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Covid Diab trials

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I’ve been trying to get my head round this, so far I’ve discovered...
1.It was developed as an glucose lowering drug for Type 2s.
2.The drug increases the amount of AZD1656 which is a hormone that helps take excess glucose out of the blood by storing it in the liver.
3.The liver then sends excess glucose to be stored as fat, by transporting it in triglycerides.
4.The trials for Type 2 were abandoned when it was discovered that the effects wore off after about 4 months, and it caused high levels of triglycerides in 20-30% of the trial participants.
medivizor.com

AZD1656 reduces blood sugar levels in type 2 diabetes, but loses efficacy over time - Medivizor

Share In a nutshell In this study researchers examined the effect of a new drug, AZD1656, and its ability to control blood sugar levels in type 2 diabetic (T2D) patients. Some background Many different drugs, such as metformin (glucophage), are used to control blood sugar levels in T2D patients...
medivizor.com medivizor.com

So far so good, but I don't really understand the leap to a Covid treatment for Type 1s and 2s.
OK, we know our blood glucose tends to go up when we are ill, and keeping it under control would be a good thing. But I have insulin to do this, and tried and tested doses to cope with it. Maybe if I was in hospital, really ill, and someone else was having to manage my blood glucose, it would make things easier to manage. But they are talking about GPs having it to hand out to Diabetics with mild cases. And the last thing I'd want to be faced with is a drug that was going to have an unknown effect on my blood glucose, for which I'd have to work out an entirely new insulin regime, all while I was feeling under the weather.
Am I being cynical, have I missed something, or is this a case of trying to jump on the bandwagon and repurpose a drug that probably cost a lot to develop, but hasn't proved a success for its initial purpose?
 
Quote from the press release...

People living with diabetes face a significantly higher risk of dying with COVID-19. One in three of all deaths with COVID-19 in hospital in England have been associated with diabetes. Diabetes, whether type 1 or 2, has been the leading single cause of co-morbidity during this pandemic. People living with type 1 diabetes are at three and a half times the risk, and people living with type 2 diabetes are at double the risk of dying in hospital with the virus compared to people without diabetes¹

That does not match my understanding of the position of people with diabetes and risk of death from COVID based on the NHS papers published in May. Unfortunately, the source of their reference 1 is not in the press release so I am not sure where they get the data from. I'm wondering if there is a bit of pudding over-egging going on designed to attract speculative investment in the project, something that appears to have worked.
 
Docb said:
That does not match my understanding of the position of people with diabetes and risk of death from COVID based on the NHS papers published in May
Click to expand...
I haven’t seen any more recent figures either, that back up that claim. It’s this use of the phrase 'associated with diabetes'. I assume a lot of people with diabetes as a co-morbidity have died, but I don’t think it has been concluded that it was the cause of death in every case. Someone aged 90, obese, South Asian, male, having had a couple of heart attacks, etc etc, who also has diabetes, and dies of Covid, is not a 'death associated with Diabetes' as far as I'm concerned.
 
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Thanks Beka. Bit late to read that tonight but I will look at it in the morning.
 
The clinical trial details: https://clinicaltrials.gov/ct2/show/NCT04516759

Early, speculative. No idea how it stacks up against the many other COVID therapeutics candidates under investigation.

In addition to its glucose lowering effect, AZD1656 may have additional benefits to COVID-19 patients via its effects on immune function.

In many patients with severe COVID-19, an overreaction of the body's own immune system can cause severe problems including damage to the lungs and heart, which can lead to breathing problems necessitating intubation and ventilation.

AZD1656 has been shown to activate the migration of T regulatory cells to sites of inflammation in preclinical experiments. This migration of Treg cells to inflamed tissue is crucial for their immune-modulatory function (Kishore et al (2017)).

AZD1656 could enhance Treg migratory capacity and may prevent the development of cardiorespiratory complications observed in hospitalised patients with COVID-19, leading to lower requirements for oxygen therapy and assisted ventilation, and reduced incidences of pneumonia and acute respiratory distress syndrome (ARDS).
 
A quick look at https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30272-2/fulltext yields the somewhat surprising observation that anybody with a T1 diagnosis is placed in a T1 box and anybody with a T2 diagnosis is put in a T2 box. No attempt appears to have been made to differentiate between those with good control and those without. The NHS papers on which I have based my understanding broke down the diabetes diagnoses into HbA1c categories. This suggested that the risks were enhanced when HbA1c was high (over 80). Diabetes under good control did not appear to be a significant factor.

Still have this uneasy feeling that a bit of cherry picking of data is going on. Brain is too rusty these days to pick apart the detail of the paper and nail it down.
 
Docb said:
A quick look at https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30272-2/fulltext yields the somewhat surprising observation that anybody with a T1 diagnosis is placed in a T1 box and anybody with a T2 diagnosis is put in a T2 box. No attempt appears to have been made to differentiate between those with good control and those without. The NHS papers on which I have based my understanding broke down the diabetes diagnoses into HbA1c categories. This suggested that the risks were enhanced when HbA1c was high (over 80). Diabetes under good control did not appear to be a significant factor.

Still have this uneasy feeling that a bit of cherry picking of data is going on. Brain is too rusty these days to pick apart the detail of the paper and nail it down.
Click to expand...

This UK "companion study" looked at HbA1c levels and BMI: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30271-0/fulltext

I linked to a California study the other day which found only age (both sexes) and obesity (only older males) as significant independent risk factors.

I think things are still not crystal clear ...
 
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