The indications so far are that people with diabetes and other chronic medical conditions, such as cardiovascular disease (CVD), will have a worse prognosis if they become infected with COVID-19, the new coronavirus that has emerged from China.
There is also evidence that diabetes can increase the risk of COVID-19 infection two to three times, regardless of other medical problems, such as CVD.
Although more detailed analyzes are needed to show a clearly defined connection between conditions such as diabetes and a worse prognosis with COVID-19, statistics suggest that this virus affects the hardest among the most vulnerable, namely, the elderly and people with multiple medical problems, especially those with long-lasting diabetes that has not been well controlled.
“The message we want to emphasize is that emergencies unmask the vulnerabilities of diabetes. The old and the sick are the most vulnerable,” said Juliana C. N. Chan, MD, Medscape medical news in an interview.
Chan is director of the Hong Kong Institute of Diabetes and Obesity at the Chinese University of Hong Kong.
Chan and other experts therefore ask that diabetic patients, those with CVD and patients with other chronic medical conditions be more vigilant in their efforts to avoid contact with the virus, although they also note that individual responses vary widely.
In the past, epidemics of infectious diseases, including severe acute respiratory syndrome (SARS) and H1N1 flu, people with diabetes were at increased risk of serious disease and death.
“I don’t think it’s an exaggeration to say that people with diabetes … are at greater risk of developing COVID-19, because the data is suggestive,” Chan observed, although he warned that long-term research will give a lot more photos. clear.
Poor control of diabetes is a risk factor for infection
Chan was a senior coauthor of a study published in Diabetology, as reported by Medscape medical news, who found that mortality rates among people with diabetes in Hong Kong have plummeted in recent years, with the exception of young people, who may be more likely to have poorly controlled diabetes.
And – especially in the context of the COVID-19 epidemic – although in that study deaths from most conditions such as CVD and cancer decreased among people with diabetes, deaths from pneumonia among people with diabetes remained virtually unchanged. .
In severe cases of infection, the COVID-19 virus invades the cells that line the respiratory tract and lungs and enters the mucus, causing pneumonia. Severe lung damage from pneumonia can cause acute respiratory distress syndrome (ARDS), which in turn can cause septic shock.
ARDS and septic shock are the leading causes of death from COVID-19.
To date, Hong Kong has had only 70 confirmed cases of COVID-19, although the first Hong Kong resident to die from the virus was a 39-year-old man with diabetes. That death was soon followed by a second death – a 70-year-old man with diabetes and other medical problems, including hypertension and kidney disease.
“Our message is to ask people with diabetes to do things early to protect themselves and reduce the risk of having problems if something happens,” Chan told Medscape.
Although the mechanism for this increased susceptibility remains unclear, research suggests that high blood glucose levels can lead to impaired immune system function.
Not yet pandemic, but Virus has claimed many more lives than SARS
By February 25, COVID-19 had infected around 80,000 people and had caused nearly 2,500 deaths worldwide.
Although the vast majority of these infections and deaths have been in China, there are now pockets of infection in Iran, Italy, Japan and South Korea, as well as a handful of cases in many other countries.
The World Health Organization (WHO) yesterday stopped calling the epidemic a pandemic, but stressed that status could change at any time.
Although COVID-19 appears highly transmissible, only a small percentage of people seem to develop a serious disease and an even smaller number die from the infection.
A recent study of 44,672 confirmed cases of COVID-19 that had been reported until 11 February and which have been analyzed by the Chinese Centers for Disease Control and Prevention (CCDC) shows that 80.9% of people at who was diagnosed with COVID-19 had a mild illness.
So far, the overall case death rate (CFR) in China is 2.3%, lower than the previous coronavirus outbreaks caused by SARS (CFR: 9.6%) and Middle East respiratory syndrome (MERS) (CFR: 34.4%).
That being said, since COVID-19 has infected many more people than SARS or MERS, the latest coronavirus on the block has already caused many more lives.
This in turn raises the question: who is most at risk of serious disease and death from COVID-19?
Case mortality rates vary based on factors such as age, gender, basic medical conditions, and geography. Outside the Hubei province in China, the epicenter of the epidemic, the CFR can reach 0.4%, compared to 2.9% within the province.
The mortality rate for diabetes is high, but the interpretation is complicated
So far, for all age groups, the highest CFR is among people aged 80 or over, at 14.8%. CFRs were higher in people with other medical conditions than in healthy people.
CVD and diabetes are high on the list, in the event that mortality rates of 10.5% and 7.3%, respectively, compared to 0.9% for people without any previous disease, according to the latest CCDC report above.
Prior to the publication of this report, two relatively small case series of COVID-19 hospitalized patients in Wuhan also suggested that older men with underlying medical problems, especially CVD and diabetes, are more likely to develop disease. serious from the virus.
However, experts warn that for COVID-19 and similar infections, several factors can distort the data, making interpretation difficult.
“The identified cases tend to be in patients who have a more serious disease than younger and healthier individuals who stay at home and do not seek medical treatment,” said Preeti N. Malani, MD, an infectious disease and health specialist. principal officer of the University of Michigan medical school, Ann Arbor.
“This is also the case for individuals who are sick enough to be hospitalized. There are more people with more chronic conditions, including diabetes [among hospitalized individuals]”Malani told Medscape via email.
“Overall, diabetes can be an indicator of other chronic health conditions such as heart disease and obesity, which could contribute to an increased risk of infection,” added Malani.
“Diabetes is also much more common with age and will continue to be an indicator of poor results [all of] these reasons, “he said.
Every person with diabetes is different; Use common sense
All this makes it difficult to make fun of the individual contribution of diabetes to the risk of infection.
“The percentage in which each medical condition contributes to … the risk of infection is difficult to analyze,” explained Andrea Luk, MBChB, FHKCP, FHKAM.
Luk is an associate professor at the Chinese University of Hong Kong and is the other senior coauthor of the study Diabetology.
“Certainly a person with diabetes and cardiovascular disease would have more risks than a person with diabetes and good glucose control and without other comorbidities,” he continued.
But because every person with diabetes is different, it’s important to consider the whole package, he stressed.
If someone with diabetes succumbs to infections, it has a lot to do with glycemic control, the duration of diabetes and the comorbid conditions related to diabetes, such as heart disease, kidney disease and stroke, as well as their age, weight and if they smoke.
Chan further clarified: “We have to judge this case by case. It is not possible to apply it across the board to all people with diabetes. A person with well-controlled diabetes is very different from someone with poorly controlled diabetes. They have a different set of factors. of risk and complications “.
Pending more detailed analysis, Chan, Luk and Malani all suggest common sense measures for patients with diabetes, CVD and other chronic conditions: stay up to date with vaccinations, avoid large crowds, wash hands frequently, avoid touching the eyes or the mouth (the so-called T zone) and wearing facial masks in the areas where COVID-19 is prevalent.
People with symptoms should also wear a mask to avoid spreading the infection to others.
Even a bad year for the flu, difficult to distinguish between the two
Malani added: “Although there is a lot of attention and concern for COVID-19, this one has [also] it has been a terrible year for seasonal flu. I recommend flu shots, especially for … patients with diabetes. “
He also suggested being considerate of the trip.
“This may not be a good time for a non-essential trip to Asia as the situation is evolving. The COVID-19 risk is still low, depending on where you go, but the risk of an interrupted trip is real,” he said. observed.
Even without an emergency like COVID-19, Chan and Luk say they can’t emphasize enough the importance of optimal glucose control for people with diabetes.
“People with diabetes or other chronic conditions should be much more careful about protecting themselves from infections,” reiterated Luk.
They should also have a lower threshold for seeking treatment if they feel they are developing symptoms of infection, he noted.
“At first, it’s hard to tell if it’s flu or COVID-19 because it looks the same way,” he said.
Chan, Luk and Malani have not disclosed relevant financial reports.
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