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
THE typical itinerant salesman in Sikaman is a herbalist. He is normally a slim macho with the capacity to perambulate the expanse of area covering the triangle of Accra-Tema-Ashiaman. In short, he can walk a total of 60 miles a day, marketing a product that cures every disease, including poverty. 
The door-to-door herbal pharmacist advertises his product by word of mouth. He has nothing to do with the Food and Drugs Board (FDB). After all, his concoctions do not feature on FM stations.
Those herbalists who cannot walk to propagate the herbal gospel, liaise with drivers of mass transportation and their mates. They are, therefore, given the chance to sell their products on Benz buses that ply the routes.
Normally, the herbalist starts his sales message with a prayer and Bible study. He asks the passengers to bow down their heads in supplication to God the father, the son, the Holy Spirit.
When a herbalist asks the passengers to close their eyes and bow their heads, Moslems on board naturally feel offended. They feel that the herbalist has no right to assume that every passenger is a Christian. They think such an assumption is an affront to Islam.
So a Moslem on board will raise the hand for a point of order. He’ll remind the herbalist that it would be in his own interest to mind his language.
“Be careful the way you address people in a public place. Not every person here is a Christian,” he’d state assertively.
Of course, the herbalist will promptly ignore him, but would all the same “watch” his tongue. Who knows whether or not the Moslem brother is inspired by Quoranic zeal to defend the tenets of Islam to the hilt?
When he starts saying, “Wallahi!” and “Inshallah!” it could be the beginning of proclaiming Islam as supreme, a point which must be driven home with talibanic precision.
So the herbalist must tread carefully lest he steps on fire.
The herbalist could even add a measure of mirth to it all, by announcing that Christians on board today have very interesting company on the journey, but that should not detract from the business of the day.
The Moslem brother will weigh the words carefully and offer a wry smile.
He must be careful the occasion does not degenerate into the use of semantics and proverbial oration to deride his conviction that public utterances must be mindful of religious sensibilities. He has made his point very clear and expects that it is taken in good faith in the interest of a peaceful journey.
The herbalist will now open the New Testament and preach salvation, stating clearly that salvation can come only through Jesus Christ and NOBODY else.
The Moslem brother will now start twitching his moustache. The visible and almost revolutionary reflexes of his upper lip can be an indication that sentiments have begun superseding reason, and the outcome could well be tragic now shift uneasily in his seat.
The time has come for him to also express his right to the religion of his fore-bears. He’ll put his hand into his pocket and rise to his feet. The time has indeed come!
This article was first published on Saturday, September 9, 2006
When the cause of a particular problem like sickness, disease, sudden illness, a social issue etc. are not known, it stands to reason that resolving it becomes a huge challenge.
Citizens would understand the government when public announcements are made to the effect that government is trying to find a solution to the issue, even though it is taking a while for it to be resolved because citizens are rational beings.
On the other hand, if the solution to a particular issue is known to everybody but the government for whatever reason, is dragging its feet in resolving it, citizens become frustrated and begin to lose trust in their leaders.
One such issue is the heavy traffic along a section of the Kasoa – Odokor road. A short stretch of bad road between the traffic light at the Weija Government Hospital and the entrance to the entrance of the overhead that leads to the N1, is the cause of the problem but nothing is being done about it, day after day, week after week, month after month. Thus is clearly unacceptable.
Another issue that requires urgent attention is the lack of pavements along a lot of streets in parts of the various Municipal Assemblies. Exercise is a prerequisite for long life and healthy living and for those of us who it has become a way of life, this issue of people putting up structures right to the edge of the drains beside the roads, are making life difficult for us.
We are compelled to walk along the roads, putting our lives at serious risk. Pedestrians should never be compelled to compete with vehicles on our streets and roads. Roads and streets are made for vehicles and pavements are made for pedestrians. That is the norm. Any attempt to normalise a situation where pedestrians are mingling with vehicles is insanity.
It is the road regulations that makes it so and therefore district or municipal assemblies are to take responsibility and ensure that spaces for pavements are not encroached upon. Citizens have rights that must be protected by their leaders and making pavements available to pedestrians, is one of them.
When we hear of teachers having sex with students, it appears it is something recent. It is not a new phenomenon. It has been there since Adam. Perhaps this issue is getting much attention due to the proliferation of social media. It was an open secret in times past when Teachers were in relationships with female students and some married them immediately after completion of school.
Some teachers were also known to be having unholy interactions with female pupils but due to the times that these acts occurred, human rights issues and the awareness around it, allowed such unscrupulous teachers to get away with their crimes.
Now we are in a different era and so a Headmaster is now in hot waters. He is alleged to have raped about 19 female students and as usual, some officials tried to cover it up and are also in hot waters and their actions or inactions in the matter are under investigation.
Why the man has been allowed to roam freely without being arrested is simply mind boggling. It appears that the law applies differently, depending on who you are. This issue came to public attention sometime in August this year, yet the police had not arrested or invited this man for question regarding the rape allegation.
It has come out that he is a Constituency Secretary of the ruling party and the question in the public domain is that, is it because he is a political figure that is why he is still walking around without questioning? I believe in the rule of law so let us hold our breadth and let the proper thing be done.
The police must however be seen to be active in this matter. God bless.
SKIP THE QUEUE, TAP THE NEWS
You can now read the Ghanaian Times and The Spectator newspapers from the comfort of your device via TimesNewsPlus.
Join our WhatsApp Channel: https://whatsapp.com/channel/0029VbBElzjInlqHhl1aTU27
