Challenges and Opportunities for Diabetes Care in the Philippines in the Time of the COVID-19 Pandemic
Keywords:diabetes, 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.
World Bank. World Bank Collection of Development Indicators. April 2020. datatopics.worldbank.org. https://tradingeconomics.com/philippines/diabetesprevalence-percent-of-population-ages-20-to-79-wb-data.html. Accessed April 21, 2020.
Department of Health-Philippines. Updates on novel Coronavirus Disease (COVID-19): COVID-19 Case Tracker. https://www.doh.gov.ph/2019-nCoV.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Resp Med. 2020;8(4):e21. https://www.ncbi.nlm.nih.gov/pubmed/32171062. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118626. https://doi.org/10.1016/S2213-2600(20)30116-8.
Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142. https://www.ncbi.nlm.nih.gov/pubmed/32278764. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144611. https://doi.org/10.1016/j.diabres.2020.108142.
Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531-8. https://www.ncbi.nlm.nih.gov/pubmed/ 32161990. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087935.https://doi.org/10.1007/s00392-020-01626-9.
Wang A, Zhao W, Xu Z, Gu J. Timely blood glucose management for the outbreak of 2019 novel coronavirus disease (COVID-19) is urgently needed. Diabetes Res Clin Pract. 2020;162:108118. https://www.ncbi.nlm.nih.gov/pubmed/32179126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102524. https;//doi.org/10.1016/j.diabres.2020.108118.
American Diabetes Association. Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care. 2007;30(Suppl 1):S48–65. https://www.ncbi.nlm.nih.gov/pubmed/17192379. https://doi.org/10.2337/dc07-S048.
World Health Organization. World Health Organization-Diabetes Country Profiles. 2016. https://www.who.int/diabetes/countryprofiles/phl_en.pdf?ua=1.
Dahly DL, Gordon-Larsen P, Emch M, Borja J, Adair LS. The spatial distribution of overweight and obesity among a birth cohort of young adult Filipinos (Cebu Philippines, 2005): An application of the Kulldorff spatial scan statistic. Nutr Diabetes. 2013;3(7):e80. https://doi.org/10.1038/nutd.2013.21.
White LV, Edwards T, Lee N, et al. Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines. Sci Rep. 2020;10:4100. https://doi.org/10.1038/s41598-020-60942-2.
Food and Drug Authority Circular 2020-007. Guidelines in the implementation of the use of electronic means of prescription for drugs for the benefit of individuals vulnerable to COVID-19. 2020. https://www.fda.gov.ph/fda-circular-no-2020-007-guidelines-in-the-implementation-of-the-use-of-electronic-means-of-prescription-for-drugs-for-the-benefit-of-individuals-vulnerable-to-covid-19/
Ghosh A, Gupta R, Misra A. Telemedicine for diabetes care in India during COVID19 pandemic and national lockdown period: Guidelines for physicians.Diabetes Metab Syndr. 2020;14(4):273–6. https://www.ncbi.nlm.nih.gov/pubmed/32283497. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7129346. https://doi.org/10.1016/j.dsx.2020.04.001.
Flodgren G. Rachas A, Farmer AJ, Inzitari M, Shepperd, S. Interactive telemedicine: Effects on professional practice and health care outcomes. Cochrane Database of Syst Rev. 2015;(9):CD002098. https://www.ncbi.nlm.nih.gov/pubmed/26343551. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473731. https://doi.org/10.1002/14651858.CD002098.pub2.
Zhou J, Tan J. Diabetes patients with COVID-19 need better blood glucose management in Wuhan, China. Metabolism. 2020;107:154216. https://www.ncbi.nlm.nih.gov/pubmed/32220612. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102634. https://doi.org/10.1016/j.metabol.2020.154216.
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