Challenges and Opportunities for Diabetes Care in the Philippines in the Time of the COVID-19 Pandemic

Abstract

*Visual Abstracts prepared by Dr. Roy Raoul Felipe

Patients with diabetes constitute a vulnerable population in the surge of the COVID-19 pandemic. COVID-19 is a viral illness caused by the virus SARS-CoV2 which originated in China, presenting with a range of clinical manifestations from fever, cough, myalgia, resembling a systemic viral illness which can progress to acute respiratory failure, and multiple organ dysfunction. In the Philippines, the burden of both diseases is high. The prevalence of diabetes, a chronic, metabolic disorder characterized by hyperglycemia, is about 7.1% in adults between 20-79 years old in 2019.¹ The country has been afflicted by a COVID-19 outbreak and as of this writing, there are already more than 6000 cases of COVID-19 infection, and more than 400 individuals have died of the disease in the Philippines. This led the government to declare an enhanced community quarantine (ECQ), which entails restricted operation and movement of people and goods, except for essential services, throughout the island of Luzon-the largest island in the Philippines, which comprises of about 57 million people, last March 16, 2020. This ECQ has been extended twice, and will remain enforced until May 15, 2020 at the earliest,² in order to control the outbreak while boosting testing capacity and the ability of healthcare facilities to respond to COVID-19 cases.

Those with diabetes can be both a direct and a collateral victim of this pandemic. Poor blood sugar control may lead to an immunocompromised state, leading to an increased risk of contracting and developing the complications of COVID-19. As a chronic disease, diabetes entails multimodal management integrating medical nutritional therapy, exercise, pharmacologic therapy, close monitoring and follow-up. Quarantine measures and restrictions in mobility have made diabetes care more challenging. The other way that persons with diabetes become collateral damage is because of the focus now on treating persons who have the COVID infection. The Philippine government has designated 19 COVID-referral hospitals in the National Capital Region, and 75 facilities throughout the Philippines. These referral hospitals were preferentially equipped by the government with manpower, personnel protective equipment, medications and other needs to be able to manage persons infected with COVID who are referred to their hubs from the community or other hospitals. However, most of the other hospitals still mostly admit only patients with COVID. This has led to a significant number of patients who would have been previously admitted to be turned away from hospitalization to prevent them from becoming infected, and instead given medications for home management. This is true for various disease conditions, including persons with diabetes.