Tale of two Pandemics: Scenarios unfolding with the clash of Type 2 Diabetes mellitus and COVID-19 in the Indian subcontinent
Keywords:
COVID-19, DM, NCDs, Pandemic, mortality, Asia
Abstract
The ongoing pandemic of COVID-19 has a spectrum of presentations ranging from mild (81%) through severe (14%) to critical illness (5%), leading to fatality which has crossed more than 15 million cases globally. Recently published data from the worst affected countries suggests that comorbidities like type 2 diabetes mellitus (DM), hypertension (HTN) and cardiovascular diseases (CVD) are the leading causes of fatality attributed to the pandemic, in addition to old age. Since DM is also a raging global epidemic, it may well have a significant impact on the outcome of burgeoning COVID pandemic, especially in low and middle-income countries like India. The bidirectional relationship of these two pandemics generates a peculiar situation which could lead to a significant loss of lives in the light of limited resources. In a country like India, with a population of 1.4 billion people, out of the 1.4 million affected so far, around 0.2 million would be suffering from diabetes. What is more disturbing is the concern that the health structure of the country is far inferior to that of countries like UK, Italy, Spain and the USA who have demonstrated an overwhelming of their health systems in the face of the current health crisis. If some country specific and innovative strategies beyond lockdown are not implemented urgently, the country will have to face devastating consequences in terms of mortality and stress on the existing health systems. In this review we analyse the background burden of the pandemics, their interaction and required strategies to prevent the repetition of consequences India suffered in Spanish flu pandemic of 1918.
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References
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[1] Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020. doi:10.1056/NEJMoa2001017.
[2] Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA - J Am Med Assoc 2020;323:1239–42. doi:10.1001/jama.2020.2648.
[3] Grifoni A, Sidney J, Zhang Y, Scheuermann RH, Peters B, Sette A. A Sequence Homology and Bioinformatic Approach Can Predict Candidate Targets for Immune Responses to SARS-CoV-2. Cell Host Microbe 2020. doi:10.1016/j.chom.2020.03.002.
[4] Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020. doi:10.23750/abm.v91i1.9397.
[5] Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein. Cell 2020. doi:10.1016/j.cell.2020.02.058.
[6] Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses. Cell Death Differ 2020. doi:10.1038/s41418-020-0530-3.
[7] van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020. doi:10.1056/nejmc2004973.
[8] Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020. doi:10.1056/NEJMc2001737.
[9] Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA - J Am Med Assoc 2020. doi:10.1001/jama.2020.2565.
[10] Worldometer. Coronavirus Cases. Worldometer 2020:1–22. doi:10.1101/2020.01.23.20018549V2.
[11] Arnold D. Death and the modern empire: the 1918–19 influenza epidemic in india. Trans R Hist Soc 2019. doi:10.1017/s0080440119000082.
[12] Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA 2020. doi:10.1001/jama.2020.4344.
[13] Situation reports n.d. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ (accessed April 16, 2020).
[14] Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA - J Am Med Assoc 2020. doi:10.1001/jama.2020.4683.
[15] Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis 2020. doi:10.1016/s1473-3099(20)30243-7.
[16] Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13. doi:10.1016/S0140-6736(20)30211-7.
[17] Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J 2020:2000547. doi:10.1183/13993003.00547-2020.
[18] Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020. doi:10.1056/nejmoa2002032.
[19] Chow N, Fleming-Dutra K, Gierke R, Hall A, Hughes M, Pilishvili T, et al. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382–6. doi:10.15585/mmwr.mm6913e2.
[20] Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;0. doi:10.1016/S2213-2600(20)30079-5.
[21] Zhang J jin, Dong X, Cao Y yuan, Yuan Y dong, Yang Y bin, Yan Y qin, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur J Allergy Clin Immunol 2020. doi:10.1111/all.14238.
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[23] Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis 2020. doi:10.1016/j.ijid.2020.03.017.
[24] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62. doi:10.1016/S0140-6736(20)30566-3.
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[26] Coronavirus: 76% Covid-19 patients men, 24% women in India, says health ministry - India News n.d. https://www.indiatoday.in/india/story/coronavirus-health-ministry-pc-73-percent-male-patients-26-percent-female-india-1663922-2020-04-06 (accessed April 16, 2020).
[27] Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020. doi:10.1056/NEJMoa2001316.
[28] Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M, et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. ImperialAcUk 2020. doi:10.25561/77482.
[29] IDF Diabetes Atlas 9th edition 2019 n.d. https://diabetesatlas.org/en/ (accessed April 16, 2020).
[30] Kosiborod M, Gomes MB, Nicolucci A, Pocock S, Rathmann W, Shestakova M V., et al. Vascular complications in patients with type 2 diabetes: Prevalence and associated factors in 38 countries (the DISCOVER study program). Cardiovasc Diabetol 2018;17. doi:10.1186/s12933-018-0787-8.
[31] Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Bärnighausen T, et al. Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030. Diabetes Care 2018;41:963–70. doi:10.2337/dc17-1962.
[32] Wang Z, Ren J, Wang G, Liu Q, Guo K, Li J. Association between diabetes mellitus and outcomes of patients with sepsis: A meta-analysis. Med Sci Monit 2017;23:3546–55. doi:10.12659/MSM.903144.
[33] A.M.B. M, M. F, G. M, R. N, A. H, K. I, et al. Association of metabolic factors with dengue viral infection on admission triage which predict its clinical course during Lahore dengue epidemic. J Pak Med Assoc 2016;66:1102–6.
[34] Toniolo A, Cassani G, Puggioni A, Rossi A, Colombo A, Onodera T, et al. The diabetes pandemic and associated infections: Suggestions for clinical microbiology. Rev Med Microbiol 2019;30:1–17. doi:10.1097/MRM.0000000000000155.
[35] Critchley JA, Carey IM, Harris T, DeWilde S, Hosking FJ, Cook DG. Glycemic control and risk of infections among people with type 1 or type 2 diabetes in a large primary care cohort study. Diabetes Care 2018;41:2127–35. doi:10.2337/dc18-0287.
[36] Sobngwi E, Mbanya JC. The double burden of infectious diseases and diabetes-A bidirectional relationship. Eur Endocrinol 2015. doi:10.17925/EE.2015.11.02.112.
[37] Li XC, Zhang J, Zhuo JL. The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacol Res 2017. doi:10.1016/j.phrs.2017.06.005.
[38] Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020. doi:10.1016/S2213-2600(20)30116-8.
[39] Alves C, Casqueiro J, Casqueiro J. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab 2012. doi:10.4103/2230-8210.94253.
[40] Frydrych LM, Fattahi F, He K, Ward PA, Delano MJ. Diabetes and sepsis: Risk, recurrence, and ruination. Front Endocrinol (Lausanne) 2017;8:271. doi:10.3389/fendo.2017.00271.
[41] Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Heal 2018;6:e619–29. doi:10.1016/S2214-109X(18)30186-4.
[42] Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol 2017. doi:10.1016/S2213-8587(17)30174-2.
[43] Number of Government Hospitals and Beds in Rural and Urban Areas | Open Government Data (OGD) Platform India n.d. https://data.gov.in/catalog/number-government-hospitals-and-beds-rural-and-urban areas?filters%5Bfield_catalog_reference%5D=95975&format=json&offset=0&limit=6&sort%5Bcreated%5D=desc (accessed April 16, 2020).
[44] National Health Profile 2019 Released - Current Affairs Today. https://currentaffairs.gktoday.in/14th-national-health-profile-released-102019319720.html (accessed April 16, 2020).
[45] https://icmr.nic.in/sites/default/files/whats_new/ICMR_testing_update_16April_9PM_IST.pdf (accessed April 16, 2020).
[46] Covid-19 tests stepped up to around 2,900 every day, Singapore News & Top Stories - The Straits Times. https://www.straitstimes.com/singapore/covid-19-tests-stepped-up-to-around-2900-every-day (accessed April 16, 2020).
[47] Covid-19 spreadsheet: A tale of two states - The Economic Times. https://economictimes.indiatimes.com/news/politics-and-nation/spreadsheet-a-tale-of-two-states/articleshow/75112691.cms?from=mdr (accessed April 16, 2020).
[48] https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf (accessed April 17, 2020).
[49] Chinese Clinical Guidance For COVID-19 Pneumonia Diagnosis and Treatment - American College of Cardiology n.d. https://www.acc.org/latest-in-cardiology/articles/2020/03/17/11/22/chinese-clinical-guidance-for-covid-19-pneumonia-diagnosis-and-treatment (accessed April 17, 2020).
[50] Puig-Domingo M, Marazuela M, Giustina A. COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology. Endocrine 2020;68:2–5. doi:10.1007/s12020-020-02294-5.
[51] https://www.idf.org/our-network/regions-members/europe/welcome.html (accessed April 17, 2020).
[52] Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Heal 2020. doi:10.1016/s2468-2667(20)30061-x.
[53] Newman MG, Zainal NH. The value of maintaining social connections for mental health in older people. Lancet Public Heal 2020. doi:10.1016/S2468-2667(19)30253-1.
[54] Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med 2020. doi:10.1056/nejmsb2005114.
[55] https://www.cdc.gov/flu/pandemic-resources/pdf/community_mitigation-sm.pdf (accessed April 17, 2020).
Published
2020-11-28
How to Cite
1.
Sharma T, Ganie MA, Sahar T, Vasudevan V. Tale of two Pandemics: Scenarios unfolding with the clash of Type 2 Diabetes mellitus and COVID-19 in the Indian subcontinent. jms [Internet]. 2020Nov.28 [cited 2026Oct.25];23(4):4-14. Available from: http://dsh.jmsskims.org/index.php/jms/article/view/789
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Review Articles
This work is licensed under a Creative Commons Attribution 4.0 International License.
