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

  • Indonesian Society of Endocrinology (ISE)
Keywords: diabetes, 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


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Author Biography

Indonesian Society of Endocrinology (ISE)

Prof. Ketut Suastika, MD, PhD
President, Indonesian Society of Endocrinology (ISE)
Professor of Medicine, Internist-Consultant Endocrinologist,
Guest Professor, Kobe Women University
Division of Endocrinology, Diabetes and Metabolism
Department of Internal Medicine, Faculty of Medicine
Udayana University, Denpasar, Bali, Indonesia
E-mail: ksuas@unud.ac.id


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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.

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Gugus Tugas Percepatan Penanganan COVID-19. Covid19.go.id. Accessed in 21 April 2020.

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.

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American Diabetes Association. Diabetes and coronavirus. https://www.diabetes.org/coronavirus-covid-19. Accessed 16 April 2020.

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. https://www.ncbi.nlm.nih.gov/pubmed/32233013. https://doi.org/10.1002/dmrr.3319.

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How to Cite
(ISE), I. S. of E. (2020). Position Statement on How to Manage Patients with Diabetes and COVID-19. Journal of the ASEAN Federation of Endocrine Societies, 35(1), 49-51. https://doi.org/10.15605/jafes.035.01.03
Position Statements