Dr Sanjay Kalra
President of the Endocrine Society of India
We are all in the midst of a COVID-19 pandemic. Diabetes has been found to be apoor prognostic factor for COVID-19 infected people, but the reality is much deeper, diabetes has a multifaceted and bidirectional link with COVID-19.
Uncontrolled diabetes is a condition of impaired immunity. In an individual with poorly controlled diabetes, immunity may be impaired increasing susceptibility towards COVID-19 infections and worse outcomes if the person gets infected. Hence, diabetes can be considered a prognostic factor in COVID-19 infections.
Unfortunately, diabetes is considered as a tool for triage in many health systems in the world. It is important to counsel everybody involved that diabetes is a heterogeneous condition. Not everyone with diabetes will have poor outcomes. Certain factors are at play here including;
So, diabetes per se should not be viewed as a tool for triage. In fact it should be considered as a tool for improvement and achieving optimal targets. In this case, the target is recovery from COVID-19 infections.
Achieve and maintain euglycemia through lifestyle and appropriate drugs
Not every dysglycemia is diabetes, many people have stress hyperglycemia which needs to be identified and treated.
Glucovigilance: Health care professionals shouldbe very vigilant regarding the screening, diagnosis, management, and monitoring of dysglycemia
Don’t ignore other endocrine glands involved in critical conditions; adrenal insufficiency and thyroid syndrome
Adrenal insufficiency is quite common in ICU settings, presents as ‘Koala Bear syndrome,’ and health care personnel should work in teams including endocrinologists to identify and treat these endocrinal insufficiencies.
Health care team’s message to patients
Those who are not infected and those in confinement/lockdown
Symptomatic COVID-19 patients
You need to be hospitalized
You may need help from other health care personnel who might be an internist, intensivist or an infectious disease expert.
Follow their advice, manage optimal glucose levels. If glucose levels are very good, continue the same regimen. If glucose not controlled, an intensive insulin regimen may be needed.