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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 35  |  Issue : 2  |  Page : 48-50

Insights into the relationship between COVID-19 and diabetes mellitus: Public health perspective


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission02-Jan-2021
Date of Decision02-Aug-2021
Date of Acceptance16-Aug-2021
Date of Web Publication27-Nov-2021

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_2_21

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  Abstract 


The coronavirus disease-2019 (COVID-19) pandemic continues to impact the lives of almost everyone across the globe. The present review has been carried out to explore and understand the relationship between COVID-19 infection and diabetes mellitus from the public health perspective. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 25 research articles were selected based on the suitability with the current review objectives. Keywords used in the search include COVID-19 and Diabetes mellitus in the title alone only. Considering the risk of poor prognosis of infection among diabetics, it has been envisaged that such people should strictly adhere to the preventive measures. Self-care plays a crucial role in the management of diabetes, and the significance of the same has immensely increased during the ongoing COVID-19 pandemic. As the people with diabetes constitute a high-risk group, it is the need of the hour to increase awareness among these people about COVID-19 infection. To conclude, the COVID-19 pandemic is far from over and the people living with diabetes are at significant risk to land up into complications, if they acquire the infection.This call for the need to intensify the preventive strategies and strengthen the health care delivery system for ensuring better management of diabetes among COVID-19 cases.

Keywords: COVID-19 pandemic, diabetes mellitus, self-care, World Health Organization


How to cite this article:
Shrivastava SR, Shrivastava PS. Insights into the relationship between COVID-19 and diabetes mellitus: Public health perspective. J Med Soc 2021;35:48-50

How to cite this URL:
Shrivastava SR, Shrivastava PS. Insights into the relationship between COVID-19 and diabetes mellitus: Public health perspective. J Med Soc [serial online] 2021 [cited 2022 Jan 17];35:48-50. Available from: https://www.jmedsoc.org/text.asp?2021/35/2/48/331339




  Introduction Top


The coronavirus disease-2019 (COVID-19) pandemic continues to impact the lives of almost everyone across the globe. As a matter of fact, as on August 10, 2021, a cumulative total of more than 200 million cases and 4.28 million deaths have been attributed to the novel viral infection.[1] The global case fatality rate of infection has been estimated as 2.2%, and the infection continues to emerge in different settings.[1] At the same time, diabetes mellitus has also been acknowledged as a global pandemic with more than 420 million people being diagnosed with the condition and the prevalence of the disease has increased to 8.5% in the year 2014.[2] Both COVID-19 and diabetes mellitus tend to impair the quality of life and pose a major burden on the health care delivery system.[3],[4] The present review has been carried out to explore and understand the relationship between COVID-19 infection and diabetes mellitus from the public health perspective.


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on patient involvement in medical education published in 2013–2021 were included in the review. A total of 28 studies similar to current study objectives was identified initially, of which, 3 were excluded due to the unavailability of the complete version of the articles. Overall, 25 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include COVID-19 and Diabetes mellitus in the title alone only (viz., coronavirus disease 2019 [ti]; COVID-19 [ti]; AND diabetes [ti]). All the articles published in the English language were only selected for the review [Figure 1]. The collected information is presented under the following sub-headings, namely COVID-19 prevalence among diabetics, Diabetics: A vulnerable group for COVID-19, Strengthening prevention component, self-care in diabetes, Implications for practice and implications for research.
Figure 1: Frameworkfortheselectionofresearcharticles

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  Coronavirus Disease-2019 Prevalence Among Diabetics Top


Considering the fact that the distribution of diabetes has been global and millions of people are suffering from the condition, there is a significant possibility of acquisition of COVID-19 infection among diabetics.[5],[6] In fact, the findings of different epidemiological and clinical studies have reported variable prevalence of diabetes among the people detected with COVID-19 infection.[5],[6],[7],[8],[9] The prevalence of diabetes has varied from <10% (in a study conducted among 1099 subjects) to 10%–20% (in a study reporting findings from 339 infected persons) to even more than 20% in a case series reporting findings from seriously ill patients.[7],[8],[9]


  Diabetics: A Vulnerable Group for Coronavirus Disease-2019 Top


People who are living with diabetes have been identified as one of the high-risk groups, which has a poor prognosis of the COVID-19 infection.[10],[11],[12],[13] The people with uncontrolled diabetes are extremely vulnerable as they tend to have uncontrolled blood sugar levels and compromised humoral and innate immunity.[11],[12],[13],[14],[15] These factors, in turn, account for an ineffective defense system and enhances the probability of an exaggerated cytokine storm.[7] In fact, the currently available evidence suggests that COVID-19 infected diabetics tend to have higher rates of hospital admission, progression to severe forms of pneumonia, more incidence of complications, including deaths, in comparison with those who have no other coexisting illnesses.[16],[17],[18] These diabetics often require hospitalization for the optimal control of blood glucose levels through the administration of insulin and often require close monitoring, which in turn enhances the risk to health care professionals as well.[6],[18],[19]


  Strengthening Prevention Component Top


Considering the risk of poor prognosis of infection among diabetics, it has been envisaged that such people should strictly adhere to the preventive measures (viz., practicing social distancing, staying indoors preferably, regular hand washing with soap and water, avoiding unnecessary travel, following cough etiquettes, etc.).[14],[15],[16],[20] It has been recommended to consume vitamin D supplements, which plays an important role in the glycemic control. The teleconsultation component has been advocated and it has been encouraged to avoid visits to health care facilities unless extremely necessary, as hospitals can act as a source of infection among these vulnerable population groups.[15],[16],[20] Furthermore, considering the availability of effective vaccines, it is of paramount importance to vaccinate the diabetics to ensure that they have some form of immunity against the novel viral infection.[21]


  Self-Care in Diabetes Top


Self-care plays a crucial role in the management of diabetes, and the significance of the same has immensely increased during the ongoing COVID-19 pandemic.[22],[23] In an attempt to interrupt the chain of transmission, lockdown has been imposed in multiple nations of varied duration and thus the practice of periodic follow-up has been disrupted for most of the known diabetics.[24],[25] Thus, it is a must that people with diabetes should strictly take care of their diet, indulge in regular physical activity based on the ability and fitness level, adhere to the drugs, practice self-monitoring of blood glucose, and be aware about symptoms of hypoglycemia or other complications.[22],[23],[24],[25] Wherever possible, the people with diabetes should use the facilities of telemedicine for their well-being, including the management of the psychosocial concerns.[23],[24],[25]


  Implications for Practice Top


As the people with diabetes constitute a high-risk group, it is the need of the hour to increase awareness among these people about COVID-19 infection. There is a need to strengthen the risk communication and community engagement network and ensure that they are informed about the preventive strategies. Further, all the hospitals should look to start teleconsultation, so that a diabetic can avoid their visit to the hospitals for common ailments or for the sake of their regular follow-up.[19],[26],[27] Moreover, there is an indispensable need to encourage people with diabetes to strictly adhere to the prevention of the infection.


  Implications for Research Top


The available studies have not yet conclusively explained the prevalence of COVID-19 among diabetics, and thus, there is a need to conduct large-scale multi-centric research. There has been a lack of clarity about the pathophysiology and the exact mechanism for the increased risk of complications of COVID-19 among diabetics. In general, there is a need to invest in research work and improve our understanding about the COVID-19 infection in people with diabetes.[10],[20],[27]


  Conclusion Top


The COVID19 pandemic is far from over, and the people living with diabetes are at significant risk to land up into complications, if they acquire the infection. This call for the need to intensify the preventive strategies and strengthen the health care delivery system for ensuring better management of diabetes among COVID-19 cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Weekly Epidemiological Update on COVID-19-10 August 2021. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---10-august-2021. [Last accessed on 2021 Aug 13].  Back to cited text no. 1
    
2.
World Health Organization. Diabetes-Key Facts; 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes. [Last accessed on 2021 Aug 13].  Back to cited text no. 2
    
3.
Pal R, Bhadada SK. COVID-19 and non-communicable diseases. Postgrad Med J 2020;96:429-30.  Back to cited text no. 3
    
4.
Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endocrinol Metab 2020;318:E736-41.  Back to cited text no. 4
    
5.
Erener S. Diabetes, infection risk and COVID-19. Mol Metab 2020;39:101044.  Back to cited text no. 5
    
6.
Abdi A, Jalilian M, Sarbarzeh PA, Vlaisavljevic Z. Diabetes and COVID-19: A systematic review on the current evidences. Diabetes Res Clin Pract 2020;166:108347.  Back to cited text no. 6
    
7.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 7
    
8.
Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect 2020;80:639-45.  Back to cited text no. 8
    
9.
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically Ill patients in the seattle region-Case series. N Engl J Med 2020;382:2012-22.  Back to cited text no. 9
    
10.
Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr 2020;14:535-45.  Back to cited text no. 10
    
11.
Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev 2020;e3319. (Ahead of Print)  Back to cited text no. 11
    
12.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020;8:e21.  Back to cited text no. 12
    
13.
Azar WS, Njeim R, Fares AH, Azar NS, Azar ST, El Sayed M, et al. COVID-19 and diabetes mellitus: How one pandemic worsens the other. Rev Endocr Metab Disord 2020;21:451-63.  Back to cited text no. 13
    
14.
Cuschieri S, Grech S. COVID-19 and diabetes: The why, the what and the how. J Diabetes Complications 2020;34:107637.  Back to cited text no. 14
    
15.
Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr 2020;14:303-10.  Back to cited text no. 15
    
16.
Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol 2020;8:546-50.  Back to cited text no. 16
    
17.
Basu S. Non-communicable disease management in vulnerable patients during Covid-19. Indian J Med Ethics 2020;V: 103-5.  Back to cited text no. 17
    
18.
Ceriello A, Standl E, Catrinoiu D, Itzhak B, Lalic NM, Rahelic D, et al. Issues for the management of people with diabetes and COVID-19 in ICU. Cardiovasc Diabetol 2020;19:114.  Back to cited text no. 18
    
19.
Chakraborty C, Sharma AR, Bhattacharya M, Sharma G, Agoramoorthy G, Lee SS. Diabetes and COVID-19: A major challenge in pandemic period? Eur Rev Med Pharmacol Sci 2020;24:11409-20.  Back to cited text no. 19
    
20.
Katulanda P, Dissanayake HA, Ranathunga I, Ratnasamy V, Wijewickrama PS, Yogendranathan N, et al. Prevention and management of COVID-19 among patients with diabetes: An appraisal of the literature. Diabetologia 2020;63:1440-52.  Back to cited text no. 20
    
21.
Powers AC, Aronoff DM, Eckel RH. COVID-19 vaccine prioritisation for type 1 and type 2 diabetes. Lancet Diabetes Endocrinol 2021;9:140-1.  Back to cited text no. 21
    
22.
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord 2013;12:14.  Back to cited text no. 22
    
23.
Banerjee M, Chakraborty S, Pal R. Diabetes self-management amid COVID-19 pandemic. Diabetes Metab Syndr 2020;14:351-4.  Back to cited text no. 23
    
24.
Moradi F, Ghadiri-Anari A, Enjezab B. COVID-19 and self-care strategies for women with gestational diabetes mellitus. Diabetes Metab Syndr 2020;14:1535-9.  Back to cited text no. 24
    
25.
Gupta SK, Lakshmi PV, Kaur M, Rastogi A. Role of self-care in COVID-19 pandemic for people living with comorbidities of diabetes and hypertension. J Family Med Prim Care 2020;9:5495-501.  Back to cited text no. 25
  [Full text]  
26.
Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract 2020;162:108142.  Back to cited text no. 26
    
27.
Lima-Martínez MM, Carrera Boada C, Madera-Silva MD, Marín W, Contreras M. COVID-19 and diabetes: A bidirectional relationship. Clin Invest Arterioscler 2021;33:151-7.  Back to cited text no. 27
    


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