The risk of a fatal outcome from COVID-19 is up to 50 per cent higher in people with diabetes, experts said, recommending regular monitoring of blood glucose and home-based exercises to maintain physical and mental health. According to the Union health ministry, besides diabetes, people having co-morbidities like hypertension, chronic kidney and heart-related issues also form a high-risk population.
Highlighting the extreme vulnerability of people living with diabetes during the current lockdown due to coronavirus, endocrinologists in the national capital said they may experience severe symptoms and complications from COVID-19 and their condition may worsen if they do not maintain good metabolic control. Additionally, they have suggested that insulin is a safe choice under such circumstances as it remains the sole therapy for people with type 1 diabetes mellitus, and a superior alternative in people with type 2 diabetes mellitus having poor metabolic control.
"The risk of a fatal outcome from COVID-19 is up to 50 per cent higher in people with diabetes than in those who do not have diabetes. The same is also true for people with hypertension, cardiovascular disease, cancer and kidney ailments among others," Dr Nikhil Tandon, Professor and Head of the Department of Endocrinology at AIIMS, New Delhi, said.
In addition to the general precautions recommended, it is important to regularly monitor blood glucose as suggested by the treating physician and maintain good hydration and adequate supply of medicines, he said. Also, patients are advised to continue regular home-based exercises as it promotes healthy lifestyle balancing both physical and mental health, Dr Tandon said. The death toll due to COVID-19 rose to 3,029 and the number of cases climbed to 96,169 on Monday.
More than 70 per cent of the fatalities are due to comorbidities, the health ministry said. With the health machinery focused on treating COVID-19 patients, Dr Ambrish Mithal, Chairman and Head, Endocrinology and Diabetology, Max Healthcare, New Delh said that people with diabetes should maintain good metabolic control (blood sugar, blood pressure, and lipids) during this period as a means of primary prevention from coronavirus infection.
If indicated, treatment should be intensified to achieve metabolic targets. Wherever possible, remote consultations using telemedicine should be utilized to reduce exposure, the endocrinologist said. "Blood glucose should be tested frequently, and ongoing medications must not be discontinued. If blood glucose is high, insulin can be used to hasten and intensify control. People should not hesitate to initiate insulin if advised by their doctor," Dr Mithal said.
At present, more than 77 million people in India are living with diabetes and in the guidelines released by the Ministry of health last month, the government stated that all known and diagnosed patients of hypertension, diabetes, COPD and mental health should receive regular supply of medicines for up to three months through ASHAs or SHCs on prescription.
Speaking on the accessibility of insulin during the lockdown period, Dr S K Wangnoo, Head, Apollo Centre for Obesity, Diabetes and Endocrinology, Indraprastha Apollo Hospital, New Delhi, said, An important component of providing personalised care to Indian people with diabetes is efforts to address the challenge of high carbohydrate diet. Premix insulins are shown to be one of the well-suited options to tackle it."
However, a major barrier in insulin's accessibility remains price, especially for insulin analogues, which are proven to be superior and safer compared to human insulin.