The Financial Express

Covid-19 and diabetes mellitus

The link, severity and self-management

The link, severity and  self-management

Diabetes is a health condition in which the body faces difficulty with converting glucose (a type of sugar) into energy. In this condition, the glucose level becomes high in the blood. If this too much sugar circulates in blood for a longer period, it can cause serious damages to the hearts, eyes, kidneys, blood vessels, and nerves. A hormone, called insulin, plays a key role in regulating the blood glucose level in the body, helps in utilising sugar in the cell, and keeps the blood sugar at the optimum level. Diabetes occurs when pancreas (from where insulin secretes) cannot produce sufficient insulin or when the body cannot make use of the insulin properly because of the body's growing resistance to insulin. This leads glucose to stay in the blood, causing a higher than normal level of glucose in the body. This is called type 2 diabetes, which is the most common diabetes worldwide, accounts for around 90 per cent of all cases of diabetes. Type 1 diabetes happens when pancreas produces little or no insulin at all. There are other types of diabetes like gestational diabetes (a form of diabetes that occurs during pregnancy) and prediabetes (blood glucose level is higher than usual, but not high enough to be considered type 2 diabetes). According to World Health Organization (WHO), 422 million people have diabetes worldwide, the majority living in low and middle income countries. Each year 1.5 million people die from diabetes. By 2025, a prediction has been made in terms of prevalence and death, with a rise to 570.9 million and 1.59 million respectively using the Auto-Regressive Integrated Average (ARIMA) model.
Among top 10 causes of death globally, diabetes is one of them. Diabetes is a complicated disease and with poorly controlled/uncontrolled blood glucose level can affect other vital organs over time. Some complications of diabetes are commonly seen including heart disease and stroke, high blood pressure, foot problems, vision problems and kidney diseases. Diabetic people have a 2-3-fold mortality risk associated with infections, cardiovascular disease, stroke, chronic kidney disease, chronic liver disease and cancer as compared to non-diabetic.
In December 2019, the coronavirus disease (COVID-19) was first reported in Wuhan, China followed by worldwide rapid outspread. According to published data globally, it has been found that diabetes mellitus is one of the most common comorbidities (presence of more than one disease or condition in the same person) present in patients sick with COVID-19. The COVID-19 severity and increased mortality are directly associated with the presence of diabetes mellitus. Furthermore, according to several studies, other typical complications of diabetes mellitus (cardiovascular disease, heart failure and chronic kidney disease) increase the COVID- 19 mortality. There are limited data to date on the link between blood glucose control and COVID-19 outcomes. A study conducted in the USA on 178 patients with diabetes hospitalised with COVID-19 found that people with uncontrolled blood glucose levels had to stay longer in hospital, had a 59 per cent higher risk of ICU admission, an approximately 97 per cent increased rate of mechanical ventilation and a twofold increase in the death rate compared with people without diabetes or well-managed diabetes. Another study on people with type 2 diabetes from China found that patients showed improved outcomes with COVID-19 who had a good control on the blood glucose level. On the other hand, severe COVID-19 infections can have a specific adverse impact on diabetes itself, causing the difficulty with managing the blood glucose level, which in turn, worsens the condition of COVID- 19 resulting in an increased mortality rate.
In general, people with diabetes are very prone to be infected with any virus. Therefore, it can be said that people with diabetes are more likely to have serious complications from COVID-19. Because long-term diabetes may aggravate the immune system and which in succession make them very vulnerable to any infectious disease. However, the risk of getting very sick with COVID-19 is comparatively low when diabetes is well-managed. Thus, it is imperative to say that people with a well-controlled blood glucose level have a higher chance to make themselves protected from COVID- 19 than people with uncontrolled/poorly-controlled diabetes.
Therefore, during this pandemic, it is essential for diabetic patients to keep their blood glucose under control to lower the risk from COVID-19. To control diabetes during the COVID-19 pandemic, they should follow some general guidance. First, monitoring of the blood glucose level more frequently than earlier. If, blood glucose concentrations are consistently higher than usual, patients must consult their physicians. Second, people with diagnosed diabetes should be vaccinated on a priority basis as soon as possible. Third, in the context of quarantine and, lockdown in particular, consumption of healthy diet and regular physical exercise should be strictly followed. Fourth, diabetic patients and mass people as well should follow the general hygiene precautions, for instance, social distancing, wearing a mask, washing hands, using paper towel or own inner elbow when coughing or sneezing, using alcohol-based disinfectants, avoiding touching the mouth, nose, eyes, etc. to reduce the risk of infection. Fifth, continuation of prescribed anti-diabetic or other medications in a pre-Covid situation. Sixth, due to limited routine healthcare facilities, diabetic patients may get advice via remote consultation and telehealth, which might contribute to control their blood sugar level in one way and help reduce person-to-person transmission in the other way. Seventh, preparing educational videos and written instructions on how to stay healthy during the COVID-19 pandemic through social media, print media, electronic media or mobile app to make people aware. Seventh, a complete clinical guideline for the management of diabetes mellitus should be prepared by health professionals and be provided to diabetic patients free of cost or at an affordable cost. This should include how to improve the immune system upon taking healthy diet and plenty of fluids, self-monitoring of blood glucose level at home, maintaining hygiene, practising foot care, stress management, etc. Eighth, people with diabetes mellitus and other people should be aware of common complications associated with diabetes such as diabetic ketoacidosis (a serious diabetes complication), hypoglycaemia (low blood sugar) and measures to prevent them. Ninth, diabetic people should be encouraged to take influenza and pneumonia vaccines in order to lessen the respiratory viral infections. Tenth, diabetic patients with other co-existing heart or kidney diseases need special care and attempts should be taken immediately in case of any emergency.
This ongoing Covid-19 pandemic is causing considerable health hazards, in particular for people with diabetes. There is no alternative to managing and practicing a healthy lifestyle and the best solution is preventing infection in the first place.

Shaheda Zannah is a researcher at Curtin University, Australia and a lecturer at Southeast University, Bangladesh
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