Diabetes in the Light of COVID-19 Pandemic

Diabetes is frightening and continues to be one of the leading causes of mortality worldwide. According to CDC, in 2020, 32.4 million people have been diagnosed with the disease, accounting for 10.5% of the US population. And while treatment options for diabetes have improved over the years, COVID-19 has made people with such disease limit their visit to their health care providers. This growing problem makes regular follow-ups and adjusting medications impossible.

How do we diagnose diabetes?

Patients can present no symptoms initially, but the most common ones include blurring of vision, excessive thirst (polydipsia), excessive urination (polyuria), and poor wound healing. Diagnosing diabetes includes one of the following criteria:

1. random blood glucose of >200 mg/dL or >11/1 mmol/L with symptoms of diabetes;
2. fasting blood glucose of >126 mg/dL or >7 mmol/L; or
3. Hemoglobin A1c of >6.5%

In a normal state, insulin is produced in the pancreas, and it plays an important part in balancing glucose in the body. Glucose activates insulin secretion. Once synthesized, insulin allows glucose to transfer within the cells, which are either used as energy or stored as fuel in the form of fat or protein. In Type 1 diabetes, which is mainly diagnosed in children, there is insulin deficiency. Without insulin, there won't be any transfer of glucose into the cells, thereby creating a continuous increase of blood glucose. Type 2 diabetes is diagnosed during adulthood and is related to low production of insulin or insulin resistance. In the early stage or prediabetic stage, glucose levels are high but not high enough to be diagnosed as diabetes. High glucose stimulates more insulin production until it reaches a state of resistance. Insulin production then declines due to overproduction, causing an increase in glucose, hence leading to diabetes.

What happens if blood glucose is not controlled?

Blurring of vision, kidney failure, nerve damage, and poor wound healing are signs of poorly controlled diabetes, making patients more prone to infections. These are symptoms that are easily recognized as a complication of diabetes. On the other side, other diabetic patients may have no symptoms at all. 7.3 million adults aged 18 years or older who met the laboratory criteria for diabetes were not aware of or did not report having diabetes, according to CDC. This concerning number represents 2.8% of all US adults and 21.4% of all US adults with diabetes. Even if this disease is preventable, diabetes being a “silent” disease can delay the diagnosis and eventually become a hindrance to early prevention or treatment. While the pandemic is still occurring, irregular follow-ups of diabetic patients with their health care providers can limit proper care and treatment. DM foot ulcers or “DM foot” is another example of a sequela of uncontrolled diabetes. According to International Diabetes Federation, a lower limb or a part of a lower limb is lost to amputation every 30 seconds due to diabetes. DM foot initially kills nerves on the feet, causing numbness. This nerve damage worsens blood circulation leading to tissue ischemia or poor oxygenation of body tissues around the foot. With poor oxygenation, ulcers would result and continue to be a breeding ground of infection. In addition to the limited interaction of chronic patients with health care providers during COVID-19, DM foot occurs more frequently as a consequence of poor adjustment of medications. Worsening foot conditions among patients is a continuing problem and may increase social and economic burdens if not addressed immediately. RELATED ARTICLE: Diabetes Myths and Facts

How do we prevent type 2 diabetes?

Patients with no known symptoms of diabetes but with risk factors such as a first-degree relative with diabetes, history of gestational diabetes, hypertension can benefit from lifestyle changes such as smoking prevention, losing weight, and doing more physical activities at home. Obesity is a serious comorbidity in patients with diabetes because excessive fat also contributes to insulin resistance. So, aiming for a normal Body Mass Index (BMI) while adding healthy eating habits can help regulate blood glucose levels. Monitoring blood glucose at home and maintaining normal glucose levels have also prevented patients from acquiring complications of diabetes. Testing should be considered in all adults at age 45. Adults less than 45 years with BMI >25 and other risk factors aforementioned may benefit from blood glucose monitoring as well. With the growing incidence of developing DM foot among patients with uncontrolled diabetes, foot care is essential to prevent infections. Proper management would greatly reduce the incidence of surgical wound debridement as well as lower limb amputations. The demand for telehealth medicine has been steadily increasing since 2020. Developing smarter devices has become more accessible to health care providers, promoting continuous remote access and follow-ups among patients. With diabetes being a chronic disease that requires frequent monitoring of blood glucose and adjusting medications, providing aid through advanced technology and quick access to patients will soon become the “new normal” among health care providers. The consequences of COVID-19 have greatly severed diabetes. Aside from being prone to infections, complications have increased due to poor follow-ups from our health care providers. With all the innovations brought about by technology, artificial intelligence, and with a vast number of resources available online, more prevention measures such as health education and positive reinforcement among health care providers as well as patients, being adaptable to changing times through technology would help lessen incidence as well as complications. And hopefully, improve the quality of life among people with diabetes.