Recently, in a letter published in the New England Journal of Medicine, an international team of 17 experts studying diabetes said that pneumonia in COVID-19 may lead to diabetes in healthy people and serious complications in diabetic patients.
A few days ago, an international expert group composed of 20 top experts in diabetes and endocrinology, including Professor Ji Linong, director of endocrinology department of Peking University People's Hospital and director of Peking University Diabetes Center, published in The Lancet "Practical Recommendations for Management of Infected Patients with Diabetes in novel coronavirus" (hereinafter referred to as "Recommendations"). According to the paper, elderly diabetic patients suffering from COVID-19 pneumonia have a higher risk of dying from the disease. At the same time, novel coronavirus may actually promote normal people to become new diabetic patients.
These studies not only give a warning to patients with pneumonia complicated with diabetes in COVID-19, but also sound a warning bell to ordinary diabetes patients and even healthy people.
Novel coronavirus "Prefers" Diabetic Patients
"Experts found that a considerable proportion of people infected with novel coronavirus in many countries are diabetic patients, and once these diabetic patients suffer from COVID-19 pneumonia, the risk of entering intensive care units and death is extremely high." Ji Linong said in an interview with a reporter from Science and Technology Daily.
Among the patients diagnosed with pneumonia in COVID-19 all over the world, researchers have found that 20% to 50% of patients suffer from diabetes, which proves that diabetes is one of the basic diseases closely related to the severity of pneumonia infection in COVID-19. Epidemiological observation in seriously infected areas in novel coronavirus and reports from some national health centers and hospitals show that the risk of diabetes patients dying of pneumonia in COVID-19 is more than 50% higher than that of patients without diabetes.
Why are there so many COVID-19 pneumonia patients with diabetes? Ji Linong explained that this is because diabetic patients are in a state of hyperglycemia for a long time, and the body's ability to prevent infection is low, thus increasing the risk of infection. At the same time, patients with pneumonia and diabetes in COVID-19 are more likely to have high blood sugar and large blood sugar fluctuation. However, the high prevalence of type 2 diabetes and many complications such as cardiovascular diseases in the elderly are also one of the reasons for the high mortality rate of elderly diabetic patients infected with novel coronavirus.
May induce new diabetes in normal people
"Judging from the current understanding of novel coronavirus, it is not as seasonal as the SARS virus. If prevention is not strengthened, there may be a risk of another outbreak. Therefore, both diabetic patients and the general population should pay more attention to the prevention of novel coronavirus. " Ji Linong said.
The Recommendation mentions that although it has not been confirmed that novel coronavirus can induce diabetes, there is evidence that novel coronavirus infection may be a factor inducing diabetes.
Experts said that novel coronavirus and ACE2 (angiotensin converting enzyme 2, which is expressed in airway epithelial cells, intestinal tract, pancreas and other tissues and was previously used as a receptor for novel coronavirus to invade cells) have strong binding strength. As virus infection can aggravate blood sugar elevation and metabolic abnormalities of diabetic patients through the more active ACE2 receptor, and potential pancreatic β cell damage caused by virus leads to insulin deficiency, novel coronavirus infection not only aggravates the condition of diabetic patients, but also may induce new diabetes in normal people.
Clinically, some patients with pneumonia in COVID-19 have been treated with glucocorticoid, which often causes blood sugar fluctuation. If glucocorticoid is used for a long time, the risk of diabetes will increase by 36%-131%.
Strengthening blood sugar management is the best defense measure.
Under the COVID-19 epidemic situation, the treatment and management of chronic diseases dominated by diabetes are challenged. According to statistics, the number of diabetes patients in China has reached 130 million, with one in every 10 people suffering from diabetes. However, the blood sugar control of diabetes patients is not optimistic, and the blood sugar compliance rate is only 15.8%.
For patients with diabetes or hyperglycemia in pneumonia in COVID-19, Ji Linong said that controlling hyperglycemia can not only reduce the risk of acute complications of diabetes, but also improve the overall prognosis of pneumonia in COVID-19. "Good blood sugar control and management are essential to reduce patient mortality and infection." He stressed.
"Diabetes patients should strengthen blood sugar and metabolism management, which is an important primary prevention measure; At the same time, different patients should carry out individualized target management, lifestyle intervention, blood sugar monitoring and corresponding drug treatment. For patients with pneumonia complicated with diabetes in COVID-19, blood sugar should be strictly controlled without increasing the risk of hypoglycemia to improve the prognosis of patients. Insulin has the advantages of no gastrointestinal side effects, obvious hypoglycemic effect, being beneficial to tissue repair, timely adjustment of dosage and being free from taboos of liver and kidney functions, and should be used as the first choice of therapeutic drugs. " Ji Linong said.
Experts said that for diabetic patients, strict control of blood sugar, balanced diet, reasonable rest and rest, and keeping a pleasant mood are the best defense measures against novel coronavirus. At the same time, under the background of normalization of epidemic prevention and control, we should do a good job in the management and prevention and control of diabetes, diagnose and treat diabetes early, control the occurrence and development speed of diabetes and its complications, and strengthen the construction of diabetes prevention and control mechanism.