The Sunday Mail
AS the world keenly follows the pathogenesis of the novel coronavirus, researchers have since observed that the lethal infection severely affects the prognosis of diabetes mellitus.
Covid-19 is a viral infectious disease which primarily affects the human respiratory system and commonly causes pneumonic changes.
By Thursday, there were 110 540 408 confirmed cases, 85 428 160 recoveries and 2 443 160 deaths worldwide.
Diabetes mellitus is a chronic metabolic disorder that affects approximately 422 million people worldwide. In 2016, an estimated 1,6 million deaths were directly caused by diabetes.
On Tuesday, Zimbabwe lost a popular and talented Zim-dancehall chanter, Soul Jah Love who succumbed to diabetes. In January 2019, legendary musician Oliver Mtukudzi also succumbed to diabetes mellitus. May their souls rest in peace!
Globally, the prevalence of diabetes mellitus among adults over 18 years of age rose from 4,7 percent in 1980 to 8,5 percent in 2014, according to the World Health Organisation.
Pathogenically, Covid-19 and diabetes are both associated with acute and chronic inflammation. Yet Covid-19 has been clinically observed to affect diabetes mellitus progression and outcome.
Physiologically, the coronavirus spike glycoprotein (S-glycoprotein) binds to the angiotensin-converting enzyme-2 (ACE-2) receptor.
ACE-2 is an enzyme attached to the cell membrane of cells located in lungs, arteries, heart, kidney and intestines. The subsequent fusion of coronavirus spikes with the cell membrane initiates viral entry.
Scientists observed that furin – a protease which enhances viral entry – was uncharacteristically elevated in diabetic patients.
Diabetes mellitus is caused by a plethora of predisposing factors which include heredity, ethnicity, age, smoking, obesity, high blood pressure and injury to the pancreas.
Unfortunately, diabetics have increased predisposition to viral and bacterial infections due to impaired immunity.
According to a study done in Italy, diabetes ranks high among the comorbidities in patients with Covid-19. And a study done in Wuhan, where the coronavirus is said to have originated, showed that patients with diabetes mellitus accounted for 2-20 percent of positive cases.
Similarly, a study done in New York concluded that among the 5 700 hospitalised patients with Covid-19, 33,8 percent – 1 808 patients – were diabetic.
Medically, chronic diabetes conditions include type-1 and type-2 diabetes. Type-1 diabetes can develop at any stage, but usually appears during childhood, or adolescence.
And the more common type-2 diabetes can naturally develop at any age, though more prevalent in adults older than 40 years of age.
However, both types of diabetes commonly lead to elevated blood sugar levels. And too much blood sugar frequently leads to serious health problems.
Clinically, diabetes patients may present with various symptoms depending on the blood sugar elevation levels. But those with type-2 diabetes may not experience symptoms.
In type-1 diabetes, symptoms tend to manifest quickly and are more severe. Signs and symptoms of diabetes mellitus include excessive thirst, frequent urination, extreme hunger, weight loss, fatigue, and blurred vision.
Physiologically, the pancreas either releases little or no insulin at all. Or the pancreas makes insulin, but the insulin produced does not work as it should – insulin resistance.
Insulin is a naturally occurring hormone produced by the beta cells of the pancreas, which helps the body to use sugar for energy.
More often, patients with increased blood sugar levels frequently experience hyperglycaemia – elevated blood sugar levels. And reduced blood sugar levels commonly lead to hypoglycaemia.
However, the disease can be controlled by religiously taking the prescribed medication, diabetic diet and exercising.
Supplementary insulin is usually prescribed for type-1 diabetes. And type-2 diabetes is commonly controlled by taking prescribed oral tablets such as metformin and glibenclamide.
Complications of diabetes commonly include cardiovascular diseases, nerve damage, kidney damage, eye damage, foot damage, hearing impairment, and depression.
In the lungs, hyperglycaemia leads to a rapid deterioration in spirometric functions, especially decreased forced expiration volume in one second.
Spirometry is a common test used to assess how well the lungs work by measuring the amount of air inhaled, air exhaled and how quickly the patient exhales.
Scientifically, it was observed that there is usually increased glucose concentration in the respiratory epithelium which harmfully affects the innate immune capacity in hyperglycaemic states.
On the other hand, severe hypoglycaemia worsens the overall mortality rate. It was scientifically proven that suboptimal glycaemia control in Covid-19 patients is correlated with higher mortality rate – 28,8 percent.
More importantly, diabetes mellitus can be prevented by regular exercises, eating healthy, limiting alcohol intake and quitting smoking.
As scientists continue to explore the deadly pathogenic connection between Covid-19 and diabetes mellitus, people must urgently consult healthcare providers if they experience signs and symptoms of diabetes.
Ultimately, diabetics must regularly check blood sugar levels, religiously take prescribed medications and diet, wear masks properly, practise good hand hygiene and observe physical and social distancing.
Everisto Mapfidze is a registered general nurse who holds a Bsc Honours in Sociology (UZ). For comments and feedback: 263774042111 or Facebook: Health Talk with Everisto Mapfidze.
