Features
DIABETES AND COVID-19
It came from a student in health care training. I have diabetes increases the severity of COVID-19. I have a strong family history of diabetes. Kindly throw more light on the subject. In responding to this, I found a fine paper by Singh et al titled “Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practicalConsiderations and published in Diabetes& Metabolic Syndrome: Clinical Research & Reviews (2020).
The disease burden of coronavirus infectious disease 2019 (COVID-19) caused by
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) has been
Increasing continuously with more than five million confirmed patients and more than 350,000 deaths globally. With a high prevalence of diabetes, it is important to
understand the special aspects of COVID-19 infection in people with diabetes.
This becomes even more important, as most parts of the world introduced
restrictions on mobility of patients in order to contain the pandemic even though they are being eased in some countries.
Diabetes and associated complications can increase the risk of morbidity and
mortality during acute infections due to suppressed immune
functions. The levels of glycated haemoglobin (HbA1c) greater than 9% have been linked to a60% increased risk of hospitalization and pneumonia-related severity duringbacterial infection. Past viral pandemics have witnessed the association of
diabetes to increased morbidity and mortality. Diabetes was considered as
independent risk factor for complications and death during 2002-2003 outbreak of
Severe Acute Respiratory Syndrome (SARS-CoV-1). Similarly, the presence
of diabetes tripled the risk of hospitalization and quadrupled the risk of intensive
care unit (ICU) admission during Influenza A (H1N1) infection outbreak in 2009.During the 2012 outbreak of Middle East Respiratory Syndrome Coronavirus
(MERS-CoV), diabetes was prevalent in nearly 50% of population. Mortality rate in patients with MERSwho had diabetes was 35%.
Emerging data suggests that COVID-19 is common in patients with diabetes,hypertension, and cardiovascular disease (CVD). Evolving data also suggest that patients of COVID-19 with diabetes are more oftenassociated with severe or critical disease varying from 14-32% in different studies. SARS CoV-2, like SARS CoV utilises angiotensin converting enzyme 2 (ACE-2) as receptor for entry into cell.ACE2 is expressed not only in the type I and II alveolar epithelial cells in the lungsand upper respiratory tract, but also several other locations like heart, endothelium,renal tubular epithelium, intestinal epithelium, and pancreas.
S-glycoprotein on thesurface of SARS CoV2 binds to ACE-2 and causes conformational changes in the ACE-2 receptors are expressed in pancreatic islets. Infection with SARSCoV has been seen to cause hyperglycaemia in people without pre-existingdiabetes.
Hyperglycaemia was seen to persist for 3 years after recovery fromSARS indicating a transient damage to beta cells.
Metformin, a common medication used in diabetes, was significantly
associated with a decreased risk of mortality in patients with chronic lower
respiratory diseases. In a study of 4321 patients with a follow up of 2-
year period, metformin users had a significantly lower risk ofdeath compared with non-metformin users. Patients with coexistent chronic obstructive pulmonary disease and diabetes.
Glycaemic control is important in any patient who has COVID-19. Though data is still evolving, data from other infections like SARS and influenza H1N1
has shown that patients with poor glycaemic control have increased risk of
complications and death. Most patients with mild infection and with
normal oral intake can continue the usual antihyperglycaemic medications.
However, it is advisable to discontinue sodium glucose transporters (SGLT-2) inhibitors because of the risk ofdehydration and euglycaemic ketosis. Metformin may also need to be stopped ifthere is vomiting or poor oral intake. Doses of other antihyperglycemic drugs likesulfonylureas and insulin may have to be altered depending upon the blood glucoselevels.
Blood glucose monitoring poses a special challenge in COVID-19 as it necessitates frequentvisits to patient’s bedside, especially if the patient is critically ill and receiving insulin.
There are several studies about the protective effect of statins in pneumonia.
Statins are known to increase ACE-2 levels and may protect against viral entry of
SARS CoV2. Also, statins are known to inhibit Nuclear factor kappa B
(NFκB) activation and might help in blunting the cytokine storm- a causative factor in COVID-19 complications.
Calcium channel blockers (CCB) have been shown to reduce severity of disease
and mortality in patients with pneumonia, presumably by inhibiting calcium influx
into the cell. It is therefore safe to continue these drugs for control of blood pressurein hypertensive patients. Since CCB has no effect on ACE2 expression, someresearchers have proposed its preferable use in patients with COVID-19 and
hypertension.
So to recap high prevalence of diabetes is seen in patients with SARS-CoV-2 (COVID-19)and the presence of diabetes is a determinant of severity and mortality. Diabetes might facilitate infection by COVID-19 due to increased viral entryinto cell and impaired immune response.Blood glucose control is important for all patients who have diabetes andCOVID-19 infection.Telemedicine can be very useful for the management of patients with diabetes inpresent times with limited access to healthcare facilities.
Once again, make sure you regularly/daily consume polyphenol-rich cocoa to among others reduce your blood glucose, reduce your blood pressure and strengthen your immune system.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
Features
Put the Truth on the Front: Ghana Needs Warning Labels on Junk Food
Walk into any supermarket in Accra, Kumasi, or Tamale today, and you will see the modern Ghanaian diet packaged as ‘progress.’ You will see breakfast cereals with cartoon mascots, fruit drinks that are mostly sugar and colour, and snacks promising energy and happiness in bright fonts.
Even products loaded with salt and unhealthy fats often wear a health halo labeled as fortified or natural, while the real nutritional risk is hidden in tiny print on the back. This is not just a consumer inconvenience; it is a public health blind spot. Ghana is living through a silent surge of non-communicable diseases (NCDs) like hypertension, diabetes, and stroke.
These conditions quietly drain household income and steal productive years. According to the Ghana Health Service (GHS) and World Health Organisation (WHO) estimates, NCDs are now responsible for nearly 45 per cent of all deaths in Ghana.
We cannot build a healthy nation on a food environment designed to confuse people at the point of purchase. Ghana must mandate simple front-of-pack warning labels (FOPWL) on high-sugar, high-salt, and high-fat packaged foods because consumers deserve truth at a glance, and industry must be pushed to reformulate.
Why Back-of-Pack Labels Are Not Enough
In theory, consumers can read nutrition panels. In reality, most Ghanaians shop under pressure, limited time, rising prices, and children tugging at their sleeves. The back label is a relic that requires a high cognitive load to interpret—essentially, the seller knows what is inside, but the buyer cannot easily tell.
This ‘information asymmetry’ is not fair. It is not consumer choice when the information needed to choose well is deliberately difficult to find.
Simple warning labels like the black octagons used in the Chilean Model act as a ‘stop-and-think’ nudge. They do not ban products but they simply tell the truth so people can decide.
Reshaping Our Food Environment
A generation ago, Ghana’s meals were mostly home-prepared, like kenkey and banku with soups and stews. Today, ultra-processed foods have become the norm, especially in urban areas. Children are growing up with sugary drinks and salty snacks as everyday items, not occasional treats.
If Ghana is serious about prevention, we must act where decisions are made—thus, the shelf. Warning labels protect parents from sugar traps and pressure the market to improve. When warning labels are mandatory, manufacturers start to compete to make healthier recipes to avoid the stigma of the label.
Addressing the Pushback
Industry will argue that labels create fear or that education alone is enough. However, health education is slow; labels work immediately. While the informal street food sector is a challenge, regulating pre-packaged goods is the practical starting point because the supply chain is traceable. We cannot wait until the whole system is perfect; we must start where action is feasible.
A 2026 Implementation Roadmap for Ghana
To move from talk to action, Ghana needs this 5-step plan:
- Issue mandatory regulation: The Ministry of Health, Food and Drug Authority (FDA), and Ghana Standards Authority (GSA) must define the label format and nutrient thresholds for all pre-packaged foods.
- Simple, bold symbols: Use plain language and clear symbols, such as “HIGH IN SUGAR,” designed for busy families, not experts.
- Transparent thresholds: Adopt technically defensible standards adapted to the Ghanaian diet.
- Transition and enforce: Provide a 12–18 month period for manufacturers to reformulate, followed by firm enforcement at ports and retail centers.
- National literacy campaign: The Ghana Health Service must pair labels with public messages explaining why high salt or sugar increases disease risk.
Conclusion: Truth Is Not a Luxury
Prevention is cheaper than treatment. A warning label costs little compared to the price of dialysis, stroke rehabilitation, or lifelong diabetes complications. A black octagon on a box of biscuits is more than a label; it is a shield for the health of all Ghanaians. It is time to put the truth where we can see it, right on the front.
By Abigail Amoah Sarfo
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Features
The Dangers of Over-Boxing

Natives of the Kenkey Kingdom were mad with joy. They were still recovering from the hangover of the kingdom’s loss of the African Cup when their spirits were rekindled. Their great warrior, Zoom Zoom, stormed Melbourne and made sure that every Australian refused food. And that was after he had drawn contour lines on the face of their idol, Jeff Fenech.
Not only did the terrible warrior transform Old Boy Jeff’s face into a contour map useful for geography lessons, but he also accomplished the feat of retaining the much-envied super-kenkeyweight title against all odds. The warrior had not been eating hot kenkey for nothing.
The Fight Against Fenech
When Jeff Fenech bit the dust in the eighth round, I was tempted to consider if Adanko Deka could not have faced him in any twelve-rounder, title or non-title bout. Adanko has improved tremendously, and soon he would be facing Pernell Whitaker.
Sincerely, I was pessimistic about Azumah’s man, who the last time took him through twelve grueling rounds of rough boxing. I expressed my fears to my colleague Christian Abbew, alias Gbonyo, who surprisingly had total confidence that the Australian brawler would fall, predictably in Round Five.
Gbonyo gave reasons for his contention, all of which I counteracted using the age factor. Fact is, I didn’t know that contrary to the laws of nature, Azumah was all the time growing younger.
When Fenech fell briefly in round one, I asked my brother whether it was the same Fenech that fought Azumah in Las Vegas. Sure, it was the same Fenech, all out to beat Azumah before his countrymen.
But the African Professor had no intention of making the Australian a hero. As he spun round the desperate Aussie, dancing and stinging out his jabs, it was not too long before I realized that the end was near.
The Eighth Round Showdown
Two minutes into the eighth round, the African ring-master proved to the whole world that he was a true son of Bukom. He himself was cornered, but like the tough nut he is, he managed to break free before overwhelming the panting Australian with several blows that made him crash headlong.
Moments after, the referee, expressing fatherly sympathy, stopped the fight to prevent an obituary. After the ordeal, Fenech’s fairly handsome face was full of newly constructed hills, valleys, ox-bow lakes—whatever. I noticed that his nose was very tired and had a miniature volcano sitting restlessly on it. Obviously, Jeff’s wife will have to nurse that nose back to its normal shape—but I’d advise her not to use iodine, otherwise her dear husband will wail like a banshee.
Reflections on Boxing
Because Mohammed Ali was the kind of boxer kids liked, many school-going kids often entertained the wish of becoming like him. I remember one day when I told my father I wanted to become a boxer, and he advised me to first complete my education to the highest level. Then, if I decided to become a boxer and was knocked out a couple of times, I’d fall back on my degrees and make a living.
Boxing used to be interesting when bouts were fought more with the mouth and tongue than with gloves. You had to brag well, psychologically belittling your opponent before beating him up physically. Mohammed Ali became a very successful pugilist because he also managed to become a poet. He often blew his horn across America, calling himself the “pretty boxer” and opponents like Joe Frazier “the gorilla.”
Ali made a living fighting hard fists like Joe Frazier, Ken Norton, Jerry Quarry, George Foreman, Leon Spinks, and Trevor Berbick. Twice he came back from retirement to fight just for money. It was Larry Holmes who finally pensioned him, and since then the great Ali has never been himself.
The Path Ahead for Azumah
When Azumah nailed Jeff Fenech on the cross and barked almost immediately that he was after the head of Pernell Whitaker, I was happy but concerned. I would have been happier if he had announced his resignation there and then—he would have been more of a hero. Beating Fenech in Australia is more newsworthy than facing Whitaker in the States.
With Whitaker, it might be a little difficult. The “Sweet Pea” is agile, has a crooked body like a snake with diarrhea, and stands awkwardly as a southpaw. He is known for having the fastest pair of fists and the rare ability to dodge punches no matter how close they may be.
Much as I do not doubt that Azumah can take his title, I also don’t want him to retire beaten. I want him to retire as a hero and live a fuller, healthy life.
As Azumah himself said after dishing Fenech, he is now a professor and has something to show for it. Like a true professor, I think it is time he resigned and took up training young talents who could draw inspiration from him and become like him in the future.
Closing Thoughts
I must say that although ageing boxers like Larry Holmes and George Foreman are making a name for themselves, boxing is not like the Civil Service, where you can even change your age and retire at 74. Zoom Zoom has delighted the hearts of the natives, and Sikaman will forever hold him in high esteem—but only when he retires as a hero.
This article was first published on Saturday, March 7, 1992.



