COVID-19 has led to an abundance, and unprecedented acceleration, of medical professionals and organizations sharing medical insights and learnings. I have had the honor of being invited into one such illustrious group under the leadership of Professor Itamar Raz, diabetologist and former head of Israel’s national diabetes health policies and Guang Ning, Head of Shanghai Clinical Center for Endocrine and Metabolic Disease, China.

My role is one of a thinking partner having worked in diabetes for 17 years advocating for a more humanistic, and less mechanistic, relationship between practitioner and patient, and having lived with type 1 (T1D) diabetes 48-plus years. Also, I will be sharing updates from the group and, at times, my and patients’ point of view. I am in a privileged position: I get to be a dancer on the dance floor, as the metaphor goes, and also observe the room from the balcony. 

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Writing Faster Recommendations and Guidelines 

The Raz/Ning team consists of more than a dozen MDs, researchers, scientists, heads of universities, and hospital departments with long and heralded careers. They are calling into frequent video calls from China, Thailand, Hong Kong, India, Italy, Spain, Belgium, Japan, Australia, Israel, Germany, the U.S., U.K., and Canada sharing their knowledge, observations, experiences, findings, literature reviews and lessons learned. Through ongoing emails, they digest a barrage of information and brainstorm prevention and treatment guidelines that they can safely, and quickly, recommend to health professionals and the public.  

Currently most pressing amid the discussion is: 

1. How do we identify those with diabetes most at risk for COVID-19 and lessen their vulnerability? 

2. What can we safely recommend now that anyone with diabetes can do to lower their risk of getting the virus? 

3. How do we reshape diabetes prevention, care, and treatment in a way that makes people with diabetes (PWD) more metabolically healthy and less vulnerable to a disease like COVID-19? 

Early findings over these last few months show that people with poorly managed diabetes and obesity are being hospitalized three to four times the rate of people without diabetes and obesity, and once hospitalized they experience more severe outcomes, including death. A recent UK study finds people with type 1 diabetes may be at even higher risk for poor outcomes than people with type 2 diabetes, if hospitalized, due to longer-term vascular damage.

Diabetes and/or its associated comorbidities - cardiovascular disease, hypertension, kidney, lung and liver disease, and obesity, have left millions vulnerable to COVID-19. Obesity has been associated with higher ICU admissions, and just looking at the United States, according to a recent study conducted by researchers at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, only 12% of Americans are metabolically healthy. 

While COVID-19, is for most of us, the first pandemic that has touched us in such a personal way, diabetes, pre-diabetes, and obesity are three pandemics we have lived with for decades that the world has all but ignored.  

Paradigm Shift for Diabetes Prevention, Treatment, and Care

As government leaders work to “flatten the coronavirus curve” the group’s longer-term mandate is to flatten the “diabetes and obesity curve.” Most epidemiologists agree a Coronavirus type of pandemic will happen again. And as Professor Raz told me quite openly, “We cannot afford to get caught with our pants down again. If we do not address our failure in diabetes and rising obesity, including childhood obesity, when the next pandemic comes the death rate will be astronomical.” 

So the team is also reimagining a new model for diabetes prevention, care, and treatment. Early thinking involves medical education that teaches all health professionals about diabetes, better-informed patients, greater collaboration and communication between health professionals and people with diabetes, attention to emotional support, and using telemedicine for more frequent contact and greater support. More to come on this.

SIDE-BAR

List of Early Recommendations

• Baseline prevention is for people with diabetes to be metabolically and nutritionally healthy and of normal weight.

• PWDs should adhere to their therapeutic regimen and seek assistance from their health care professionals to improve glycemic control. 

• People with diabetes should improve their metabolic control preemptively so that their risk of complications will be lower. To do so, maintain a healthy balanced diet. Including antioxidants like vitamin C or zinc may be of benefit as well as supplements that improve immunity like Vitamin D and Selenium. Adhere to an individually tailored physical activity regimen. Outdoor activity, when possible, should be included for PWDs at a low risk of severe disease. Stop smoking. 

• Those infected with the coronavirus should monitor their glucose levels closely, strive for achieving glucose levels as close to normal as safely possible, and contact their healthcare professionals to consider medication changes as individually mandated. 

• Have a sustainable supply of medicines and equipment.

• Educate health teams in the hospital on the critical impact of high glucose when people with diabetes are ill, and help teams work collaboratively. 

• Address emotional and mental health recommendations.

• Re-imagine diabetes caretaking from the perspective of a systems view, including public health measures and policies, improved social justice legislation, community, wellness, and mental health resources. 

Recommendations for What People with Diabetes Can Do Now

1. The best prevention against COVID-19, outside of the general recommendation of social distancing and washing your hands, is to keep oneself nutritionally and metabolically healthy. 

What does that mean? Eat a healthy balanced diet, including antioxidants like vitamin C, found in fruits and leafy greens, supplements like zinc, selenium, and Vitamin D.  You can get a day’s worth of selenium from eating just two Brazil nuts. *Some evidence shows Vitamin D reduces the risk of COVID-19 infections and deaths and may help manage cytokine storms. Do some form of exercise, if possible aerobic to bring up your heart rate and anaerobic to build muscle. These “lifestyle” changes can help bring down chronic inflammation and weight, and lower the risk for comorbidities - heart disease, hypertension, obesity, liver, and lung disease - all of which are risk factors for COVID-19. 

* At this time, the evidence of Vitamin D and other supplements’ use for prevention, and as treatment, is inconclusive and group members have varying opinions on their efficacy. However as they may be beneficial, they are included in the recommendation. The group agrees, however, that healthy eating, including a tailored nutritional program if necessary, and healthy lifestyle behaviors are paramount. 

2. Keep blood sugar levels in range as much as possible

Those not infected with the virus should follow their management plan and monitor their glucose levels closely. Those infected with the coronavirus should strive for glucose levels as close to normal as safely possible and contact their healthcare professionals if medication changes, or any assistance, is needed.  Why? While it appears people with well-managed diabetes (both type 1 and type 2) are not necessarily at greater risk of getting the coronavirus, early evidence shows hyperglycemia (high blood sugar) may make one more vulnerable to COVID-19 and cause more severe outcomes. 

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