Obesity and diabetes pandemics
The specialist also draws attention to the fact that obesity is a chronic pandemic. The most affected areas are Europe, Russia, North and South America, as well as the Middle East. He claims that the “pandemic” of obesity has developed greatly in the last 30-40 years.
In addition, humanity around the world is also facing a diabetes pandemic. Regarding Romania, studies show that 1 in 9 people suffer from diabetes, specifically 11% of the population. “The 2007 predictions for 2025 have already been exceeded for diabetes worldwide in 2016. Currently, there is another undiagnosed one for every patient diagnosed with diabetes,” says the doctor.
The covida-19 pandemic
In early 2020, a new pandemic emerged, this time contagious. Dr. Nicolae Mircea Panduru draws attention to the fact that the map of this pandemic corresponds to the same areas where obesity and diabetes are problematic among the population: North America, South America, Russia, Europe and the Middle East.
Are there frequent lung injuries?
A diabetes specialist explains whether we can talk about the dangerous intersection of these three pandemics. “The SARS CoV-2 virus occurs in patients with diabetes and obesity in already affected lungs,” says the doctor.
In obese people, respiratory functional mechanisms are affected and increased intra-abdominal pressure leads to diaphragmatic ascent and to overload of the respiratory muscles and eventually to contraction of these muscles. According to doctor Mircea Panduru, these changes mean reduced functional capacity and vital capacity of the lungs.
“In obese and diabetic patients, autonomic pulmonary neuropathy also occurs, which is also manifested by sympathetic and parasympathetic dysfunction, and also affects the change in airway caliber. In addition, there is a lack of ventilation response to hypoxia. All this is prone to infection, in diabetes Diabetes mellitus can also lead to phrenic nerve neuropathy, which further exacerbates pulmonary dysfunction.Even if this pulmonary complication in diabetes is little known and even if lung damage occurs in obesity, I would like to point out that it’s not just a patient with a lung injury, “says a diabetes and nutrition specialist. A patient with diabetes and obesity suffers from damage to several organs because, as the doctor mentions, there is almost no organ affected in his body.
Risk of infection / severe course of COVID-19
Concomitant diseases such as obesity and diabetes are included in the calculation of the risk of SARS CoV-2 infection. There are more than 145 models of infection prediction, and more than 50 prognostic models have been published (severe progression, mortality, admission to ICU, intubation, length of hospital stay).
Obesity increases the risk of SARS CoV-2 infection after contact by 25-40%, depending on the extent of obesity and the result used. According to the doctor, the ratio between the body mass index and the risk of infection with the new coronavirus is in the form of the letter J. That is, when the body mass index exceeds 30-39 kilograms per square meter, the risk is limited.
In a result calculated by MedLife experts using the CovidSAFE app, the result they generated shows that obesity can increase the risk of infection by 6-33%, depending on other outcome parameters and the extent of obesity.
Speaking of diabetes, studies show that this disease, with or without complications, is the most important comorbidity that affects the risk of SARS CoV-2 infection after myocardial infarction. Dr. Nicolae Mircea Panduru shows how studies say this disease is even more important in the case of COVID 19 than obstructive pulmonary disease. In the case of risk assessments calculated by MedLife experts for a new coronavirus infection, diabetes increases the risk by 5-35%, depending on glycemic control, complications and comorbidities.
“All of these estimates manage to identify between 73 and 81% of patients infected with SARS CoV-2,” says the specialist.
Obesity affects not only the risk of infection but also the risk of severe COVID-19 disease. In a meta-analysis of six studies involving more than 3,200 patients, obesity was associated with a 21% increased risk of hospitalization in intensive care. In addition, obesity was associated with a 105% increase in the risk of mechanical ventilation. This risk persisted regardless of age group, whether young or old.
Diabetes also affects the risk of severe COVID-19 infection. In a meta-analysis of more than 28 studies and more than 7,000 patients, it was reported that more than 78% of the new coronavirus-infected patients examined had a good clinical course and only 20% of them. clinically severe (admission to intensive care, respiratory distress syndrome, or need for mechanical ventilation). Diabetes ranks fifth among the most important risk factors.
The specialist also says that not only diabetes is important in this context, but also the quality of glycemic control, ie glycosylated hemoglobin. Studies published on this topic show that for every 1% increase in glycosylated hemoglobin prior to SARS CoV-2 virus infection, the risk of severe disease progression increased from 1.3 to 1.6-fold.
Vitamin D deficiency associated with obesity, diabetes, and COVID-19
“Another element linking obesity, diabetes and SARS CoV-2 is vitamin D deficiency. In a meta-analysis involving more than 8176 patients with COVID, the prevalence of vitamin D deficiency was 39%. In addition, vitamin D concentrations were below 50 nanomoles per liter increased the risk of infection by 21%.
In addition, when analyzing vitamin D concentrations below and above 75 nanomoles per liter, the number of intensive care hospitalizations and the number of deaths increased 1.8-fold, ”says Dr. Nicolae Mircea Panduru.
The specialist also draws attention to the fact that COVID-19 disease leads to increased blood sugar during the disease. In the case of a study conducted in Switzerland (a meta-analysis of three studies, as there are very few studies analyzing how COVID-19 affects blood sugar), it is shown how blood sugar increases on average during SARS CoV-2 infection, in patients with high disease severity about 40 milligrams per deciliter.
Glycosylated hemoglobin also increased by up to 0.5%, but the difference did not prove to be statistically significant. This happens, as a diabetes expert says, because the duration of the disease is short, 14-21 days, and glycosylated hemoglobin reflects the average blood glucose for three months.
Treatment of diabetes in patients with COVID-19
One rare study on this topic divided infected patients into two groups, some with good glycemic control, somewhere at 115 mg / dl, and another group with more relaxed glycemic control with an average of 196 mg / dl. Sir. Comparing these two groups, it was found that in patients with good glycemic control, the risk of severe disease progression was reduced by 87%.
To achieve good glycemic control, Nicolae doctor Mircea Panduru says oral antidiabetics are effective, and Metformin is at the top of the list among these drugs. “The only meta-analysis of metformin treatment in patients with COVID-19 shows that this drug reduces the risk of severe development (as well as the mortality rate) by 46%,” he explains.
As noted by the expert, there are other oral antidiabetics that are safe in the treatment of patients with COVID-19. For example, he talks about a retrospective study in Italy that showed that dipeptidyl peptidase 4 (DPP-4i) inhibitors are safe in these patients. This study divided individuals into COVID-free diabetics, SARS CoV-2-infected patients, hospitalized patients, and patients with severe pneumonia. The results showed that the number of patients treated with DPP-4i inhibitors was approximately the same in all four groups, indicating that there was no direct association between treatment with these drugs and the risk of severe development.
“Another class of drugs compared to DPP-4i was the class of sodium and glucose co-transporter-2 (SGLT2) inhibitors, which have been shown to be as safe in patients with COVID-19 as DDP-4i inhibitors. In addition, patients with diabetes should be treated for blood pressure, and more than 80% of diabetics are treated with a special class of drugs that inhibit or block the angiotensin system.This large group of drugs contains two classes of drugs: angiotensin “converts and angiotensin receptor blockers and COVID-19. Both classes of drugs are safe in terms of mortality, but angiotensin receptor blockers have a slightly higher risk of being admitted to intensive care,” says the doctor.
Regarding the findings, expert Mircea Panduru says that obesity and diabetes increase the risk of SARS CoV-2 infection and the severe development of COVID-19. The use of risk assessments helps to detect people at high risk for infection and severe evolution in a proportion of 70-80% before infection or worsening of the clinical condition.
Furthermore, glycemic control reduces the risk of infection and severe progression of COVID-19, and Metformin, DDPi, and SGLT-2i are safe drugs in patients with COVID.
It should also be noted that concentrations below a certain level of vitamin D are associated with an increased risk of infection and severe disease progression, but there are insufficient data on vitamin D treatment in these patients.
The article is part of the MedLife Let’s do Romania well campaign.
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