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How To Manage Chronic Diseases In Virus Era – Experts

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As COVID-19 cases surge, with over 20 million confirmed infection cases and more than 700,000 deaths in over 200 countries and territories, focus is tilting towards how to manage the severe cases.

While the virus is not a respecter of persons or status, people with pre-existing medical ailments – hypertension, diabetes, kidney diseases, HIV/AIDS, cancer, tuberculosis, etc. – happen to be more vulnerable, medical experts have continued to warn.

At least, 70 per cent of those who have died as a result of COVID-19 complications were those with preexisting chronic diseases, as doctors insist that the viral infection presents a double challenge for such people with comorbidities.

In the United States, for example, a government study claimed that “nearly 40 per cent of people who have died with COVID-19 had diabetes.” Pictures in other countries are not better either. Other chronic ailments have also been fingered as great contributors to huge COVID-19 fatalities.

How coronavirus affects people with diabetes

To change the sad narrative and educate the public on what can be done during the coronavirus pandemic, Eko Hospital held a webinar recently on “COVID-19 and Chronic Diseases: Focus on Diabetes and Hypertension.”

According to doctors, people who have diabetes – regardless of what type – are no more likely to catch coronavirus than anyone else. Although the majority of people who do get coronavirus – whether they have diabetes or not – will have mild symptoms and may not need to go into hospital, diabetics are more vulnerable.

Anyone with diabetes, including those with type 1 or type 2 (gestational and other types), is vulnerable to developing a severe illness if such people do get coronavirus – though the ways coronavirus affect people vary from person to person.

When people fall ill, the body tries to fight the illness by releasing stored glucose (sugar) into the blood stream to give energy. But because the body can’t produce enough or any insulin to cope with the illness, blood sugar rises.

For diabetics, the body is made to work overtime to fight the illness, making it harder to manage the diabetes. This often leaves diabetics more at risk of having serious blood sugar highs and lows.

Out of people who have died from COVID-19 in Nigeria, Dr. Sunny Kuku said between 22 and25 per cent are diabetic. This means that at least one in five people that have lost their lives to coronavirus complications is diabetic.

The emeritus endocrinologist, who is one of the triumvirate that founded the famous Eko Hospital, warned that the situation becomes worse when hypertension, cardiovascular diseases and respiratory illnesses and other non-communication diseases.

“This is so because diabetes is one of the conditions that lower the (body) immunity and infections are more common where immunity is lowered. There is also a vicious cycle because infections are also linked to diabetes; diabetes has two-pronged attack. It lowers the immunity and then the infections worsen in diabetics.

Diabetics who have COVID-19 disease tend to have obesity, especially the abdominal obesity. Abdominal obesity is what we call insular resistance. We also know that diabetics with insular resistance due to abdominal obesity do produce more small molecules or active agents that are destroying the system.

That is one of the major problems of COVID-19 disease and diabetics with obesity tend to get it more than others,” he explained. The foremost endocrinologist added that it is also known that diabetics who have complications such as kidney and heart diseases have worse outcomes with COVID-19 than people who don’t have the virus.

How to manage diabetes and hypertension during COVID-19

In asymptomatic diabetics who have tested positive, Dr. Kuku admitted that “we don’t do much with them,” adding that all that doctors need to do is to advise them to be tighter in their control and watch their diet.

“We advise them to be tighter in their control, test their glucose (level) more often, watch their diet, exercise as we advise everybody to do and more importantly, to obey the rules: wash your hands, social distancing and avoid crowd, and if possible, stay at home or self-isolate if you see symptoms,” he said.

Dr. Kuku said it is different for the COVID-19-positive people battling with the type 2 diabetes. According to him, type 2 diabetes constitutes nothing less than 90 per cent of diabetes in Nigeria. He said remedy open to the physician managing such a condition includes titrating the blood sugar and ensuring that the diabetes is controlled.

For type 1 diabetes, it is mandatory that patients remain on insulin,  adding that diabetics should know a lot about diabetes so that they can be their own doctor and their nurse and even know more than their doctor. “Cough is common in COVID-19 disease and we use a lot of cough mixtures.

I want to remind our diabetics that cough syrups have a lot of sugar in them and they can worsen their diabetes. So, they should be very careful when taking cough syrups. There are other drugs that can lower blood sugar; so they need to be very careful,” Kuku said.

While speaking, Dr. Oyatokun Olugbenga, a consultant cardiologist, said high blood pressure increases COVID-19 death risk.

According to him, patients with raised blood pressure have a two-fold increased risk of dying from COVID-19 compared to patient without high blood pressure. This is a scenario that plays out in virtually all the countries, he said, though he cautioned that hypertension has always been a leading cause of death even before COVID-19.

“Most common risk factors associated with increased morbidity and mortality are hypertension, obesity, advanced age and diabetes mellitus. Studies have shown that 13 to 30 per cent of severe cases have hypertension and diabetes.

In Nigeria, Olugbenga said studies rated prevalence of hypertension at 30 to 45 per cent, with prevalence rising with age. Sadly, only a third of patients are aware of their hypertension status; only a third of which takes medications regularly and have good blood pressure control, he said.

The cardiologist recommended that hypertensive patients should always continue to take their medications, ensure adequate home measurement of their blood pressure to ensure good control, adhere to lifestyle and dietary recommendations, and restrict hospital visits as much as possible. For patients with stable hypertension, the medical doctor urged them to embrace e-clinic while the elderly patients with multiple comorbidities are advised to always contact their doctors first if symptomatic to evaluate need for hospital visit – considering the risk of getting exposed to the virus in the hospital.

Prof Ogbera Anthonia, consultant endocrinologist, said individuals with diabetes are at the increased risk for bacterial, parasitic and viral infection.

“Usually, people with higher glucose levels are likely to be at greater risk for infection than those with more normal glucose levels. This is because high glucose levels can inhibit white cell function.

However, current data suggest that people with diabetes are usually not at increased risk for catching the coronavirus, but once they become infected, they may do less well, particularly if they are severely ill enough to warrant hospitalisation in an intensive care unit setting.

Even though COVID-19 disease is unpredictable, younger people as a whole do better than older people.

The more complications are present, such as cardiovascular disease and chronic kidney disease, the higher the risk for mortality and doing poorly. Clinical research suggests that diabetes and obesity are firmly associated with increased risk of COVID-19 complications or sever symptoms.

Diabetic patients with uncontrolled blood sugar levels are more susceptible to developing severe symptoms resulting in prolonged hospitalisation and increased risk of death.

In addition, risks of developing critical illness caused by COVID-19 in patients with diabetes or obesity rise proportionally in the presence of other pre-existing medical conditions such as hypertension, heart disease and kidney disease,” she said. I

While maintaining that people with diabetes are more likely to experience severe symptoms and complications when infected with a virus, the consultant endocrinologist submitted that the risk of getting sick from COVID-19 is likely to be lower if people manage their diabetes properly.

“When people with diabetes do not manage their diabetes well and experience fluctuating blood sugars, they are generally at risk for a number of diabetes-related complications.

Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because the body’s ability to fight off an infection is compromised,” she added.

Speaker after speaker emphasised that living with diabetes during the virus era involves people to look after themselves, knowing that changes in lifestyle, stress and illness can impact glucose levels in all sorts of ways.

Like other speakers at the webinar, Prof Anthonia advised Nigerians that the future of healthcare is tele-medicine because COVID-19 is not going anywhere soon. “So we have to adopt telemedicine as the way to go,” she said.

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