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
My focus today is on eye care and therapy among Ghanaian migrants in Finland, as I continue to move away from the subject of personalities or groups and their accomplishments within the Ghanaian community in Finland that I have been writing on.
Eye conditions are remarkably common in the world. Experts say that those who live long enough will experience at least one eye condition during their lifetime. According to the World Health Organisation (WHO), globally, at least 1 billion people have a near or distance vision impairment that could have been prevented or has yet to be addressed.
In recent times, I have been thinking about eye problems among Ghanaian migrants in Finland about how they take care of their eyes and their general wellbeing. Health experts say that in the absence of timely detection, reduced or absent eyesight can have long-term personal and economic effects.
Finnish healthcare services
Finland has a very good healthcare delivery system and social services accessible to all residents in the country. Information about healthcare delivery services is provided for every citizen.
Many migrants, including those in the Ghanaian community, are aware of these opportunities and are expected to take advantage of such chances.
Experts say that vision impairment affects people of all ages, with the majority being over the age of 50. Cataracts and uncorrected refractive errors are estimated to be the leading causes of vision impairment; other causes for vision impairment cannot be ignored. Age-related degeneration, glaucoma, long-standing systemic conditions like diabetes causing diabetic retinopathy, infectious diseases of the eye and trauma to the eye are all key causes for vision impairment that need to be addressed.
When it comes to Ghanaian migrants, I have been asking myself what kind of challenges they may face in accessing health information and care services. Do they adhere to calls or requests/invitations to go for check-ups in order to detect health defects early enough to enhance a successful treatment?
Migrants’ vulnerability
Research has shown that migrants or minorities are vulnerable and they face challenges accessing information, including language barriers in Finland. There was potentially lower levels of awareness, perceptions of risk, and misconceptions not addressed in public health guidance and the national response.
Glaucoma is prevalent, and although the Finnish healthcare system covers the whole population and its services are mainly tax-financed, criticism have been levelled at unequal access to care and large variations in the distribution of healthcare services. Research indicates that migrants or people with a culturally and linguistically diverse background face challenges in accessing such information. The Finnish government and health authorities have been promoting digitalisation of personal health records and aspects of healthcare services, although older Russian migrants, for example, face barriers.
Enhancing inclusion
I think Ghanaian migrants in Finland should see the need to adhere to invitations by health personnel to undergo routine medical checks at points in time. I know Ghanaian migrants generally cooperate on such issues.
All the same, I think it is pertinent for migrant associations to help the health authorities and formally create awareness among their members and other migrants, especially in collaboration with some Finnish institutions, for the good of all.
This will no doubt enhance inclusion of migrants in Finnish society. As I wrote previously, the role of migrant associations 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.
The social media outlets could be used as an important means for disseminating information and it could be a key medium through which migrant groups or associations and other institutions could educate people.
Thank you!
Dinah came to our home early the following morning, as Martin was having breakfast. He congratulated her for qualifying as a doctor, and chatted briefly with her about her new posting and arrangements for starting work.
Then he left for work, hoping to see her ‘later’. For the next three hours I had a heart to heart chat with her, and she got a feel of the reality I was facing.
“Sarah, I’m concerned about the situation in your home. Martin seems to have decided that he doesn’t need a wife after all, that he is better off enjoying life with his beer colleagues and girls. I don’t think even his parents can influence him. But let’s continue to pray, and act with wisdom, especially in how you talk and how you react to provocation. Although the situation seems bad, I’m glad to notice that it has not affected you mentally.
Now that you have virtually secured admission to the university, you must stay focused on getting the degree. You have to create a life for yourself. Let’s start planning.”
Paul was waiting at Royalty restaurant when we got there. We had a great time. Paul asked Dinah quite a lot of questions about her experiences with the medical course, and she was happy to share them.
I had the greatest surprise when I found out that he wasn’t, as I thought, an ordinary clerk and driver who distributed bills and collected payments for his employers, but the owner of the company. And his company didn’t just collect rubbish and dump them, but was also involved in recycling.
And beyond that, he was helping industrial establishments to deal with chemical waste. After lunch, he first dropped me at home, and took Dinah to my parents’ place.
The following morning, Martin announced, with a sour face, that his mother would arrive in the evening, and would spend a few days. I wasn’t expecting much to change, but I got ready to do some shopping and cook some meal.
Paul asked me what I was doing the rest of the day, and I told her that my main reason for coming to Takoradi is to spend some time with you.
So he suggested that I go with him to the office, so I did. First of all, his office is quite impressive. I spent a couple of hours on the Internet whilst he worked, then we went to the Sports Club.
Nice place. I met two doctors who want to recruit me to work for their company, which owns twenty clinics around Ghana. We left the club at about seven-thirty, bought some chips and grilled chicken, and went to his place to eat. Sarah, Paul is one very humble but really impressive guy.
He’s picking me up for lunch at twelve-thirty.
“Ei Sarah, you seem to be making some headway.”
“You must be joking. He told me something very interesting, which I will discuss fully with you tomorrow.”
“And what could that possibly be?”
“We will discuss it tomorrow. But clean your ears out. It is very interesting.”
After a couple of days, Martin had finished breakfast and was about to leave, when his mother motioned to him to wait.
“When will you come back this evening? And in what state will you be? What’s happening to you, Martin? Where do you go after work every evening?”
“Mama,” he said as he moved to the door, “I’m sorry I have to leave. Moreover, I’m not a boy anymore. I’m quite capable of managing my affairs.” But his mother blocked the door.
“If you are capable of managing your own affairs, why did you call to make all those complaints about Sarah? Since I’ve been here, I’ve noticed that the place is always clean, this stupid lifestyle, or we will force you to change.”
“What will you do, Mama, beat me up?”
His Mama surprised him with a big, nasty slap, nearly flooring him. Very angry, he picked his briefcase and went out.
He came home very late as usual, ate and dropped off to sleep. The following morning he confronted me as I was preparing his breakfast.
“Sarah, what nonsense have you been telling my mother? If you can’t keep your mouth shut, then it’s best you go to your parents. After all, even though our parents gave their blessing to our coming together, we are not officially married. So you are free to leave. I will live my life the way I want.”
He paused when his mother appeared.
“Martin, Sarah hasn’t said one word about you since I’ve been here. But you, Martin, you called and made all kinds of allegations against her. And since I’ve been here, I’ve found out the truth. And you have the nerve to ask her to go away? Now I understand why her father wouldn’t give you his full blessing. Don’t worry. I’m leaving this morning. Immediately I get home, your father and I will go to her parents and apologise to them.”
Nice place. I met two doctors who want to recruit me to work for their company, which owns twenty clinics around Ghana. We left the club at about seven-thirty, bought some chips and grilled chicken, and went to his place to eat. Sarah, Paul is one very humble but really impressive guy.
Surprisingly, Martin was not happy that his mother was coming to spend some days with us. Dinah called as I was about to leave.
“Dinah, I was just leaving home to do some shopping. Martin’s mother is coming here this evening, and will be spending a few days, so I want to do some cooking. What’s up?”
“Well, I had a great evening yesterday. On the way to the hotel, then I will personally come back and take her home.”
“Martin, I came here from Koforidua three days ago, not because I have nothing to do at home, but because your father and I thought we should find out how you and Sarah are doing. Yet since I’ve been here, you’ve not sat down with me for even fifteen minutes.”
“Mama, I’m getting late for work. Can’t this wait till when I get back? There’s always good food available. She washes your clothes and even irons them. And what’s your response? You’ve turned yourself into a ghost, leaving home first thing in the morning and coming home late, every day. All those tales you told us about Sarah, they have turned out to be lies. Listen, you either change. I hope you understand the implications of the behaviour you are putting up. You are not only rejecting Sarah, you are rejecting your parents. You can go away. Sarah will take me to the Accra station.”
To my great surprise, he left.
By EKow de Heer
