Position Statement on How to Manage Patients with Diabetes and COVID-19

Abstract

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