World Diabetes Day 2020: COVID-19, Diabetes and Vaccination

Bhubaneswar: This day is celebrated as World Diabetes Day which was started way back in 1991 by International Diabetes Federation (IDF) and World Health Organisation (WHO) to create awareness about diabetes and the escalating health threat posed by it.

World Diabetes Day has been accorded as an official United Nations Awareness Day and has been thus regarded as the ‘World’s Largest Diabetes Awareness Campaign’. The whole month of November is celebrated as ‘Diabetes Awareness Month’ and is dotted with thousands of local campaigns, activities, screening camps, charitable work, meetings and many such activities aimed at making more and more people aware regarding diabetes and its complications.

 THEME: THE NURSE AND DIABETES

Every year the International Diabetes Federation decides on a theme for World Diabetes Day. This year it is “The Nurse and Diabetes’. The campaign aims to raise awareness around the crucial role that nurses play in supporting people living with diabetes.

 BLUE CIRCLE LOGO

The blue circle is the global symbol for diabetes. It signifies the unity of the global diabetes community in response to the rising number of people affected by diabetes.

 COVID 19 AND DIABETES

People with diabetes have an increased risk of developing a number of serious health complications, known as co-morbidities. Consistently, high blood glucose levels can lead to serious diseases such as CVD, i.e., heart and brain stroke, in addition to diabetic retinopathy, diabetic nephropathy, also called diabetic kidney disease and peripheral neuropathy. People with diabetes also have a higher risk of developing infections, including serious ones.

Hyperglycemia in people with diabetes is likely to cause dysfunction of the immune response, which, in turn, leads to failure to control the spread of invading pathogens in these people. Hence, people with diabetes are very susceptible to infections like COVID‐19, said Dr Mahesh Rath, Diabetologist and Assistant Professor at Hi-Tech Medical College and Hospital, Bhubaneswar.

Precautions for People with Diabetes to Prevent or Reduce Chances of Developing COVID‐19

People with preexisting medical conditions (such as diabetes, heart disease, and asthma) and older people, in general, appear to be more vulnerable to becoming severely ill with the COVID‐19. The precautions advised to the general population to reduce the chances of developing COVID‐19 are all recommended for people with diabetes, in addition, as few specific precautions and recommendations are also necessary.

Management of Diabetes in those with Confirmed COVID‐19

In case a person with diabetes develops symptoms of fever, cough or difficulty in breathing, it is appropriate to immediately contact a doctor (initial contact to be through phone, unless very severe symptoms).

For people with diabetes who have been confirmed to have COVID‐19, it is important to have regular blood glucose monitoring and have adequate glycemic control. This is likely to reduce the risk of severe COVID‐19. There are specific considerations regarding the use of and also need to avoid some anti‐hyperglycemic agents, which a diabetes specialist would best suggest and guide you.

Importantly, if any anti‐hyperglycemic drugs are discontinued, the alternative treatment of choice is usually insulin. Further, if insulin therapy is already ongoing in a patient, it should be continued and not stopped. For type 1 diabetes and COVID‐19, there is clear need of more frequent and close blood glucose monitoring and adjustments of insulin dose based on blood glucose values.

The treatment goals and recommendations for patients who have been in reasonably good control and in the out‐patient setting (e.g., isolation or quarantine) and do not require hospitalization/intensive care admission due to COVID‐19

Elderly People with Diabetes and COVID‐19

COVID‐19 is a new disease, and currently, there is limited information regarding the risk factors for the severe form of the disease. The current information, clinical knowledge, and expertise suggest that older adults (over 65 years of age) and people of any age who have serious underlying medical conditions such as diabetes, heart disease, and asthma are likely at higher risk for severe illness from COVID‐19.

Diabetes management in the elderly should focus on prevention and limiting the impact of geriatric medical conditions (i.e., those encountered in elderly persons), hypoglycemia (low blood glucose levels), and neurodegenerative conditions (impairment in the functioning of nervous system and brain).

When older people with diabetes develop a viral infection such as COVID‐19, it is harder to treat due to fluctuations in blood glucose levels and possibly, the presence of diabetes complications and other comorbid conditions such as hypertension, coronary heart disease, and stroke. There appear to be two reasons for this. First, the immune system is compromised, making it harder to fight the virus and likely leading to a longer clinical recovery period. Second, the virus may also thrive better in an environment of elevated blood glucose. Special care is required in prescribing and monitoring pharmacologic therapies in older adults with diabetes.

Overall, for older people with diabetes and confirmed COVID‐19, safer oral anti‐hyperglycemic agents, and insulins with careful dosage adjustment based on regular blood glucose monitoring) are recommended as the preferred treatment for obtaining optimal glucose control.

COVID 19, Vaccines and Alternatives 

Currently COVID 19 has no definitive vaccine and multiple countries have initiated advanced researches to discover a potent vaccine to counter this ever growing pandemic under the watchful eyes of WHO.

To date, just two coronavirus vaccine has been approved. SPUTNIK V – formerly known as Gam-COVID-Vac and developed by the Gamaleya Research Institute in Moscow – was approved by the Ministry of Health of the Russian Federation on 11 August. Experts have raised considerable concern about the vaccine’s safety and efficacy given it has not yet entered Phase 3 clinical trials. A second vaccine in Russia, EPIVAC-CORONA, has also been granted regulatory approval, also without entering Phase 3 clinical trials.

Other vaccines which are in advanced stages of development are: COVAXIN (Bharat Biotech, India), NOVAVAX (Maryland, United Kingdom), CANSINO BIOLOGICS (China), OXFORD-ASTRAZENECA-SERUM INSTITUTE (India), CORONAVAC (Sinovac, China), JOHNSON & JOHNSON (USA), MODERNA (USA), SINOPHARM (Wuhan, China).

Alternatives

Now that specific vaccines for COVID 19 are still under development, keeping in view the winter months and rising cases of COVID 19, certain researches have shown that there are few other regular vaccines which help in combating the COVID 19 infection by increasing the lung immunity They are Influenza Vaccine, Pneumococcal Vaccine and BCG Vaccine. These said vaccines are extremely safe and do not show any adverse effects. They have shown their efficacy in preventing respiratory diseases since decades and are the best alternatives till a specific vaccine is made available. This can be taken by people unaffected by COVID and also by those who have recovered from COVID 19 infection under expert guidance of an Adult Vaccination Specialist.