Position Statement on How to Manage Patients with Diabetes and COVID-19
Epidemiology, clinical features, and mortality of COVID-19
In 31 December 2019, 27 cases of pneumonia of unknown aetiology were identified in Wuhan City, Hubei Province in China; and in 7 January 2020, The Chinese Centre for Disease Control and Prevention (CCDC) subsequently named the cause of this disease as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Thereafter, the World Health Organization (WHO) declared this outbreak as a Public Health Emergency of International Concern in 30 January 2020;
and then in 11 February 2020 this disease was named Coronavirus Disease 2019 or COVID-19 by WHO.1,2
The most frequent clinical features of COVID-19 are fever, cough, and shortness of breath; although recently some unusual symptoms such as loss of smell and taste are reported. The incubation period of the disease is between 2-14 days.1 Based on a review and meta-analysis by do Nascimento et al., of a total of 61 studies including 59,254 patients, it found that the most common disease-related symptoms were: fever (82%), cough (61%), muscle aches and/or fatigue (36%); dyspnea (26%), headache (12%), sore throat (10%), and gastrointestinal symptoms (9%).3 Another systematic review and meta-analysis on data from Wuhan also showed very similar result that fever, cough, fatigue, and dyspnea were the most frequent clinical symptoms. It was found that the most prevalent co-morbidities were hypertension (17%), diabetes (8%), cardiovascular diseases (5%) and respiratory system disease (2%).4
Summary of a report of 72,314 cases from the CCDC revealed that spectrum of disease was mild 81% (36,160 cases), severe 14% (6,168 cases) and critical 5% (2,087 cases). The case-fatality rate (CFR) of the disease was 2.3% (1,023 of 44,672 confirmed cases), 14.8% in patients aged >80 years (208 of 1,408) , 8.0% in patients aged 70-79 years (312 of 3,918), and 49.0% in critical cases (1,023 of 2,087). The CFR was elevated among those with pre-existing comorbid conditions, i.e.: 10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for hypertension, and 5.6% for cancer. Among diabetics, CFR is actually 3 times higher compared to general population.5 Based on the latest global situation reported by WHO (April 20, 2020), there are 2,314,621 person with confirmed COVID-19 and 157,847 death (6.8%).2
In Indonesia, the latest report from Gugus Tugas Percepatan Penanganan COVID-19 (April 20, 2020) showed the number of people confirmed with COVID-19 were 6,760 with 590 death (8.7%) cases related to COVID-19.6
2. WHO Int. Coronavirus disease 2019 (COVID-19) Situation Report-92. Accessed 21 April 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200421-sitrep-92-covid-19.pdf?sfvrsn=38e6b06d_4.
3. do Nascimento IJB, Cacic N, Abdulazeem HM, et al. Novel coronavirus infection (COVID-19) in humans: A scoping review and meta-analysis. J Clin
Med 2020;9(4):941. https://doi.org/10.3390/jcm9040941.
4. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: A systematic review and meta-analysis.
Int J Infect Dis. 2020;94:91-5. https://www.ncbi.nlm.nih.gov/pubmed/32173574. https://doi.org/10.1016/j.ijid.2020.03.017.
5. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China summary of a report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. https://www.ncbi.nlm.nih.gov/pubmed/32091533. https://doi.org/10.1001/jama.2020.2648.
6. Gugus Tugas Percepatan Penanganan COVID-19. Covid19.go.id. Accessed in 21 April 2020.
7. Zhou T, Hu Z, Yang S, Sun L, Yu Z, Wang G. Role of adaptive and innate immunity in type 2 diabetes mellitus. J Diabetes Res. 2018:7457269.
https://www.ncbi.nlm.nih.gov/pubmed/30533447. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250017. https://doi.org/10.1155/2018/7457269.
8. Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26(3-4):259-65.
9. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16(Supp.1):S27-36.
https://www.ncbi.nlm.nih.gov/pubmed/22701840. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354930. https://doi.org/10.4103/2230-8210.94253.
10. Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Met Syndr. 2020;
14(3):211-2. https://www.ncbi.nlm.nih.gov/pubmed/32172175. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102582. https://doi.org/10.1016/j.dsx.2020.03.002.
11. American Diabetes Association. Diabetes and coronavirus. https://www.diabetes.org/coronavirus-covid-19. Accessed 16 April 2020.
12. Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020;e3319.
13. National Health Service. Specialty guides for patient management during the coronavirus pandemic. Clinical guide for the management of people with
diabetes during the coronavirus pandemic. 19 March 2020 version 2. Publications approval reference: 001559. https://www.england.nhs.uk/coronavirus/
wp-content/uploads/sites/52/2020/03/speciality-guide-diabetes-19-march-v2-updated.pdf. Accessed 16 April 2020.
14. Ma WX, Ran XW. The management of blood glucose should be emphasized in the treatment of COVID-19. Sichuan Da Xue Xue Bao Yi Xue Ban:
Journal of Sichuan University Media Science edition. 2020; 51(2): 146-50.
15. Perkumpulan Endokrinologi Indonesia (Indonesian Society of Endocrinology). Pedoman pengelolaan diabetes melitus Tipe 2 dewasa di Indonesia.
Penerbit PB Perkeni, 2019. ISBN 978-602-53035-2-4.
16. American Diabetes Association. 15. Diabetes care in the hospital: Standards of medical care in diabete-2020. Diabetes Care. 2020;43(Suppl 1):S193–202.
17. Matthews R. Glucose control key with COVID-19 in diabetes, Say Experts. Medscape Medical News. Mar 18, 2020. https://www.medscape.com/
viewarticle/ 927044. Accessed 16 April 2020.
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