The Impact of COVID-19 on Patients With Diabetes

Drug Topics®: Hi, my name is Gabrielle Ientile with Drug Topics® and today I'm talking to Carla Cox, registered dietitian and certified diabetes educator, about COVID-19 effects on individuals with diabetes. Dr. Cox, thank you so much for joining me today.

Cox: Thanks for asking me.

Drug Topics®: I'd like to start with a little bit of your professional background and what your day to day has been like during quarantine.

Cox: Historically, I have done many aspects of diabetes care. I've both been inpatient, outpatient, I've been in a multidisciplinary setting, I've been in an endocrinology practice, and now I'm in a pediatric endocrinology practice. I work 1 on 1 with patients. What I've been doing since COVID is we are doing virtual, so doing Zoom with our people with diabetes versus 1 on 1, which is not nearly as cool for me, but it is still getting the job done. We're starting a lot of people on new technologies and diabetes that, if I didn't do virtual, we would not be doing so it's good.

Drug Topics®: We've been hearing a lot about how individuals with underlying medical conditions are at a higher risk for severe illness with COVID-19, and a lot of research is being done to understand how the virus is affecting different people. So what has been some of the research that you've seen on how COVID-19 is affecting those with diabetes, and how does the virus affect those individuals?

Cox: Good question. First of all, it's important for people with diabetes, particularly those that are well managed, that their risk of getting COVID-19 is no greater than anybody else. I have a lot of people that are kind of hiding because they're so worried about getting it. In reality, they're not at a greater risk. So that's something everyone should know. If they do get COVID-19 and they're in the older population group over the age of 60, and they have a comorbid condition particularly in relationship to diabetes, or if their diabetes is been poorly managed - so that means to me if they've had a lot of variability in their glucose, or if it's been chronically elevated for a long time, which some people live with - if they have those things, then they're much higher risk of morbidity and mortality than they are if they have diabetes and they're well managed. Also, people with diabetes that have had it for a long time, particularly those with type 2 diabetes and obesity, and that are not, once again, as well managed as one would hope, many of them also have heart disease. That's a real common side effect, and so those people that have both high glucose numbers and heart disease are at much higher risk.

Drug Topics®: You mentioned some steps that people with diabetes can take is managing their diabetes well - what are other ways that they can prepare and protect themselves from the virus?

Cox: So that's a great question, and I think many of us don't know the answers to that, but it would be the same thing for people without diabetes. Number one is managing their diabetes throughout their lifetime is important for a whole host of reasons: 1 of those is, of course, if you get sick, it's much more difficult to manage their glucose values when they're sick. If it has already been high, it makes them much more susceptible to a progressive problem. Ways to prevent that: 1, manage diabetes well, 2 do the things that other people are doing: washing their hands when they're out in public and when they get back home, that's always important for all of us, regardless if it's COVID, or if it's anything else. We get flu every year, so they need to be doing that anyway. They should also get a flu shot. That's another thing has been proposed even for COVID. Even though it doesn't affect COVID, they don't want to 2 things happening at once. At least that's my understanding. I think the other thing is don't be close to people are sick. If someone is ill, you're supposed to go to a family party, and someone is really ill, a good idea is just call up and say, "I think I'm going to go next time, but this time, this is probably not where I need to be to prevent them from getting sick to start with." The other thing they need to do is be prepared. They should have plenty of glucose strips available, or a second sensor if they're wearing a continuous glucose monitor so they're always able to check their glucose in case they do get sick. They should also have a sick day plan provided by their healthcare provider.

Drug Topics®: How can pharmacists support those with diabetes during this time?

Cox: Pharmacists are wonderful, they support people across the spectrum, right? And they support them all the time, but now new things that are going on. I actually talked to 1 of my colleagues who is a pharmacist about what pharmacists are doing right now and how are they helping, and 1 of the things they're doing is allowing people to drive by and pick up their pharmaceuticals outside of the store or the pharmacy, wherever they are. They're also doing some home deliveries. My understanding is that many home deliveries are not charging anymore at this point during the COVID, so that's another thing they're doing. Some are actually setting up the drive-by COVID testing stations near their pharmacy or right outside of the parking lot, so that's another thing they're doing. I think the last thing that's important for everyone is for some of those people that are unemployed are losing their health insurance because of this horrible COVID-19 and how it has disrupted our lives - for some people, the pharmacist can actually help them find some product that may be either free, which some of the insulin companies are giving free, or very reduced rates during this COVID time to help support people that have lost their insurance or don't have the money to pay for it.

Drug Topics®: From what you've seen, should people with diabetes be at all concerned about possible drug or supply shortages?

Cox: It doesn't appear to be. The companies have been very upfront about saying we have not had a reduction in our production, and that goes for glucose strips, that goes for medications. Some of the medications that may be treating the disease itself may be in short supply, but as far as their diabetes supplies there does not appear at this time to be a shortage.

Drug Topics®: And then going forward, what is this pandemic telling us about diabetes prevention and diabetes care?

Cox: The same thing we've been saying for a long time: managing diabetes, preventing complications, all of those things will help prevent severe comorbid conditions or prevent severe illness if they’re on top of it before they get sick. I think that's the message we've been talking about for a long time, and if they manage their diabetes well, there is a much lower risk of having some of these conditions that make them at higher risk. The other thing that people can do if they're also struggling with weight management, if they're able to keep their weight within a reasonable range, that's going to help them too, because apparently, with this particular virus, those that are carrying a lot of extra weight are not doing very well. That's another thing we can learn from this.  Hopefully, it's a reboot. People have had diabetes for a long time. It's a very tedious disease, whether you have type 1 or type 2 diabetes. Checking your glucose all the time, thinking about what you're eating, doing your exercise, all those kinds of things, and sometimes, after years of doing that, and maybe relaxing your own standards, this is a reboot to say, “Oh, I really do need to take care of this. This is very important for me: not just about the diabetes, but about if I get sick, and I've managed my diabetes, I'm going to probably do better.”

Drug Topics®: And from your perspective, how well has the healthcare system in the United States responded to the pandemic? Are they able to effectively treat COVID-19 patients who have diabetes now, and in the upcoming weeks or months as well?

Cox: That's a really good question, and, of course, it varies by state and by community. The city of New York I know has had some struggles in the past, though they sound like they're very ready for it now. I have been very impressed with how everyone has come together. Both private and public companies have come together to work on how are we're going to care for people with diabetes or without diabetes that have COVID, and how we are going to work together to try and get rid of this awful scourge that we have right now. I think they've done a great job. The concern has been with people who are hospitalized - are they able to do the glucose checks they need to do? Are they able to oversee people well enough? The advice from the Diabetes Association, both the Diabetes Educator Group and also the American Diabetes Association is they should be prepared to take care of themselves, actually, in the hospital as far as glucose testing. The FDA has allowed personal glucometers to check glucose, which they never used to do, and also continuous glucose monitors, which many people wear. They're allowing them in hospital care because it's better for the people caring for them, and they can also help to take care of themselves a bit while they're in the hospital. I think they are doing a reasonable job, and the person with diabetes just needs to be up front with their diabetes team: tell them if they're getting sick, be tested. If they end up in the hospital, they need to chat with their personal care provider as well, because some of the oral medications they're taking may not be appropriate when they're having this particular virus.

Drug Topics®: What do you see as the most important takeaways on this topic?

Cox: Prevention. Not getting it is really important. I think always taking care of yourself so that you're ready for any insult that we have. We have a virus come around every year, and severe viruses come around every few years, and so we just need to realize this is not an isolated incident. We need to be prepared with having enough supplies, with having good relationships with our healthcare providers, and with taking care of ourselves so that if something happens, and we actually do get any kind of disease or virus or even some chronic disease, like cancer, that we are in a position to be healthy before that occurs.

Drug Topics®: Great. Those are all the questions that I have. Is there anything else you'd like to add before we wrap up?

Cox: I think the biggest thing too, is that once again, people with diabetes and families are so scared about getting COVID. And they just need to recognize that they are not at greater risk unless they are running these really high numbers and their body is already inflamed and ready to be not well. They just need to be doing the things that they're talking about - that they are careful of who they sit next to, that they're careful about washing their hands - we should be doing that all the time. The take home message is to be smart about preventing disease, any kind of infectious disease, and taking home some of the lessons that we've learned from this.

Drug Topics®: Great. Dr. Cox, thank you so much for offering your expertise today and stay safe.

Editor’s note: This interview transcription has been lightly edited for style and clarity.

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