As we all know, diabetes and infection go hand-in-hand. From our experience back in 2003 SARS coronavirus infection and 2009 H1N1 influenza infection, people with diabetes had worse outcomes.
About 10-30% of people who died from COVID-19 in densely populated cities like Mumbai and Delhi were living with diabetes.
The outcome of the COVID-19 infection on patients with diabetes is also varied. Scientists and researchers are trying to get answers to the questions about this novel virus. One such question that remains unanswered is – are people with diabetes more prone to get COVID-19?
If yes, then why? Let us explore!
According to the International Diabetes Federation (IDF), there are two major factors that increase the susceptibility of patients with diabetes to COVID-19 infection.
Patients with diabetes are already struggling with their lowered immunity. Microscopically, it has been seen that poorly controlled diabetes has been linked to inhibited lymphocyte proliferation, reduced functioning of monocytes or macrophages, abnormal delayed-type hypersensitivity reaction and inactivation of the complement system.
In simple words, immunity gets compromised with pre-existing diabetes. With lowered immunity, the risk of getting COVID-19 rises notably.
‘Patients with diabetes, are already struggling with their lowered immunity’
-International Diabetes Federation
Currently, minimal information is available to establish a link with hospitalised COVID-19 patients with diabetes or hyperglycemia.
Wuhan study: A retrospective study at Wuhan Union hospital, China, (n=174) was done to study the association of COVID-19 with pre-existing diabetes. The results of the study showed that those with diabetes (n=24) had a higher risk of severe pneumonia compared to those with no diabetes. This study also gave a new possibility that the SARS-CoV-2 virus might be damaging the pancreatic islet cells, thereby causing insulin deficiency and hyperglycemia.
Additionally, it was observed that those hospitalised with COVID-19 have elevated levels of lactic dehydrogenase, α-hydroxybutyrate dehydrogenase, alanine aminotransferase, and γ-glutamyltransferase. These elevated enzymes suggest injury of the myocardium, kidney, and liver, which explains why some of the patients died from multiple organ failure. Although the sample size was small, this study found a link between COVID-19 infection and pre-existing chronic conditions like diabetes.
US-based study: Another study was done in 88 U.S. hospitals with a total of 1122 patients with COVID-19 infection which had 451 patients with diabetes. It was concluded among hospitalised patients with COVID-19, diabetes occurred more frequently. Patients with diabetes had extended hospital stay and higher mortality than patients without diabetes or uncontrolled hyperglycemia.
CORONADO study: Another recent study (CORONADO) was done in 53 French centres with 1317 participants with diabetes and confirmed COVID-19 infection. It aimed to study the phenotypic characteristics and prognosis of patients with diabetes admitted to hospital with COVID-19 infection. It revealed that body mass index (BMI) was independently associated with death or intubation at seven days.
In other words, in diabetes, each increase in BMI is associated with an increase in the risk of intubation or death in the seven days following admission for COVID-19. The result of this study is published in the renowned journal of Diabetologia and is registered as an ongoing clinical trial (NCT04324736).
The results of these studies are thought-provoking and quite alarming. Therefore, clinicians must ponder what specific care they should give to their patients with long-term diabetes to avoid infection with this novel coronavirus.
According to the American Diabetes Association (ADA), the risk of getting very sick from COVID-19 is likely to be lower if your diabetes is under control.
‘The risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed’
-ADA April 2020 release
In March 2020, in collaboration with IDF, the Research Society for the Study of Diabetes in India (RSSDI), has come up with practice guidelines for Indian healthcare professionals on COVID-19 and Diabetes.
According to Partha Kar, MD, National Specialty Advisor in Diabetes & Endocrinology Department at the National Health Service (NHS) England, clinicians should work to improve the two modifiable factors – weight and blood glucose. There should be a renewed focus on both.
‘Clinicians should work to improve the two modifiable factors – weight and blood glucose’.
-Partha Kar, MD, National Specialty Advisor, Diabetes for NHS England
With the recent nationwide lifting of the lockdown, people with diabetes should be counseled about the possible higher risk for COVID-19 infection. Healthy nutrition, home-based exercises, along with medication adherence, is the dire need of the hour.
Doctors and patients are adapting to the “new normal” of reduced or nonexistent face-to-face diabetes visits by adopting virtual mhealth technologies for diabetes management. Consultations via telemedicine, virtual coaching, mobile app-based diabetes management programs can improve diabetes-related outcomes and also protect this vulnerable subset of the population from COVID-19 infection.
Much before this virus entered India, people with diabetes had already started using the latest device called AGM (Ambulatory Glucose Monitoring is formerly known as CGMS-Continuous Glucose Monitoring System) to monitor their blood glucose levels. It had dual benefits – reduced infection rates and improved diabetes-related health outcomes.
Physicians should re-emphasise public health prevention measures such as hand hygiene, social-distancing, use of masks, etc.
At Fitterfly we offer remote wellness programs and technology-driven solutions for better health monitoring. We help in boosting your immunity and achieving better diabetes control with our team of experts. Life changes when a highly infectious global pandemic like COVID-19 meets a non-communicable epidemic-Diabetes. With changing life, the time has come to manage your diabetes in a novel manner!