Preparation and foresight, the secrets to staying healthy
The first wave of epidemics of the new coronavirus (Covid-19) seems to have receded in our country, as the numbers of cases, hospitalizations and deaths have decreased significantly. However, the pandemic is not over, local outbreaks are being recorded in Greece and a second wave of infections is very likely.
Therefore, we should all be careful and vigilant, keeping our distance, wearing masks where necessary and applying personal protection and hygiene measures. But it is also particularly important to remember those who are most susceptible to infection.
Prevention is always the best strategy
Patients with diabetes are one of the categories at increased risk of more severe infection, complications or death if infected with the new coronavirus. Indeed, a recent study showed that the number of diabetic patients with Covid-19 who had to be hospitalised in an intensive care unit was twice as high, while mortality was three times higher compared to non-diabetic patients.
Causes
The are many reasons for this. Diabetic patients have an impaired immune response to infections. Poor glycaemic control disrupts many aspects of the diabetic patient’s defence against viral infections and also against a possible secondary bacterial infection of the lungs. In addition, hyperglycaemia exacerbates inflammation. Also, patients with diabetes more often present co-morbidities as well as complications of diabetes, which further aggravate and complicate Covid-19 infection. Indeed, many patients with type 2 diabetes are obese, and obesity is also a risk factor for severe infection. Similarly, complications of diabetes, such as diabetic nephropathy and ischemic heart disease, are factors of more severe and more complicated disease.
It is therefore very important during the pandemic for patients with diabetes and their endocrinologists to take precautions and prepare themselves to reduce the risk of developing both coronavirus and other diseases, as well as to reduce the possibility of serious infection in the event of Covid-19 development. It is also an opportunity for diabetic patients to improve their glycaemic control and to control co-morbidities and complications of diabetes, with the aim of protecting their health.
In order to do so physicians should first identify those categories of diabetics who are at higher risk, such as diabetics with the following characteristics, in order to intensify their clinical care:
- Patients with type 1 diabetes
- Age 65 years and above
- Patients with insulin-treated type 2 diabetes
- Patients with co-morbidities and diabetic complications
- Patients with glycosylated haemoglobin (HbA1c) 8.5%
At the same time, physicians should advise all patients with diabetes to:
- Follow the protection and hygiene measures as defined by the Greek CDC (ΕΟΔΥ).
- Reduce behaviours that increase the risk of Covid-19 infection.
- Check their blood sugar levels regularly and even more often during an illness or infection.
- Make sure they achieve their glycaemic targets.
- Have clear instructions in case of sickness (sick day rules).
- Get the appropriate vaccines.
- Have regular laboratory testing to monitor their diabetes.
- Modify their medication when and as needed.
Also, patients with diabetes should:
- Comply with the preventive measures that apply to everyone.
- Take their medication to ensure that their blood pressure, cholesterol and blood sugar are well controlled.
- Maintain good glycaemic control with regular self-monitoring.
- Have regular contact with the treating physician.
- Follow a healthy lifestyle, with regular exercise, proper nutrition, adequate sleep and good hydration.
- Seek prompt medical help in case of acute disease or diabetic complications.
Prevention is always the best strategy
We are facing a rare and complex combination, involving a medical epidemic (diabetes mellitus) within a medical pandemic (Covid-19). To face this unprecedented phenomenon, we need to be well prepared and farseeing, protecting our health as best we can.
In the case of high-risk groups, such as diabetic patients, physicians and patients should ensure that glycaemic targets are met, that adequate hydration is maintained and that all measures to avoid infection with the new coronavirus are carefully implemented. Prevention is always the best strategy. By following this tactic, the benefit will be double, as we will have successfully managed a new medical pandemic and one of the largest epidemics in human history.