18th Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease Highlights

New insights on the intersection of diabetes, obesity, and COVID-19

Intersection of COVID-19 and Diabetes

Presenters at the Society for Vascular Surgery’s 18th annual World Congress on Insulin Resistance Diabetes & Cardiovascular Disease, held virtually this year because of the pandemic, urged those with diabetes and other metabolic issues to continue to be vigilant about their conditions as the COVID-19 pandemic rages on.

A panel titled “Two Pandemics in Collision,” organized by the journal Lancet Diabetes & Endocrinology, covered issues in which COVID-19 and the diabetes epidemic have converged to create distinct challenges, and spoke on strategies to best handle them.

The panel featured presentations on COVID-19 and diabetes from Paul Zimmet MD, management of care for patients with COVID-19 and diabetes from Stefan Bornstein MD, and a session on obesity and delays in bariatric surgeries during COVID-19 with Geltrude Mingrone MD.

COVID-19 and Diabetes: How One Pandemic Exacerbates Another

Doctor visits for patients with diabetes are alarmingly down because patients fear going to the doctor and risking interactions with others who may have COVID-19, or because their budget for medical care is diminished. Glycemic control is also hindered as routines are upended and patients struggle to pay for needed maintenance, often added to the stress of pandemic-related financial challenges. In addition, food scarcity and stay-at-home orders can make it more difficult to stick to a healthy diet and exercise regimen, even for patients who had previously been on track and improving on both fronts. All of these complex layers add the risk of COVID-19 complications to patients who are already struggling to control their diabetes.

Dr. Zimmet discussed the International Diabetes Federation projection that there would be 420.5 million people with diabetes  by 2017, which proved to be correct, as well as how the organization is predicting up to 600 million people with diabetes worldwide by 2045. 

The bottom line here, which is uncontested, is that patients with diabetes who also contract COVID-19 are at a much higher risk for serious morbidity and mortality. These added layers complicate an already dire diabetes pandemic.

For patients who are apprehensive about in-person medical appointments, Zimmet suggests encouragement to use telemedicine to help them maintain routines and adherence. “As the rates of diabetes and other non-communicable diseases continue to increase worldwide, now, more than ever, NCD (non-communicable disease) prevention and control must be a priority,” he says.

Cellular Crosstalk in Endocrine Tissues in the Era of COVID-19

Stefan Borenstein MD is interested in understanding the mechanisms and clinical implications of cellular crosstalk in endocrine tissues with a specific focus on the endocrine function of adipose tissue and its involvement in the development of obesity-associated comorbidities.

He pointed out that metabolic patients are at a higher risk because the Coronavirus uses endocrine pathways, which is also why COVID-19 creates endocrine issues such as hyperglycemia and other metabolic conditions that require glucose monitoring in patients who were not previously diagnosed with diabetes.

The endocrine pathways that the Coronavirus hijacks play a crucial role in blood pressure regulation, metabolism, and inflammation. This is because the virus is not only using this receptor to enter the cell and cause damage, it also induces hyper-inflammation which can lead to insulin resistance, other metabolic irregularities, and respiratory failure.

“The better we help our patients to control their blood glucose, the better we can have an improved outcome,” he states. That means that it’s more important than ever to provide support to patients suffering from diabetes who need assistance to control their blood sugar, as unregulated high blood sugar puts the body into an inflammatory state that is more dangerous during COVID-19 that having diabetes if it is controlled and blood sugar is kept stable.

Dr. Borenstein emphasized this important correlation between diabetic complications and glycemic control for reducing severity of COVID-19 infections and discussed new clinical research that points to a 30 percent reduction in mortality with severe cases of the Coronavirus when patients are given oxygen combined with dexamethasone, a potential new treatment for those who arrive with high blood sugar when they are hospitalized with COVID-19.

Borenstein's takeaway is in regard to patients with uncontrolled diabetes who have an increased risk for severe Covid-19 infections: “Adequate management is crucial for these patients,” he attests, adding that both insulin resistance and hyperglycemia will accelerate the effects of COVID-19, while the systemic inflammation that comes with the disease can induce insulin resistance.

Delays in Bariatric Surgery During COVID-19: Determining Sequence

Despite the fact that the American Society for Metabolic & Bariatric Surgery (ASMBS) made the statement that obesity surgery is not elective, these critical surgeries are still being tabled, both to help with hospital resources overburdened by the COVID-19 pandemic and because many patients do not want to have surgery while there’s a widespread communicable disease.

Geltrude Mingrone MD presented an order of succession to help which physicians determine which patients should receive bariatric surgeries first as an assessment tool to continue providing bariatric surgeries during the pandemic for those who can benefit most.

She outlined three categories of obese patients that can be used to determine how quickly bariatric or metabolic surgery is scheduled during COVID-19. They include:

  • Category one: Those with unstable conditions that could deteriorate quickly and rapidly lead to more severe symptoms or dysfunction.
  • Category two: Expedited access to surgery within 90 days to patients with more stable conditions but still substantial risk of morbidity or mortality issues, complex medical regimens or insulin requirements, and patients who must lose weight for other surgical procedures, such as a needed organ transplant, orthopedic surgery, or gender reassignment surgery.
  • Category three: Surgery that can wait 90 days or more for patients with more stable clinical conditions who have only mild dysfunction or symptoms. These are patients are not likely to see a decrease in the effectiveness of surgery because of a delay.

The assessment sequence offers an effective strategy to determine when a patient should have bariatric or metabolic surgery while hospitals are overburdened from the COVID-19 pandemic, allowing a continuation of needed surgeries.

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