Where are you located again if I may ask?

Same issue in Fort Bend County. One of my hospitals is suspending any outpatient surgery where the patient might need to stay overnight and the other is taking it hour by hour. Trouble is I have a guy scheduled for surgery tomorrow morning and he likely will need to stay overnight. Hope I don't have to cancel him last minute.

On the average, how long is the 30s-40s crowd staying in the hospital before being discharged?

atag said:

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Where are you located again if I may ask?

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Bham metro.

Marcus Aurelius said:

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in a week from around 12. At my hospital. New wing for less sick ones opened up. MICU (the COVID-19 unit) full and about to overflow to other units. Community spread and many younger patients. Numerous 30s 40s. Think this mirrors experiences in other hard hit states. We peaked at 18 or so in March.

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Any guess at average number of comorbidities for younger patients?

And what races? Seems like Hispanic and African American are getting hit at higher rates than other races

Can you provide an insight regarding death rate? The US daily cases has been rising since June 23rd; however, the number of daily death has not followed infection rate.

Can you confirm, are both T1 and T2 diabetes considered co-morbidities or just T2?

Good ? Haven't seen data re this but one would assume similar risk. However DM2 usually is associated more with obesity and insulin resistance, also risk factors. AKA Syndrome X.

I just saw T2 on the CDC website but wasn't sure if that was accurate.

CowtownAg06 said:

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I just saw T2 on the CDC website but wasn't sure if that was accurate.

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UK has a huge population of T1 and they say A1C <7 is pretty nominal risk.

They also are seeing a proportion of T2 on metformin having a better survival rate. My T1 wife is on metformin with a 5.9ish A1C so I figure she's got bases covered. She's also got O blood.

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I just saw T2 on the CDC website but wasn't sure if that was accurate.

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From everything I have read, Type 1s with good control history have not shown any issues. Older Type 1s with poor A1C did have higher risk. Type 2s get to that state for a reason I suppose.

https://healthblog.uofmhealth.org/health-management/what-to-know-about-covid-19-if-you-have-diabetes

https://www.medscape.com/viewarticle/932175

https://www.medscape.com/viewarticle/930856#vp_2

Curious. Do all of your 30s and 40s have comorbidities?

5.9 is pretty incredible. I'm a 30yo diabetic and have never had a1c that good. Usually around 6.2-6.5 which is perfectly fine but 5.9 is mind blowing.

AgsMyDude said:

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Curious. Do all of your 30s and 40s have comorbidities?

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No.

What's their blood type?

Not serotyping. Unless CVPT. Hospital not endorsing this yet as not an academic center and not in setting of a research trial. Insurance kick backs. Although I need to look back at all my plasma TX pts and document serotype ( a lot).

KlinkerAg11 said:

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What's their blood type?

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Curious of this as well.

culdeus said:

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CowtownAg06 said:

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I just saw T2 on the CDC website but wasn't sure if that was accurate.

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UK has a huge population of T1 and they say A1C <7 is pretty nominal risk.

They also are seeing a proportion of T2 on metformin having a better survival rate. My T1 wife is on metformin with a 5.9ish A1C so I figure she's got bases covered. She's also got O blood.

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5.9 A1c?
Metformin for a T1D?

ryan12 said:

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5.9 is pretty incredible. I'm a 30yo diabetic and have never had a1c that good. Usually around 6.2-6.5 which is perfectly fine but 5.9 is mind blowing.

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Closed loop system on fiasp. Could dial in 5.6 if she wanted

Sandman98 said:

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culdeus said:

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CowtownAg06 said:

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I just saw T2 on the CDC website but wasn't sure if that was accurate.

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UK has a huge population of T1 and they say A1C <7 is pretty nominal risk.

They also are seeing a proportion of T2 on metformin having a better survival rate. My T1 wife is on metformin with a 5.9ish A1C so I figure she's got bases covered. She's also got O blood.

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5.9 A1c?
Metformin for a T1D?

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Yes
Yes. It's much more common in UK for T1 to get metformin than US. It's cheap so I figure it doesn't get pushed by sales reps.

Interesting. Hadn't heard of this, but it kind of makes sense since metformin increases insulin sensitivity -> could potentially decrease the amount of insulin someone needs. Or make them more responsive to the amount given, which would have long term benefits related to decreased usage.

Will have to read more into this.

But as far as your theory that it's because drug reps don't push it because it's cheap, that may not be the case. As far as I know the newer SGLT2 inhibitors that help you pee out sugar are rather expensive. That could hypothetically work in type ones as well, mechanistically. I think it's more likely to do with what local institution did the research and if it hasn't made it across the pond yet.

CT75 said:

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Would this 30-40s crowd that is hospitalized now been hospitalized back in March-May? Or would they have been told to stay at home and ride it out? Are the dynamics of admitting patients with COVID different now than a few months ago?

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Curious to know the answer to this question as well.

bigtruckguy3500 said:

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Interesting. Hadn't heard of this, but it kind of makes sense since metformin increases insulin sensitivity -> could potentially decrease the amount of insulin someone needs. Or make them more responsive to the amount given, which would have long term benefits related to decreased usage.

Will have to read more into this.

But as far as your theory that it's because drug reps don't push it because it's cheap, that may not be the case. As far as I know the newer SGLT2 inhibitors that help you pee out sugar are rather expensive. That could hypothetically work in type ones as well, mechanistically. I think it's more likely to do with what local institution did the research and if it hasn't made it across the pond yet.

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It makes sense for type 2 diabetics who have insulin sensitivity issues, but doesn't make a lot of sense in true T1DM given that their issue is not sensitivity, but insulin production. The REMOVAL trial actually set out to answer this question and found that there is no evidence of improved glycemic control or a reduction in insulin used when metformin was added to the typical insulin regimen of T1 diabetics. The study does use a bizarre primary endpoint; however, the results match our current understanding of T1 diabetic pathophysiology.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641446/

Dr. Not Yet Dr. Ag said:

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bigtruckguy3500 said:

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Interesting. Hadn't heard of this, but it kind of makes sense since metformin increases insulin sensitivity -> could potentially decrease the amount of insulin someone needs. Or make them more responsive to the amount given, which would have long term benefits related to decreased usage.

Will have to read more into this.

But as far as your theory that it's because drug reps don't push it because it's cheap, that may not be the case. As far as I know the newer SGLT2 inhibitors that help you pee out sugar are rather expensive. That could hypothetically work in type ones as well, mechanistically. I think it's more likely to do with what local institution did the research and if it hasn't made it across the pond yet.

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It makes sense for type 2 diabetics who have insulin sensitivity issues, but doesn't make a lot of sense in true T1DM given that their issue is not sensitivity, but insulin production. The REMOVAL trial actually set out to answer this question and found that there is no evidence of improved glycemic control or a reduction in insulin used when metformin was added to the typical insulin regimen of T1 diabetics. The study does use a bizarre primary endpoint; however, the results match our current understanding of T1 diabetic pathophysiology.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641446/

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The way it's been promoted to us is that it stops the liver from dumping glucose.

For this reason you also see T1 taking a shot of vodka before working out, this accomplishes the same thing as metformin, on a macro level. (But is not so healthy)

We played with ozempic briefly. The SI factor in her pump dropped (number raised) by 20% or more. That was before she couldn't hold any food down.