKey="Cardona U">Urrutia M Cardona</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fayfman, M" uniqKey="Fayfman M">M. Fayfman</name></author><author><name sortKey="Davis, G" uniqKey="Davis G">G. Davis</name></author><author><name sortKey="Duggan, E" uniqKey="Duggan E">E. Duggan</name></author><author><name sortKey="Urrutia, M" uniqKey="Urrutia M">M. Urrutia</name></author><author><name sortKey="Chachkhiani, D" uniqKey="Chachkhiani D">D. Chachkhiani</name></author><author><name sortKey="Shindler, J" uniqKey="Shindler J">J. Shindler</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Diabetes Res Clin Pract</journal-id><journal-id journal-id-type="iso-abbrev">Diabetes Res. Clin. Pract</journal-id><journal-title-group><journal-title>Diabetes Research and Clinical Practice</journal-title></journal-title-group><issn pub-type="ppub">0168-8227</issn><issn pub-type="epub">1872-8227</issn><publisher><publisher-name>Elsevier B.V.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32333969</article-id><article-id pub-id-type="pmc">7175913</article-id><article-id pub-id-type="publisher-id">S0168-8227(20)30410-1</article-id><article-id pub-id-type="doi">10.1016/j.diabres.2020.108160</article-id><article-id pub-id-type="publisher-id">108160</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Response to COVID -19 and Diabetes: Can DPP4 Inhibition Play a Role? – GLP-1 Might Play One Too</article-title></title-group><contrib-group><contrib contrib-type="author" id="au005"><name><surname>Morin</surname><given-names>Nathaniel</given-names></name><email>Nathaniel.morin@ahs.ca</email></contrib><aff id="af005">36 Sunlake Circle SE, Calgary, Alberta, Canada. T2X 3J2</aff></contrib-group><pub-date pub-type="pmc-release"><day>22</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>22</day><month>4</month><year>2020</year></pub-date><elocation-id>108160</elocation-id><history><date date-type="received"><day>13</day><month>4</month><year>2020</year></date><date date-type="accepted"><day>17</day><month>4</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Elsevier B.V. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier B.V.</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><kwd-group id="kg005"><title>Keywords</title><kwd>COVID</kwd><kwd>Glucagon Like Peptide 1 (GLP-1)</kwd><kwd>Interleukin 6 (IL-6)</kwd><kwd>Hyperglycemia</kwd></kwd-group></article-meta></front><body><p id="p0005">Hello,</p><p id="p0010">I recently came across your commentary on the function of dipeptidyl peptidase 4 (DPP-4), its possible role in coronavirus infection, and your hypothesis that DPP-4 inhibition may play a role in severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) treatment<xref rid="b0005" ref-type="bibr">[1]</xref>. As my role is in surgery, acute systemic inflammation in people with type two diabetes is always on my mind to improve perioperative glycaemia and outcomes. I wanted to add to your discussion based on my experience in this field.</p><p id="p0015">Endogenous cortisol, catecholamines and Interleukin-6 (IL-6) are main drivers in the post-operative stress response, causing insulin resistance and resulting in hyperglycemia in people with diabetes<xref rid="b0010" ref-type="bibr">[2]</xref>. This effect is so dramatic after cardiac surgery that up to 80% of people develop hyperglycemia regardless of diabetes status<xref rid="b0015" ref-type="bibr">[3]</xref>. Post-operative IL-6 increase has shown to cause glucacon like peptide 1 (GLP-1) release<xref rid="b0020" ref-type="bibr">[4]</xref>, and GLP-1 analogue administration has shown efficacy in reducing post-operative hyperglycemia brought on by cardiac surgery<xref rid="b0025" ref-type="bibr">[5]</xref><italic>.</italic> Pre<italic>-</italic>operative administration of GLP-1 analogues have also shown efficacy in reducing post-operative hyperglycemia<xref rid="b0030" ref-type="bibr">[6]</xref>, including superiority compared to pre-operative long acting insulin<xref rid="b0035" ref-type="bibr">[7]</xref>. Unfortunately, DPP-4 inhibitors have yet to show the same degree of efficacy in this regard<xref rid="b0040" ref-type="bibr">[8]</xref>, <xref rid="b0045" ref-type="bibr">[9]</xref>.</p><p id="p0020">As many people are likely taking GLP-1 analogues while mildly ill with SARS-COV-2, it may also be worthwhile studying the effects of GLP-1 analogues in preventing or reducing the sustained hyperglycemia resulting from systemic inflammation related to SARS-COV-2 infection. Based on their efficacy in preventing and treating hyperglycemia related to systemic inflammation after cardiac and non-cardiac surgery, GLP-1 analogues may play an important future role as well.</p><p id="p0025">Thank you for your time, and stay well soon.</p><sec id="s0005"><title>Conflicts of Interest</title><p id="p0030">I have no conflicts of interest to declare.</p></sec><sec id="s0010"><title>Funding</title><p id="p0035">I have received no funding from any external source.</p></sec></body><back><ref-list id="bi005"><title>References</title><ref id="b0005"><label>1</label><element-citation publication-type="journal" id="h0005"><person-group person-group-type="author"><name><surname>Iacobellis</surname><given-names>Gianluca</given-names></name></person-group><article-title>COVID-19 and diabetes: Can DPP4 inhibition play a role?</article-title><source>Diabetes Research and Clinical Practice</source><volume>162</volume><year>2020</year><fpage>108125</fpage><pub-id 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