From the Department of Diabetes & Endocrinology, Assistant Professor of Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Associate Professor of Medicine, Mayo Clinic, Rochester, Minnesota.
Endocr Pract. 2020 Aug;26(8):923-925. doi: 10.4158/EP-2020-0302.
The pandemic of novel coronavirus disease 2019 (COVID-19) has triggered an international crisis resulting in excess morbidity and mortality with adverse societal, economic, and geopolitical consequences. Like other disease states, there are patient characteristics that impact clinical risk and determine the spectrum of severity. Obesity, or adiposity-based chronic disease, has emerged as an important risk factor for morbidity and mortality due to COVID-19. It is imperative to further stratify risk in patients with obesity to determine optimal mitigation and perhaps therapeutic preparedness strategies. We suspect that insulin resistance is an important pathophysiologic cause of poor outcomes in patients with obesity and COVID-19 independent of body mass index. This explains the association of type 2 diabetes mellitus (T2DM), hypertension (HTN), and cardiovascular disease with poor outcomes since insulin resistance is the main driver of both dysglycemia-based chronic disease and cardiometabolic-based chronic disease towards end-stage disease manifestations. Staging the severity of adiposity-related disease in a "complication-centric" manner (HTN, dyslipidemia, metabolic syndrome, T2DM, obstructive sleep apnea, etc.) among different ethnic groups in patients with COVID-19 should help predict the adverse risk of adiposity on patient health in a pragmatic and actionable manner during this pandemic.
新型冠状病毒病 2019（COVID-19）大流行引发了国际危机，导致发病率和死亡率过高，并产生了不利的社会、经济和地缘政治后果。与其他疾病状态一样，存在影响临床风险并确定严重程度谱的患者特征。肥胖症或基于肥胖的慢性疾病已成为 COVID-19 发病率和死亡率的重要危险因素。当务之急是进一步对肥胖症患者进行风险分层，以确定最佳缓解策略，甚至可能制定治疗准备策略。我们怀疑胰岛素抵抗是肥胖症和 COVID-19 患者不良预后的一个重要病理生理原因，与体重指数无关。这解释了 2 型糖尿病（T2DM）、高血压（HTN）和心血管疾病与不良预后之间的关联，因为胰岛素抵抗是导致基于糖代谢紊乱的慢性疾病和基于心血管代谢的慢性疾病向终末期疾病表现发展的主要驱动因素。在 COVID-19 患者中，以“并发症为中心”的方式对不同种族人群的肥胖相关疾病进行严重程度分期（HTN、血脂异常、代谢综合征、T2DM、阻塞性睡眠呼吸暂停等），应该有助于以务实和可操作的方式预测肥胖对患者健康的不良风险。
