Los retos del cuidado de las personas con diabetes durante el estado de emergencia nacional por COVID-19 en Lima, Perú: recomendaciones para la atención primaria

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Abstract

RESUMEN Las personas con diabetes mellitus tipo 2 infectadas por SARS-CoV-2 tienen mayores riesgos de desarrollar COVID-19 con complicaciones y de morir como consecuencia de ella. La diabetes es una condición crónica en la que se requiere continuidad de cuidados que implican un contacto con los establecimientos de salud, pues deben tener acceso regular a medicamentos, exámenes y citas con personal de salud. Esta continuidad de cuidados se ha visto afectada en el Perú a raíz de la declaratoria del estado de emergencia nacional, producto de la pandemia por la COVID-19 pues muchos establecimientos de salud han suspendido las consultas externas. Este artículo describe algunas estrategias que han desarrollado los diferentes proveedores de salud peruanos en el marco de la pandemia para proveer continuidad del cuidado a las personas con diabetes y finalmente brinda recomendaciones para que reciban los cuidados que necesitan a través del fortalecimiento del primer nivel de atención, como el punto de contacto más cercano con las personas con diabetes.

Translated abstract

ABSTRACT Patients diagnosed with type 2 diabetes mellitus, who then become infected with SARS-CoV-2, are at greater risk of developing complications from COVID-19, which may even lead to death. Diabetes is a chronic condition that requires continuous contact with healthcare facilities; therefore, this type of patients should have regular access to medicines, tests and appointments with healthcare personnel. In Peru, care and treatment continuity have been affected since the national state of emergency due to COVID-19 began; because many healthcare facilities suspended outpatient consultations. The strategies presented in this study were developed by different Peruvian health providers in the pandemic context to ensure care continuity for people with diabetes. This article provides recommendations to strengthen primary healthcare, because it is the first level of healthcare contact for patients with diabetes.

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Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

Lei Fang, George Karakiulakis, Michael Roth (2020)

The most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study by Xiaobo Yang and colleagues 1 were cerebrovascular diseases (22%) and diabetes (22%). Another study 2 included 1099 patients with confirmed COVID-19, of whom 173 had severe disease with comorbidities of hypertension (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), and cerebrovascular disease (2·3%). In a third study, 3 of 140 patients who were admitted to hospital with COVID-19, 30% had hypertension and 12% had diabetes. Notably, the most frequent comorbidities reported in these three studies of patients with COVID-19 are often treated with angiotensin-converting enzyme (ACE) inhibitors; however, treatment was not assessed in either study. Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. 4 The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs). 4 Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2. 5 ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19. If this hypothesis were to be confirmed, it could lead to a conflict regarding treatment because ACE2 reduces inflammation and has been suggested as a potential new therapy for inflammatory lung diseases, cancer, diabetes, and hypertension. A further aspect that should be investigated is the genetic predisposition for an increased risk of SARS-CoV-2 infection, which might be due to ACE2 polymorphisms that have been linked to diabetes mellitus, cerebral stroke, and hypertension, specifically in Asian populations. Summarising this information, the sensitivity of an individual might result from a combination of both therapy and ACE2 polymorphism. We suggest that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs. Based on a PubMed search on Feb 28, 2020, we did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients. © 2020 Juan Gaertner/Science Photo Library 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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The impact of physical activity on psychological health during Covid-19 pandemic in Italy

Grazia Maugeri, Paola Castrogiovanni, Giuseppe Battaglia … (2020)

The worldwide spread of COVID-19 has upset the normality of Italian daily life, forcing population to social distancing and self-isolation. Since the containment precautions also concern sport-related activities, home workout remained the only possibility to play sports and stay active during the pandemic. The present study aimed to examine changes in the physical activity levels during self-quarantine in Italy, and the impact of exercise on psychological health. A total of 2974 Italian subjects has completed an online survey, but only 2524 subjects resulted eligible for this study. The questionnaire measured the total weekly physical activity energy expenditure before and during quarantine (i.e. the sum of walking, moderate-intensity physical activities, and vigorous-intensity physical activities) in Metabolic Equivalent Task minutes per week (MET–min/wk) using an adapted version of International Physical Activity Questionnaire and their psychological well-being using the Psychological General Well Being Index. Of the 2524 Italian subjects included in the study, 1426 were females (56.4%) and 1098 males (43.6%). Total physical activity significantly decreased between before and during COVID-19 pandemic (Mean: 2429 vs. 1577 MET–min/wk, ∗∗∗∗p < 0.0001), in all age groups and especially in men (Female, mean: 1994 vs. 1443 MET–min/wk, ∗∗∗∗p < 0.0001; Male, mean: 2998 vs. 1754 MET–min/wk, ∗∗∗∗p < 0.0001). Furthermore, a significant positive correlation was found between the variation of physical activity and mental well-being (r = 0.07541, ∗∗∗p = 0.0002), suggesting that the reduction of total physical activity had a profoundly negative impact on psychological health and well-being of population. Based on this scientific evidence, maintaining a regular exercise routine is a key strategy for physical and mental health during a forced rest period like the current coronavirus emergency.

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COVID-19 and Diabetes: Knowledge in Progress

Akhtar Hussain, Bishwajit Bhowmik, Nayla Cristina do Vale Moreira (2020)

Highlights • Diabetes mellitus has been associated with severity and death in patients with COVID-19. • Chronic inflammation, increased coagulation activity, immune response impairment, and potential direct pancreatic damage by SARS-CoV-2 might be among the underlying pathophysiological mechanisms contributing to the increased morbidity and mortality of COVID-19 in people with diabetes. • Clinical evidence does not support the discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers in people with diabetes and COVID-19. • Caution should be taken to avoid potential hypoglycemic events related to the use of chloroquine in people with diabetes and COVID-19. • Glucose levels should be monitored rigorously, and dose adjustments of anti-diabetic drugs may be necessary. • Patient tailored therapeutic strategies, multidisciplinary team approaches and lower thresholds for hospitalization of patients with diabetes and COVID-19 may impact positively on their outcomes.

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Author and article information

Journal

Journal ID (publisher-id): rins

Title: Revista Peruana de Medicina Experimental y Salud Publica

Abbreviated Title: Rev. perú. med. exp. salud publica

Publisher: Instituto Nacional de Salud (Lima, , Peru )

ISSN (Print): 1726-4634

Publication date (Print and electronic): September 2020

Volume: 37

Issue: 3

Pages: 541-546

Affiliations

[3] Londres orgnameImperial College London orgdiv1Department of Epidemiology and Biostatistics, School of Public Health United Kingdom

[1] Lima Lima orgnameUniversidad Peruana Cayetano Heredia orgdiv1CRONICAS Centro de Excelencia en Enfermedades Crónicas Peru

[5] Sidney orgnameUniversity of New South Wales orgdiv1The George Institute for Global Health Australia

[2] Ginebra orgnameHospital Universitario de Ginebra y Universidad de Ginebra orgdiv1Departamento de Medicina Tropical y Humanitaria Suiza

[4] Lima orgnameHospital Cayetano Heredia Perú

Article

Publisher ID: S1726-46342020000300541 Publisher ID: S1726-4634(20)03700300541

DOI: 10.17843/rpmesp.2020.373.5980

PubMed ID: 33295559

SO-VID: 6f967cdf-1863-4053-b02f-423501252632

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 11 June 2020

Date accepted : 08 July 2020

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Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 6

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Most cited references 35

Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

The impact of physical activity on psychological health during Covid-19 pandemic in Italy

COVID-19 and Diabetes: Knowledge in Progress

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