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Medicine Matters diabetes

At the EASD, we talked about the COVID-19 and diabetes and the independent risk association between both type 1 and type 2 diabetes and also COVID-related death. Of course, there are many risk factors for poor outcomes, including assisted ventilation, admission to ICU, and also deaths in people with COVID-19.



This include advanced age, pre-existing conditions, such as heart disease, kidney failure, and also stroke, and also obesity. But even after we adjusted for these risk factors, both type 1 and type 2 diabetes, people have two to three times higher risk of having adverse outcomes if they get COVID-19.



And of course, people with diabetes are different. In a young person with type 1 diabetes, they might very well manage with no complications. The chance of survival is very good, as compared to people who have long-standing in diabetes with multiple risk factors and poor control. The outlook is poor if they get COVID-19.



An independent association between a glucose level and also poor outcomes in COVID-19 really highlights the importance of optimal glycemic control, not just during inpatient management, but also in the outpatient management, because during acute illness, people with diabetes who cannot regulate the glucose effectively, under those stressful situations, they become particularly vulnerable when systems can fail.



And also we discussed the importance of insulin in the session, because really, people with diabetes, their main primary defect is actually inadequate action, either qualitative or quantitatively. And this is very important to ensure the person can utilize glucose as an energy source effectively.



And so during inpatient management, insulin use is important. And I think health providers need to be aware of this, because really, not just COVID-19, but there have been a lot of studies showing that people admitted to ICU, or medical ward, or surgical ward, as a reason, good glycemic control is essentially associated with good outcomes provided they use carefully with low risk of hypoglycemia.



But of course, the key question is even the glucose on admission has prognostic significance and highlighting that really all patient management of diabetes is important. Diabetes is a very complex disease. It's very silent and progressive. These people can have multiple risk factors.



And people have to live with diabetes for decades and it highlights the importance of really self-management and also knowing what the risk factors are, the sort of things that they should do to protect themselves during the day, for example, the importance of some kind of good lifestyles, as well as having regular follow up and being adherence to the medications. And during the lockdown in many countries, many of these people with diabetes diseases, they do not have access to care.



And it's really a crisis that has posed challenges, but at the same time opportunities, where care providers use the technology to help manage these individuals, particularly like in Taiwan and also some people with type 2 diabetes. And I think here we have always been talking about how do we make care more accessible and also more affordable for people with diabetes for decades.



And I think this is really an opportunity for us to rethink and reform the way how we deliver care, so that these people really can be more empowered with their risk profiles in order to manage their conditions more effectively. But during the discussion, we also highlighted that social disparity and care disparity is really a major concern.



And that is on top of these two epidemics of COVID-19 and also diabetes. We now have this epidemic of social and also care disparity, which really calls for a more systematic approach, including policies and also reformed systems, so that these disadvantaged communities are actually not denied care and also to ensure that they also can be protected.



Otherwise, you see, we will be having problems on the health care system. So I think the COVID-19 and also diabetes really highlight the complexity of our new world, where everything is interconnected, political, economic, social, and also technological. In many ways, diabetes and COVID-19, they share similar premises.



This disease is silent and serious. And if they are not well-controlled or not diagnosed, they can collapse the health care system. And yet they are potentially preventable and treatable. But to do that, you really need collaborative effort including governments leaderships, intersectional collaboration, and also individual participations supported by science and also data.



So as we actually-- we hope we will soon get out of this COVID-19. But we hope everybody will need to rethink as to how we, as an individual, as an organization, and also as a community, to try and change the fate of this big population of people with diabetes so that they are protected and in order to reduce that risk of having these devastating conditions so that our system can be sustainable.