Management of diabetes during fasting and COVID-19 – Challenges and solutions

Abstract

Introduction: Fasting is observed as a religious custom in various forms across the globe. Among them, the Ramadan fasting is very common and widely practiced. People with diabetes observe fasting with or without obtaining medical advice. Uncontrolled diabetes appears to be a risk factor for COVID-19 infection and its poorer outcomes. Fasting during Ramadan is challenging in people with diabetes. This year, the background of COVID-19 made it difficult for both the patients and health care workers to effectively manage diabetes and its complications during Ramadan. Because of a lack of sufficient evidence, clinicians were perplexed in handling this difficult situation. Materials and Methods: We accessed PubMed, Google Scholar, various guidelines and other evidence-based articles to review the available current literature which deals with diabetes, Ramadan, and COVID-19. Results: The importance of pre-Ramadan assessment, adequate nutrition, and hydration, choosing the right therapy has been emphasized. This review tries to address the common practical challenges and relevant possible solutions for the same. Due consideration has been given to various socio-cultural practices that can influence the management of diabetes patients in the setting of Ramadan and COVID-19 pandemic. Conclusions: Diabetes is associated with increased severity and susceptibility to COVID-19. People with diabetes should go through systemic and structure-based management during fasting. Family physicians who deliver personalized care play a vital role in managing diabetes during this crisis period. Telemedicine is emerging as an effective mode of managing various needs of individuals.

COVID-19 Pathophysiology and Clinical Effects on Multiple Organ Systems - A Narrative Review

“…In the gist of the current COVID-19 pandemic, current guidelines advise people with Diabetes Mellitus to continue taking their medication in order to maintain glucose control. Moreover, the guidelines also suggest stocking up on an additional 30-day supply of medication and supplies to be able to monitor blood glucose levels at home [55,55,56]. The International Diabetes Federation has mentioned that people with diabetes are amongst the high-risk categories that can have a serious illness if they contract the SARS-CoV-2, however, it is best not to rush to the hospital in order to contain the virus [53].…”

“…The International Diabetes Federation has mentioned that people with diabetes are amongst the high-risk categories that can have a serious illness if they contract the SARS-CoV-2, however, it is best not to rush to the hospital in order to contain the virus [53]. National Health Service (NHS) clinical guidelines for the management of diabetic patients in COVID-19 recommend expedition of treatment and discharge of inpatients and implementation of the virtual clinics/teleconsultations [54,55,56]. However, NHS fails to address the challenges which might be faced in regards to literacy, poor access and for people who might be not wellversed with technology.…”

“…Total bilirubin levels are elevated from 0%-35.3% of Covid-19 positive patients. Elevated alkaline phosphatase (AKP) and gamma-glutamyl transferase (GGT) levels have been reported in patients with comorbid NAFLD and this was associated with a more severe disease course and a poor prognosis [47][48][49][50][51][52][53][54][55][56][57][58]. Studies have found moderate microvascular steatosis, mild lobular and portal activity, mild sinusoidal dilatation and an increase in mitotic cells and ballooned hepatocytes on liver biopsy of Covid-19 patients [69,70,71].…”

“…Cytotoxicity: The SARS-CoV-2 may directly infect hepatocytes and cholangiocytes -since the receptor of the virus, ACE2 is present on both types of cells and induce apoptosis via a caspasedependent pathway [62]. It is important to note, however, that biopsy of liver tissue from a patient who died from COVID-19 has shown no viral inclusions [62][63][64][65][66][67][68][69] [47][48][49][50][51][52][53][54][55][56][57][58].…”

Lockdown and diabetes–what actually happened?

“…Telemedicine options should be made available to remote parts of the world which can cater to the vulnerable population. 9 During this crisis, the family doctors can play an important role in taking care of the members of the families they encounter on a day to day basis. This can help in proper follow-up and also ensure that due attention is being given to the individual as a whole thereby improving their quality of life.…”