An individual with Diabetes Mellitus is immunocompromised and patients of diabetes have a severe respiratory infection with H1N1, Influenza, and COVID-19.
COVID 19, has emerged communicable diseases across the globe affecting more than 100 countries. The virus primarily spread by respiratory droplets. The disease has been varied to the mild flu-like illness to fatal pneumonia, respiratory failure, and death. The actual mortality rate is less than 1 % as there are unreported, unconfirmed, and asymptomatic carrier cases as well.
COVID 19 has caused a global pandemic. COVID virus primarily causing rapidly spreading pneumonia requiring ICU care and ventilatory support.
Data of the patients affected by COVID 19 and Diabetes Mellitus are still limited. The data collected from Wuhan, China 158 patients,82 deaths,76 recovered shows that the comorbidity is a significant predictor of mortality. A report of 72314 cases of COVID 19 published by the Chinese center of disease control prevention showed increased mortality in patients with Diabetes Mellitus(2.3% overall and 7.3% in Diabetes Mellitus).
In the current scenario, it would be reasonable to assume that the patients with Diabetes Mellitus at higher risk of developing infection with COVID 19 and its complication.
Other chronic medical conditions like heart disease, kidney disease , advanced age are likely to add up to the severity of the disease caused by COVID 19 in diabetic patients.
We need to reinforce certain measures in diabetic patients and educate about infection with COVID 19.
The following measures and precautions should be taken and practiced by diabetic patients.
A.Specific measures in patients with diabetes:
1. Good blood sugar control: As it might help in reducing the risk of infection and the severity of the disease. It may also lessen the chances of superadded bacterial pneumonia as well. More frequent self blood sugar monitoring can be done at home.
2. Nutrition and adequate protein intake are also important along with minerals and vitamin supplementation as suggested by doctors/physicians.
3. Diabetic, Heart disease, and Kidney disease patients need special care. Their cardiac /renal status should be stabilized.
4. Exercise is beneficial but it is advisable to avoid crowded places like gymnasium, swimming pools, and common areas used in condos for exercise. The walk can be done in open areas like parks.
5. It is important to vaccinate for influenza and pneumococcal infections as per guidelines.
B.General Preventive Measures:
1. Handwashing with soap and water , using alcohol-based hand rub. 2. Practice proper respiratory hygiene with a covering of mouth and nose with a mask, covering face while sneezing, coughing with elbow or tissue paper. Avoid touching of eyes, mouth, and nose.
3. Non-essential travels should be avoided.
MEASURES TO BE TAKEN IN PATIENTS OF DIABETES WITH COVID 19.
1. Any patients develop cough, fever, breathlessness should seek medical consultation and inform the authorities. 2. The affected person should follow all isolation guidelines as laid by the government. 3. The majority of patients have mild disease and can be managed at home with proper medical consultation. Proper hydration should be maintained with acetaminophen, steam inhalation. 4. Patients with type 1 Diabetes mellitus should check blood sugar and urine ketones more frequently if fever and hyperglycemia occur. 5. Doses of oral hypoglycemic should be reviewed by the physician. The patient should follow sick day guidelines. 6. Oral agents like metformin and SGLT- 2 inhibitors need to be stopped in hospitalized patients with severe disease.
7. Insulin is the preferred agent for control of hyperglycemia in hospitalized sick patients.
UNPROVEN THERAPIES AND FUTURE DIRECTIONS
As there are no specific treatments available. Specific drugs have been used like Remedesvir, Lopinavir, Ritonavir, Interferon 1 beta, and chloroquine has been used in many countries and guidelines have been laid according to the respective health authorities. Vitamin C supplements have some role in the prevention of pneumonia and its effect on COVID 19 needs evaluation. Zinc nanoparticle was shown to have inhibitory effects on H1N1 viral loads, though the effect on COVID 19 is still unknown and untested.
Efforts to develop a vaccine are underway in many countries including India. Humans' trial has been started and in India, it is started by ICMR in July 2020. The development of a vaccine would be a major tool to contain this global epidemic.
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