Coronavirus: Novel way to manage Diabetes amid Covid-19
As the world navigates these challenging times, India’s diabetes burden has taken on a new significance.
It’s been a tough year for those battling diabetes, not only has Covid made life harder for the patients but also increased their chances of having lifestyle related disorders. Amidst pandemic induced restrictions and increase of vulnerabilities how should a diabetic patient manage the chronic disease and keep the glucose levels under check. Hindustan Times Vertika Kanaujia speaks to Dr. Ambrish Mithal, Endocrinology & Diabetes - Max Healthcare.
Diabetes has been a big NCD burden on the Indian population for quite some time. How has Covid impacted its prevalence?
Dr. Ambrish Mithal: As the world navigates these challenging times, India’s diabetes burden has taken on a new significance. While people with diabetes may not necessarily be at a greater risk of contracting COVID-19, they are definitely at risk of adverse outcomes. The chances of people with diabetes, especially among those with other comorbidities like high blood pressure, heart and kidney disease, requiring oxygen, ICU care and succumbing to the infection are at least twice that of people without diabetes.
COVID-19 has highlighted the importance of managing NCDs like diabetes in the setting of an infectious disease pandemic. Newer approaches for managing NCDs are imperative to avoid future epidemics.
We saw the second wave being considerably dangerous for diabetics. What are the complications posed by uncontrolled diabetes and the risks it poses to patients, especially during Covid?
Dr. Ambrish Mithal: Patients infected with COVID-19 experience a sharp rise in their glucose levels. This happens because of the stress of infection and the use of steroids for treating COVID (which is common and sometimes unavoidable). In our study from Max Healthcare, more than 50% of patients hospitalized for COVID had high glucose levels. 10% of those diagnosed with diabetes on admission did not even know that they had the condition. Clearly, patients with diabetes had poorer outcomes than those without diabetes.
In addition, deterioration in glucose control linked to COVID increases the risk of chronic complications of diabetes - involving various body organs like the kidney, heart, eyes, and feet.
In the second wave, India also witnessed a surge in the cases of opportunistic infections including rare and serious fungal infections such as mucormycosis, linked to uncontrolled diabetes, and steroid use.
We must thus ensure better health outcomes for the pre-diabetic and diabetic population in India by ensuring appropriate monitoring and timely management of glucose levels.
How has Covid increased the challenges to diabetes management in India?
Dr. Ambrish Mithal: The second wave of the COVID-19 pandemic hit India hard. Routine diabetes care has been affected, with infrequent hospital/clinic visits and less testing. However widespread use of telemedicine for consultation and home laboratory collection of samples has helped circumvent this barrier to some extent.
Increased time spent at home also results in changes in diet, sleep and exercise, along with increased professional and pandemic stress, leading to suboptimal glycemic control. Our study, as well as research data, showed that poor glucose control at admission resulted in poor outcomes. The importance of maintaining glucose control during this period is extremely crucial.
When people with diabetes contract COVID-19, the treatment can be challenging because of wide fluctuations in glucose level. Many such patients have to be managed at home and in our experience, the use of modern technology to continuously monitor glucose has proven to be very useful in this situation.
Covid-induced restrictions have made it difficult for diabetics to undergo regular check-ups and make lifestyle changes. How can patients check glucose levels regularly?
Dr. Ambrish Mithal: The commonly used technique for glucose monitoring is via glucose strips and glucometers. This involves needle pricks several times a day and gives us values at that instant without providing much information about trends. Continuous glucose monitoring using sensor-based devices is excellent for monitoring and managing diabetes at home. It presents real-time information on glucose trends, visualizing the 24-hour roadmap of the individual’s glycemic variations, thus helping users swiftly detect hyperglycemic (high glucose levels) or hypoglycemic (low glucose levels) events. This enables timely interventions.
Continuous glucose monitoring enables users to check their glucose readings more frequently which has been shown to significantly improve glycemic control.
How will constant monitoring be beneficial to patients and how do daily activities impact one’s glucose levels?
Dr. Ambrish Mithal: Continuous glucose monitoring helps record glucose levels throughout the day. This presents real-time information about glucose level trends and thus helps both patients and doctors make more informed decisions, including lifestyle or treatment modifications across diet, physical activity, and medicines.
In comparison to traditional monitors, continuous glucose monitoring provides patients with many benefits, enabling better management of glucose levels, fewer low glucose emergencies, and decreased need for finger sticks.
Constant monitoring can also equip patients with user-friendly charts showing patterns in their glucose level trends. This can enable meaningful discussions between doctors and patients. Such insights can also enable personalized lifestyle and therapy interventions so the patient can achieve their holistic diabetes management goals. Thus, point of care, wearable technology can pair well with tele-consultations, while also reducing pain points such as waiting time for lab results and discomfort with blood draw.
What is the best possible way to maintain glycemic control? What are the other benefits associated with the same?
Dr. Ambrish Mithal: Maintaining glycemic control is crucial to the management of diabetes. Traditionally used HbA1C tests have some limitations, including the inability to capture rapid fluctuations in glucose levels, and misleading values in conditions such as anemia, pregnancy, and hemoglobinopathies which contribute to further fluctuations.
While it is imperative to achieve target HbA1C levels for diabetes management, continuous glucose monitoring data allows doctors to focus on an additional vital metric – Time in Range (TIR). This metric measures the time spent by the patient in a target glucose range, specific to his or her condition.
In addition to Type 1 and Type 2 diabetics, special populations with diabetes such as pregnant women, pediatric patients, young adults and older, high-risk individuals with co-morbidities also require close monitoring of their glycemic levels throughout the day. Here, TIR can help patients understand their glucose levels better while providing more actionable information. By leveraging customized TIR targets and practices for different subsets of the Indian diabetic population, physicians across the country can enhance health outcomes for patients, so they enjoy better health outcomes as well as improved quality of life.
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