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COVID-19 and Diabetes

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By Dr. Aman Pathania

The entire world is suffering from a new type of viral infection, caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) has declared the COVID-19 outbreak to be a public health emergency of international concern. COVID-19 more commonly affects people with co-existing diseases like diabetes mellitus. Diabetes Mellitus (DM) is a metabolic endocrine disease and an international health threat that causes high blood sugar or when the body cannot use glucose normally. As glucose is the main source of energy for the body’s cells. Glucose is made by the pancreas and the levels of glucose in the blood are controlled by a hormone called insulin. Insulin helps glucose enter the cells. Diabetes is of two types. Firstly, Type 1 Diabetes (in this condition when the pancreas does not make enough insulin). Secondly, Type 2 Diabetes (in this type when the body can’t respond normally to the insulin that is made). The diabetes patient has a high risk of infection of COVID-19 as compared to the normal person. According to the latest global estimate from the International Diabetes Federation 2020 shows, the number of affected patients is approximately 502 million. In India, approximately 7.8 crore people diabetic as of 2020. Diabetes is the leading cause of end-stage renal disease, adult-onset blindness, and non-traumatic lower extremity amputations and also causes more disability, and life-threatening disorders.

Diabetic patients with COVID‐19 infection have a higher risk of complications such as high blood sugar, diabetic ketoacidosis, neuropathies, shock condition, pneumonia, and dehydration. The person suffering from diabetes has higher stress conditions that increase the release of hyperglycaemic hormones which raises the level of blood glucose and abnormal glucose variability.  People with diabetes are more susceptible to infections of any kind either bacterial, fungal, or viral because their immune response is weaker and their glucose blood circulation is impaired. That is the older people who are suffering from pre-existing conditions such as diabetes are more likely to get infected with Covid-19 and also cause a greater risk of mortality in COVID-19 patients. Hence, it is necessary to maintain fine control of this non-communicable disease, especially in the elderly above 60 years of age. Both increased and low levels of blood glucose can compromise immunity, thus making the patient more susceptible to infections. In one analysis, ketosis (a complication of diabetes) occurred in 6·6% of patients with COVID-19 and resulting in a high mortality rate (34·3%). In the CORONADO study,  13·1% of the participants had diabetes-related disorders at admission including 132 patients with severe hyperglycemia and 40 with ketosis, of whom 19 had diabetic ketoacidosis.

How does COVID-19 affect people with diabetes mellitus?

People with diabetes be likely to live in a chronic inflammatory state, which increases the risk of the severe inflammatory response to Covid-19 that can lead to a life-threatening cytokines storm. Consequently, this immune overreaction is thought to harm some people more through organ damage than via the actual viral infection. But diabetes can also weaken the immune system that fights various infections like viruses. Coronavirus protein uses ACE2 (Angiotensin-converting enzyme 2) to get entry into the cells. It is seen that people with type 2 diabetes have more ACE2 receptors in many tissues, including tissues lining the blood vessels, thus opening many more doors for the Covid-19 to enter the body.

The patients with COVID-19 with diabetes have a worse prognosis, most probably because of the concurring effect of multiple factors. In an American survey, 33 people with type 1 diabetes with COVID-19 were identified they were young (mean age 24 years), with high glucose concentrations at presentation, and diabetic ketoacidosis reported in 45·5% of the cases. Similarly, obesity, hypertension, and cardiovascular disease were the most commonly seen comorbidities. The chance of getting diabetes increases with age in the general population and as well as in patients with COVID-19. The average age of patients having diabetes affected with COVID-19 is older as compared to those without diabetes.

Evidence from many studies indicates that glycemic variability in people with diabetes is associated with complications of DM, and this can be minimized by excellent control of blood glucose on daily basis. People require frequent monitoring and necessary intervention based on blood glucose levels, Self-monitoring of blood glucose(SMBG), early diagnosis of the disease. Awareness and self-education can play important role in the management of DM like lifestyle changes, healthy dietary intake, medication, exercises, and meditation for stress management, control of weight. Measures to prevent corona like wearing mask, hand sanitization along with necessary interventions to control diabetes can help to prevent further complications.

Stay safe, eat healthy, stay healthy!!

(Author is Homeopathic Physician. The views expressed are personal opinion of the author. He can be reached at amanpathania444@gmail.com)

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