BENGALURU : In the wake of the ongoing pandemic, the care of chronic diseases like diabetes, hypertension, etc, is getting difficult and is often neglected due to fear and focus on Covid-19. In India 73 per cent of Covid-19 deaths are linked with co-morbidities, including diabetes, hypertension, cardiovascular and respiratory diseases. Let’s address some basic questions on how to manage diabetes better and whether there are any special precautions people with diabetes must take during the pandemic:
Are people with diabetes more likely to develop Covid-19 or likely to have complications?
There is no data to suggest people with diabetes are more likely to develop Covid-19. But they are more likely to develop serious complications if they get corona. Increasing age and obesity are added risk factors. A study suggested higher mortality in patients with HBA1C > 7.5%.
Can patients continue regular diabetes medication if they develop Covid-19?
If they are sick enough to be hospitalized, the doctors will take care of them in the hospital. If patients are in home quarantine most medications can be continued. If they are unable to eat or are vomiting, they need to temporarily stop certain medications like Metformin, SGLT2I during the illness. In a recent study, the patients who were on diabetes medication DPP4I (Sitagliplin) did better than those who were not, including mortality(18 vs 37%).
Does diabetes control worsen with Covid-19?
Yes, Covid-19 infection can worsen hyperglycemia due to insulin resistance, may precipitate diabetic ketoacidosis and Hyperosmolar Hyperglycemia Syndrome. This hyperglycemia can further increase with use of steroid medications in some patients. But there is no need to worry, this can be managed with medications including insulin injections and close monitoring of blood glucose. The key is to check the blood glucose especially if you are sick.
Is it safe to take the regular BP and cholesterol medications during Covid-19 infection?
There were initially some concerns regarding ACE Inhibitors and ARB, but these can be safely continued as studies have showed no harm. Cholesterol lowering medications like statins needs to be continued as Covid-19 can cause cardiac complications and statins in fact are protective.
Can patients with diabetes take influenza vaccine during this pandemic?
Yes, the annual flu vaccine should be taken as indicated, in fact, preventing influenza reduces hospital visits and possibility of concomitant Covid-19 infections.
What are the indirect effects of Covid-19 for persons with diabetes ?
The pandemic has caused lot of indirect consequence like stress, disruption in diet, exercise and routine prevention care. Patients should maintain healthy diet, exercise at home, terrace or parks or practice yoga while maintaining social distancing and observing hygienic measures. Most importantly take regular medication and monitor blood glucose B P, weight etc. at home. Stay digitally connected with friends, family and your medical team and tide over this pandemic safe and sound.
The authors are from the Diabetes and Endocrine Department, Vikram Hospital, Bangalore.