Article published in the magazine Nature Metabolism alerts to the situation of quality of care for patients with metabolic diseases
It has just been published in the magazine Nature Metabolism the article Consequences of the Covid-19 pandemic for patients with metabolic diseases. Bruno Geloneze, researcher at the Obesity and Comorbidities Research Center (Cepid OCRC) from Unicamp is co-author of the article, which deals with the consequences of Covid-19 in patients with metabolic diseases. The article was written by a group of experts representing all continents and alerts to the catastrophic situation of the quality of care for patients with metabolic diseases, especially diabetes and obesity.
According to experts, patients with metabolic diseases face increasing challenges in the Covid-19 pandemic, as a consequence of the prolonged lockdown, the exhaustion of healthcare systems, the viral disease itself and the effects of drugs introduced to treat SARS infection. -CoV-2.
“Reduced access to primary care providers and a high demand for care of critically ill patients with Covid-19 divert hospital staff and resources that are consequently lacking in other areas of care. This situation represents a substantial risk for all patients with chronic diseases, especially those with chronic metabolic diseases such as diabetes and obesity”, says Geloneze.
The specific points covered by the article are: treatment of patients with Covid-19 and metabolic diseases; access to healthcare; acute care for patients with diabetic foot; care for patients with obesity; care for patients with obesity and vaccination.
Treatment of patients with COVID-19 and metabolic diseases
Dexamethasone has been the standard treatment along with oxygen supplementation for hospitalized patients, reducing mortality in critically ill patients. The problems, according to the article, are that high doses used in serious infections greatly worsen glycemic control and trigger diabetic coma due to metabolic acidosis and hyperosmolar coma. Doctors delay the intensive use of intravenous insulin and, in the absence of continuous monitoring, critical situations of hyperglycemia or hypoglycemia can alternate.
“Dexamethasone can cause severe edema and increased blood pressure. At the cellular level, it can induce the death of insulin-producing cells and result in the permanent need for insulin in people who only used oral medications”, explains Geloneze.
Access to healthcare
According to the World Health Organization (WHO), 155 countries have reduced or interrupted assistance programs for patients with chronic metabolic diseases, and in 47 countries diabetes assistance has been severely reduced. Furthermore, patients are afraid of contracting the disease and avoid appointments and have been switching anti-diabetes and antihypertensive medications that have been mistakenly linked to greater risks of disease severity due to Covid.
“The worst-case scenario should be observed in the future when more chronic complications of diabetes, such as retinopathy and nephropathy, in addition to cardiovascular diseases will be more common”, warns Geloneze.
Acute care for patients with diabetic foot
Acute diabetic foot wounds are more frequent in this poorly controlled scenario and often require hospitalization for the use of antibiotics, surgical care, immobilization and chronic care for wound rehabilitation. In the current situation, care has been postponed or not applied and the risk of amputation has increased by 300% in developed Western countries.
Care for patients with obesity
Isolation and the resulting psychological changes have facilitated weight gain in people prone to gaining weight due to physical inactivity and stress and depression. Furthermore, patients indicated for surgical treatment of obesity have faced the partial or total closure of bariatric surgery services around the world. It is known that the queues increase and the mortality of these patients is expected to increase in this period of time.
Vaccination
Patients with diabetes and metabolic diseases should be included in the initial phases of vaccination as priority groups. However, priority vaccination programs for these patients for influenza and pneumonia have already failed around the world. Changing the scenario is another big challenge.
“With this article, we want to encourage doctors and patient interest groups in the area of diabetes and obesity to raise their voices to ensure adequate care and admission of these patients to healthcare in each area, region and country”, reinforces Geloneze .
Bruno Geloneze, researcher at Cepid-OCRC at Unicamp and co-author of the article. Photo: Antonio Scarpinetti - SEC/Unicamp
Access the article: Consequences of the Covid-19 pandemic for patients with metabolic diseases
original article published on the Unicamp FCM website.
