The COVID-19 pandemic remains a global health concern, and those living with chronic medical conditions such as diabetes have been identified as being at increased risk of severe symptoms and complications from the virus. Those who have been admitted to the hospital for COVID-19 were also found to have new cases of hyperglycaemia or high levels of blood sugar, with some persisting beyond infection, according to some reports.
Because diabetes is a condition that can happen to anyone regardless of age, it is important to understand how to properly manage it, particularly when access to healthcare is restricted by recurring lockdowns.
Impact of COVID-19 for people with diabetes
The impact of COVID-19 in people with either type 1 or type 2 diabetes can vary in their age, complications they have developed and how well they have been able to manage their condition according to the American Diabetes Foundation.
Recent cases have also shown that people who already have diabetes-related health problems are likely to have adverse outcomes, whichever type of diabetes they have. For example, those who underwent a renal transplant have weaker immune systems because they are taking immunosuppressants, which can be further compromised by the virus.
During the first and second pandemic waves in India, new cases of diabetes have been linked to COVID-19, with some recovering from the virus but have developed “full-blown diabetes” with no known risk factors or health concerns. Others have developed “black fungus” (mucormycosis) which is said to be triggered by using steroids for critically ill COVID-19 patients.
While science-backed evidence is still limited, what is urgently needed is dynamic medical knowledge and patient education in managing this condition.
Diabetes and COVID-19 vaccination
Questions around the effect of COVID-19 vaccines in people with diabetes have recently emerged, prompting health organizations such as the International Diabetes Foundation to publish related guidelines. There are also emerging reports that vaccination can lead to a sudden spike in blood sugar.
While the cases might vary, those that we have observed in India so far are self-limiting and does not require major changes in treatment for diabetic patients. It is also worth noting that elevated blood glucose levels are common among patients taking dexamethasone, a steroid that is a front-line treatment for COVID-19. Further clinical investigations are needed to support these findings, but patients should be generally watchful of sudden increases in blood sugar or blood pressure.
In this view, good monitoring routines are key to prevent any potential complications. And when it comes to vaccines, there is no sufficient evidence as of now about the efficacy of the COVID-19 vaccines for diabetic patients or which type of vaccine is the best option. But one thing is certain: getting vaccinated whether you are a diabetic patient or not is critical and is the most viable solution to get protected against the virus.
Improving healthcare professional and patient education
Currently, the primary care for diabetic patients is being managed by general practitioners. As one of the countries with the highest number of diabetic patients globally, clinicians in India need to offer a strong response against diabetes based on prevention, early diagnosis and a proper treatment plan.
For example, while existing clinical guidelines provide best practices for diabetes management in primary care, the body of research related to COVID-19 and vaccination is evolving day by day. Because clinical knowledge is never static, clinicians must quickly adapt and apply this new knowledge to deliver the best possible care.
Knowledgebase tools such as a digital health library are critical to better equip clinicians with easy and timely access to evidence-based information. A high-quality knowledge base should adhere to the Five Rights of Clinical Decision Support to support the decision-making process and improve patient engagement.
At the same time, the availability of new models of care such as telemedicine is already enabling greater access to healthcare while non-invasive interventions such as messaging applications and emails allow for efficient information sharing between doctor and patients.
For patients, don’t overlook the basics
When people are mainly confined to their homes, our day-to-day activities are also disrupted. This prolonged isolation becomes conducive to unhealthy food choices and reduced physical activity.
Studies have shown the link between sedentary lifestyles and diabetes because it impairs glycemic control (control of blood sugar levels) – a common risk that is associated to the development of this condition. The benefits of physical exercise coupled with a healthy nutritional plan cannot be overstated, even at this time of social distancing. It helps patients to stay at a healthy weight, control blood pressure and blood sugar, and lower harmful cholesterol levels – all of which are key to diabetes self-management.
Participating in self-management education programmes can also help patients learn the skills to manage to manage their diabetes and related conditions more effectively. The programmes are tailored to individual needs, guided by evidence-based standards and delivered by trained healthcare professionals to improve overall patient education.
It is quite clear that diabetic patients are at an increased risk of having severe complications from COVID-19 and leveraging the latest evidence-based information is vital to improve primary care especially when remote support is likely to be relied upon for the longer term. Equipping clinicians with point of care solutions that support the current COVID-19 landscape not only ensures best appropriate response but also best patient outcomes.
Dr. Anoop Misra, Chairman, Fortis-CDOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, and Director, National Diabetes, Obesity and Cholesterol Foundation, and Diabetes Foundation (India)
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