Hypertension followed by Diabetes are co-morbidities in COVID-19 patients - Prof. Javed Akram


Diabetes Session during PSIM’s Mid-Summer conference
Hypertension followed by Diabetes 
are co-morbidities in COVID-19 
patients - Prof. Javed Akram
Start treatment with Metformin and use 
Insulin but do not use SGLT2 inhibitors

MUZAFFARABAD. (AJK): The session devoted to Diabetes during the PSIM’s Mid-Summer conference on Saturday September 4th 2020 was jointly chaired by Prof. Bikharam Devarajani and Prof. Shamsudidn Sheikh. Prof. Javed Akram Vice Chancellor of UHS was the first speaker who talked about Managing Diabetes during COVID-19 Pandemic with special reference to role of Insulin. So far over eight lac seventy six thousand people he said, have died due to COVID all over the world. During Covid smell and taste is lost more in females. Other symptoms include fever, cough, diarrhoea, fatigue, shortness of breath and respiratory problems.

Continuing Prof. Javed Akram said that hypertension is the most common comorbid condition in Covid followed by diabetes besides chronic kidney disease and cardiovascular diseases. Quantity of virus is the driver of mortality in COVID, Other causes of mortality include hypoxia, coagulopathy, metabolic disorders, secondary infection are some other co-morbidities. He also referred to cytokine storm. Almost 95% of deaths in COVID is due to coagulopathy. Start treatment with Metformin and do not use SGLT2 inhibitors. He then talked about atherothrombosis in COVID19 and pointed out that almost 15% of Covid patients had diabetes while 22% of ICU admissions accounted for COVID19. These patients are pushed to the ICU because of diabetes. In our study so far the sample size is small but it showed that almost 89% of the patients went into remission with the use of triple therapy which included Hydroxychloroquine. It is important that the patients are asked to do regular exercise. Treat their anxiety and ask them to take healthy balanced food. Telemedicine can be of immense help. Monitor their blood sugar regularly to prevent complications. Practice hand washing and all patients with diabetes should be put on Insulin therapy till they are in hospital. All guidelines recommend stopping the use of SGLT2 Inhibitors in diabetics during Covid19 pandemic.

Prof. Bilquis Shabbir, Prof. Sajid Abaidullah along with others chairing one of the sessions
during PSIM’s Mid-Summer Conference held at
Muzaffarabad on September 4th, 2020.

He emphasized the importance of regular monitoring of the patient and also spoke about needle resistance in insulin therapy. He concluded his presentation by stating that about 15% of COVID patients develop diabetes which increases mortality significantly. Insulin therapy remains the first line of treatment of diabetes in COVID, he added.

Innovations in Technology
related to Diabetes Management

This was followed by another interesting presentation by Prof. Zaman Sheikh from Karachi who shared the information regarding new developments in technology related to management of diabetes. He also referred to CAMFLLIA TIMI61 trial which enrolled about twelve thousand patients and proved that it was cardio protective. He then laid emphasis on cost effective therapy and mentioned about SAID, SIDD, SIRD, MOD, MARD trials and different classifications of diabetes mellitus.

Continuing Prof. Zaman Sheikh said that with the use of new technology one will be able to easily check blood sugar, total cholesterol. In the days to come we will see many new information technology based devices and their use will increase in the management of diabetes and many other chronic diseases. We will have a CGM six months device. We will have watches which will measure blood glucose, they will also remind the patients about the timing of taking their drugs. These devices will make various laboratory investigations easy like measuring HbA1c, lipid profile. Studies have showed that just 1% reduction in HbA1c reduces the risk of complications and death. We will have combined insulin’s and one will require just once weekly dose of DPP4 inhibitors and all this is going to become possible in the near future.

Speaking about the other technological innovations Prof. Zaman Sheikh said that smart insulin’s will become available and once weekly insulin is likely to become available soon. Various preparations including ICODFC v BIF are currently under trial. We will have oral insulin’s, three months dosage, use of insulin through buccal, nasal and rectal insulin’s as well as insulin stickers would also become available. Of course everything comes with a cost and these devices might be costly to begin with and their maintenance may also pose some problem for some of the patients. However life style modifications remains the most important intervention.

Prof. Bikaram

In his concluding remarks Prof. Bikharam remarked that it is an established fact that with diabetes there will be higher mortality in Covid. Life style changes are much more important in managing diabetes. Lack of exercise, over weight remain a problem and according to studies almost 40% of our population is suffering from metabolic disorders. Artificial Pancreas is not working. Prof. Shamsudidn Sheikh said that diabetes remains a very common problem which needs to be identified early and treated effectively. Responding to a question regarding increasing the dose of insulin to replace Bigunides or SGLT2 inhibitors, it was pointed out that one should individualize the patient and arrange tailor made therapy to suit every individual patient. One can also use high dose of analogues.

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