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
Today, I focus on the Global Methodist Church in Finland, as I continue with my description of institutions and personalities and their accomplishments as members of the Ghanaian Diaspora in Finland. I give special attention to the Ghanaian Methodist Fellowship, which is under the Global Methodist Church in Finland.
The Global Methodist Church in Finland is quite new, having split from the United Methodist Church Finland.
The Church in Finland has seen significant strides and accomplishments within the short time that it has been established in Finland, which must be highlighted.
Some history
The Methodist Church in Finland has existed for over 100 years since 1800s. It was conducted mainly in the Finnish language, according to Pastor Freeman Awuah. In 2012, a Finnish member of the Helsinki church and the then Mr Freeman Awuah, a Ghanaian immigrant who had joined the church, started bible studies which was turned into the English version of the church.
Many Ghanaians joined and they formed the Ghana Fellowship church within the Finnish Methodist church with services conducted in Twi.
In 2025, the Ghana Methodist Fellowship joined the Global Methodist Church and became quite well grounded. The Methodist Church generally does not have much influence in Finland as compared to the Lutheran and Orthodox churches. Even so, the Global Methodist Church currently has two branches, in Espoo and Lahti.
The Church has three ordained pastors, with the Finnish pastor as the leader of the church, assisted by Pastor Freeman Awuah (who was ordained a pastor a few years ago) and another Ghanaian pastor (Pastor Paul Brewu, who was recently ordained).
Activities and achievements of the Church
The Global Methodist Church in Finland conducts church service on Sundays. The service starts at 11 in the morning and closes by 1 p.m. When the service is done in Finnish there is English translation, and there is the service by the Ghana Methodist Fellowship, which meets once a month.
There are other meetings on other days when the church has what is termed Community Fellowship (Bible Studies) on Tuesdays in English, Thursdays in Finnish and Fridays in Twi at 6 pm.
The Global Methodist Church in Finland continues to shepherd people in their religious lives for God’s glory. The church opens its doors to people of every nationality, including Finns, other Europeans, and other African migrants, aside those of Ghanaian origins.
“We are a family church because we are a family to other migrants and we care for the needs of each other or others in all situations that we can be of help.
For example, in the women’s group, we have an organisation in Finland which works to fight against human trafficking. The women’s group has also adopted an orphanage in Ghana where we help the less privileged ones”, Pastor Awuah revealed.
But there are also challenges, according to Pastor Freeman, as with any new group or institution that faces initial obstacles. Also, the COVID-19 situation brought a huge challenge such as physical resources and logistics. The lockdowns resulted in church services not conducted regularly, and done online. People are still interested in online worships than physical meetings, he said, adding: “We are trusting God to help”.
Impact of the Ghanaian migrant community
The Global Methodist Church in Finland plays a prominent role as a religious group that serves Ghanaian migrants and others in the Finnish society.
The Ghanaian community has great impact since majority of the church membership are of Ghanaian origin (about 60 per cent). There are other nationalities and it is thus a very multicultural body.
Integration
By its activities, the Global Methodist Church is thus helping to ensure integration of its members well into the Finish society.
This is important since social interaction and citizens’ well-being are an important part of the integration process in Finland.
As I mentioned some time ago, the role of migrant associations and groups such as the Global Methodist Church acting as bridge-builders for the integration and inclusion of migrants through participation in the decision making process and by acting as a representative voice is highly appreciated in Finland. Thank you!
GHANA MATTERS column appears fortnightly. Written in simple, layman’s terms, it concentrates on matters about Ghana and beyond. It focuses on everyday life issues relating to the social, cultural, economic, religious, political, health, sports, youth, gender, etc. It strives to remind us all that Ghana comes first. The column also takes a candid look at the meanings and repercussions of our actions, especially those things we take for granted or even ignore. There are key Ghanaian values we should uphold rather than disregard with impunity. We should not overlook the obvious. We need to search for the hidden or deeply embedded values and try to project them.
With Dr Perpetual Crentsil
Email: perpetual.crentsil@yahoo.com
I picked Kwakyewa up, and we drove to the site on the Aburi road. We drove for some five minutes, and a security man opened the gate, and we entered the 40 acre plot secured with a fence wall.
‘Here we are. I have just started buying materials. I am planning on building one hundred apartments, and fifty top class houses’. ‘
David, are you telling me that this is all yours?’
‘Yes. All mine. I carefully engaged with the chief of the town, and his elders. I paid him all the arranged monies, in the presence of his people. And I have started work on a school building for the town, and I’m renovating his palace. When the block of houses is sold, I will invest the bulk of the funds here.
I will start with twenty houses, without taking any loan. When I sell them, then I will build many more’.
We went round the site, and spoke with the workers who were clearing the land. After an hour we went back in the car and drove off. ‘You are not saying anything, Kwakyewaa’. ‘
What can I say? It’s just incredible. I will stay for as long as you need me’.
Many thanks, Kwakyewaa.
I will count on your support. I will continue working with the EU for another couple of years, so I will be up north a lot of the time. So you will be in charge’. After spending another couple of hours at the city centre site, we decided on lunch’.
We got down at Sankofa, and I took her hand as we walked to take our seats. After taking a sip of my drink I looked across the big room and saw Abena staring at us, a look of utter shock on her face. She continued to stare as Kwakyewaa spoke about the changes she had to make due to her extended stay in Ghana. After a while I ignored her and focused on the discussion.
‘Now listen, Kwakyewaa, this is a most important part of what we have started to do, as a couple, and as business partners.
For starters, I would like you to prepare a budget of the expenses you need to make as a result of postponing your return and staying here for three months, and I will pay you the money.
In the coming days we will decide on how much money you need to be comfortable. Then, later on, we will take the bigger decisions resulting from continuing with the relationship.
Suddenly she got off from her seat, sat on my lap and hugged me, as the other guests watched in appreciation. Unfortunately I could not look in Abena’s direction.
We parted at the office at the close of day. Kwakyewa joined Eva and Robert for the drive home, as I drove home. Although I was playing my favourite jazz tunes, my head was spinning with thoughts of Kwakyewaa. Abena was beautiful, but Kwakyewaa was in a completely different league altogether.
And she combined queenly beauty with incredible sharpness of mind. She calculated business issues with ease, and she planned and recorded everything. And to top it all, it was obvious from the first day that she cared about me.
This time, business was going well, but the relationship side was also cool. This time, I could forget about Abena and her big ego and sharp tongue.
I sat to watch TV, but started feeling sleepy, so I rose to go and lie down when my phone rang. It was Kwakyewaa. ‘Bernard, Abena just came in. She’s furious. She’s throwing verbal bombs at Esaaba, saying things like “if you think you will insult me by fixing David Kwakyewaa, you are joking.
If I wanted Bernard I wouldn’t have thrown him out. David is junk. She can have him. I’ve gotten someone far better than him. You are all stupid”. ‘
And what did Esaaba say?’ asked.
‘We didn’t say anything. Which made her angrier, so she rained insults for quite some time, and went to her room’.
‘Nice one. It’s good you ignored her. Hey look! She has just sent me a message. Let me check and get back to you’.
I opened the message and read. ‘Bernard, so you are now Kwakyewaa’s boyfriend. Congrats. I thought you would spend sometime to improve yourself before trying to get a girlfriend, but obviously you think otherwise. Pray that she also doesn’t throw you out soon’. I sent her a reply.
‘Madam, I’m tired of your insults and lies. I will come and show this to Mom first thing tomorrow, and tell her about the things you have been saying about me. I may also do you a favour by telling her about a certain transaction by which Jennifer sold an arrogant girl for peanuts.
Goodnight’. She called me numerous times, but I did not pick her call. At six following morning, my doorbell rang, and I went to find Abena and Esaaba, and let them in. ‘David’, Esaaba said after I had offered them seats, I hear you have threatened to come and see Mom this morning to tell her about the message Abena sent to you. Well, we have come to apologize to you, not only for the message but also for anything she has said about you.
She says it will not happen again, so please forgive her, and cancel your plan of coming to see Mom’.
‘Yes, David’, Abena said. ‘I am very sorry. I promise it will never happen again’.
‘Okay. I accept your apology, even though the things you’ve been saying were not true, and they really hurt me, because I did not get the chance to defend myself to the people who heard it’.
‘And David’, Abena said, please do me a favour. ‘You said Jennifer sold me for peanuts. Is it true, or you were just rebutting what I said’.
‘Let’s do it this way’, I said. ‘Call Jennifer, and ask her if it is true that she was paid by your boyfriend for fixing you with him. I’ve heard he has not given her the full amount, so she has been calling him to demand the balance’. ‘I don’t believe it, but let me call her and see’.
She called Jennifer. After a few moments she started shedding tears. ‘Esaaba let’s go’, she said quietly. I walked them to the roadside and hired a taxi to take them home.
At the office a couple of hours later, Kwakyewaa came to sit by my desk and looked straight at my face.
‘So what happens now? Esaaba told me what transpired at your house. ‘What she does is none of my business. Maybe she will go and sort things out with her rich boyfriend’.
‘I was afraid she would decide to fight to have you back. I have been really worried’.
‘Are you joking? We have already agreed on what Esaaba calls a smooth transfer. We have a relationship, and I’m very pleased with it. Let’s make plans for the future as we agreed’.
‘Okay. I have already started implementing my plan. I have told my parents about you, and my plan. They have accepted it. From this evening, I will spend a lot of time with you, at your house. Now, let’s talk about activities for today’.
By Ekow de Heer
