Diabetes and Corona

April 24, 2021 posted by Dr. Sunil Saraf

Type 2 diabetic Asian Indians and COVID-19: Lessons learnt so far from the ongoing pandemic

COVID-19 disease has stalled the world due to global pandemic & also badly affected India. Early Indian data published by ICMR has shown that around 63% of COVID-19 patients are between age group 50 & 60 yrs, with male preponderance. Old age, smoking, co morbidities like hypertension, diabetes mellitus (DM), ischemic heart disease, COPD & stroke are few of the parameters predicting the course of disease & outcomes. Current evidence suggests that DM is significantly associated with increased mortality risk of COVID-19 patients. Certainly DM is one of the important co morbidities in COVID-19 patients.

New Onset Diabetes in Covid- 19

The presentation of diabetics with COVID-19 is severe compared to non-DM patients. Severe hyperglycemia & diabetic ketoacidosis in patients with previous history of diabetes are common observation. On admission, in few of the patients with near normal HbA1c, new-onset hyperglycaemia has been noticed. This so-called “COVID-19 related DM” is a matter of concern during management. Eventually all of them are being managed by subcutaneous or intravenous insulin to achieve normoglycemia during hospitalization.

DM is associated with impaired immunity. Both long-term and short-term hyperglycemia alters chemotaxis, subsequent phagocytosis & impaired complement fixation. DM can lead to proinflammatory state with increased levels of cytokines including interleukin-6 (IL-6) and tumour necrosis factor α (TNF-α).

Association of Glycemic control & outcomes in patients with COVID– 19

Study shows the association of glycemic control with mortality in COVID-19 patients. Among 7300 cases of COVID-19, overall Type 2 diabetes (T2D) is associated with higher mortality compared to non diabetics. Further, well-controlled diabetics had less mortality compared to poorly controlled diabetics. Pre existing T2D patients required significantly more intensive treatments like higher need of antibiotics, steroids. Also, patients with T2D had a greater occurrence of ARDS, acute heart injury, acute kidney injury, septic shock, and disseminated intravascular coagulation (DIC) & overall mortality than the non diabetic group.

Recent evidence also supports the need of strict glycaemia control. T2D with well-controlled blood glucose (BG) (mean: 115 mg/dl) required significantly less integrated treatments than those with poorly controlled BG (mean: 196 mg/dl).

The levels of mean HbA1c in these well-controlled & poorly controlled DM groups were 7.3% & 8.1% respectively. The well-controlled cohort with glycemic variability between 70 mg/dl and 180 mg/dl is significantly associated with reduced medical interventions, major organ injuries & all-cause mortality.

Challenges for Diabetes Control in COVID – 19 Pandemic

A typical Indian T2D phenotype is centrally obese with high insulin resistance, younger in onset, more prone to develop macro & micro vascular complications of DM. Various surveys suggest that more than 50%–70% Indian diabetics have average HbA1c more than 8.5% which is way higher than desired glycemic control target of 7%. Thus it makes Indian diabetics more prone for complications of diabetes including infections.

Lessons learnt from Covid- 19 Pandemic.

In conclusion COVID-19 pandemic has been a great challenge for developing country like India for patients with chronic diseases like DM, HTN, IHD, and COPD. It forms a huge socioeconomic burden on the country. This pandemic has been a learning lesson for Indian diabetics to achieve a strict glycemic control & hence to prevent short/long term complications of DM including infections. Patient's awareness toward disease understanding, management and prevention will have a huge impact.

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