HTL Strefa

Covid-19

COVID-19 and Patients with Diabetes

Increased incidence of COVID-19 in patients with diabetes

The spread of the novel SARS-CoV-2 coronavirus (COVID-19) has reached pandemic proportions and represents a threat for increased morbidity and mortality, which is particularly observed in older persons and in people with co-morbidities such as overt diabetes, obesity and hypertension.

The high incidence of diabetes throughout the world makes this particularly concerning as the COVID-19 pandemic progresses. Emerging data, particularly from China, indicates that patients with diabetes are at high risk for COVID-19 infection. For example, a large observational report including 1099 patients with confirmed COVID-19 infection indicated that 173 people with severe disease suffered from comorbidities including hypertension (23.7%), diabetes mellitus (16.2%), coronary heart diseases (5.8%), and cerebrovascular disease (2.3%). In another study of 140 patients who were admitted to a hospital with COVID-19, 30% had hypertension and 12% had diabetes.

Diabetes increases morbidity and mortality in diabetic patients with COVID-19

Emerging information suggest that individuals with diabetes are at increased risk for complications including death. For example, the most distinctive comorbidities in 32 non-survivors from a group of 52 intensive care unit patients with COVID-19 in a study in China were diabetes (22%) and cerebrovascular disease. Very recently, a summary report from the Chinese Center for Disease Control of 72 314 cases across the country showed an overall fatality rate of 2.3% but this was increased to 10.5% in people with cardiovascular disease and 7.3% and 6%, respectively for people having diabetes or hypertension. These observations are consistent with prior data concerning people with respiratory diseases. For example, mortality rates among persons with diabetes in Hong Kong aged 75 and over from pneumonia exceed mortality rates in this age group due to cardiovascular disease and cancer. Similar evidence of risk among persons with diabetes has been reported for the two earlier COVID infections, severe acute respiratory syndrome (SARS) which began in 2002 and affected more than 8000 persons, mainly and in Asia and the Middle East, and the respiratory syndrome (MERS) in 2012 which affected more than 2000 persons, mainly in Saudi Arabia.

Importance of glycemic control in those with coexistence of COVID-19 infection and diabetes

To date, there have been only limited experimental studies directly addressing the role of hyperglycemia in the pathogenesis and prognosis of viral respiratory diseases. However, it has been shown that elevated blood glucose levels can directly increase glucose concentrations in airway secretion. In vitro exposure of pulmonary epithelial cells to elevated glucose concentrations significantly increased influenza virus infection and replication, suggesting that hyperglycemia may increase viral replication in vivo. Elevated glucose levels may also serve to suppress the anti-viral immune response. These findings are consistent with studies of patients infected with highly pathogenic avian influenza, whereby hyperglycemia was associated with a fatal outcome. Hyperglycemia may also affect pulmonary function such that influenza virus-induced respiratory dysfunction is exacerbated in patients with diabetes. In animal models of disease, diabetes is associated with numerous structural changes to the lung.

Collectively, experimental data support the notion that glycemic control can have beneficial effects on clinical outcomes in patients with coexistent diabetes and viral respiratory diseases such as COVID-19. However, there are a number of challenges that arise with regard to optimal metabolic control. First, it will be important to raise the awareness among those on the front line of the importance of glycemic control in these patients. In this regard, optimal treatment of such patients should involve a multidisciplinary team approach including specialists in emergency medicine, infectious diseases, respiratory function and endocrinology. Further, support from nutritionists and exercise rehabilitation specialists may be required during prolonged periods of hospitalization and recovery. Experience from China describes some of the first patients treated for Covid-19 infection and shows that during their hospital stay, metabolic control was inadequate as defined by fasting and/or glucose levels outside of the reference ranges.

There are, however, several important unknown issues regarding diabetes and COVID-19. It is unclear whether there are differences in the rates and severity of infections in men versus women with diabetes and whether there is a difference in rates of infection and severity of infection in type 1 versus type 2 diabetic patients. Data shows that an increasing number of diabetic patients are cancelling their routine visits to diabetes clinics. This development along with the increased stress associated with social isolation and lack of physical activity provides a fertile ground for worsening glycemic and blood pressure control, further predisposing these vulnerable patients to COVID-19 infections.

Measures to prevent COVID-19

The following measures are suggested for the prevention of this disease in patients with diabetes:

A.Specific Measures in Patients with Diabetes:
a) It is important that people with diabetes maintain good glycemic control, as it might help in reducing the risk of infection and also its severity. More frequent monitoring of blood glucose levels (with use of self-monitoring blood glucose) is required. Good glycemic control may lessen the chances of superadded bacterial pneumonia as well.
b) Patients with diabetes and co-existing heart disease or kidney disease need special care and attempts should be made to stabilize their cardiac/renal status.
c) Attention to nutrition and adequate protein intake is important. Any deficiencies of minerals and vitamins need to be taken care of.
d) Exercise has been shown to improve immunity, though it might be prudent to be careful and avoid crowded places like gyms or swimming pools.
e) It is important to get influenza and pneumonia vaccinations. The latter may decrease the chances of secondary bacterial pneumonia after respiratory viral infection, however, data regarding the present viral epidemic is not available.

B. General Preventive Measures:
a) Thorough handwashing with soap and water should be encouraged since it kills the virus. Use of alcohol-based hand rubs is also useful.
b) There is a need to practice proper respiratory hygiene by covering the mouth and nose with the elbow or a tissue when coughing or sneezing. Touching of the mouth, nose and eyes should be avoided.
c) Contact with an affected person needs to be minimized. Use of recommended face masks is advised if there is a contact with someone with respiratory symptoms.
d) Non-essential travel to major affected areas should be avoided in order to restrict the spread of infection.

C. Measures in Patients of diabetes with COVID 19 infection:
a) In case a person with diabetes develops a fever, cough, runny nose or dyspnea, the appropriate health authority needs to be notified as testing for this disease is available at selected places only.
b) The affected person needs to be isolated for 14 days or till the symptoms resolve (whichever is longer). Country-specific guidelines need to be followed.
c) The majority of patients have a mild form of the disease and can be managed at home. Hydration should be maintained and symptomatic treatment with acetaminophen, steam inhalation etc. can be given.
d) Patients with type 1 diabetes should measure blood glucose and urinary ketones frequently if fever with hyperglycemia occurs. Frequent changes in dosage and correctional bolus may be required to maintain normoglycemia.
e) Anti-hyperglycemic agents that can cause volume depletion or hypoglycemia should be avoided. Dosage of oral anti-diabetic drugs may need to be reduced. Patients should follow sick day guidelines and may need more frequent monitoring of blood glucose and drug adjustment.
f) Hospitalized patients with severe disease need frequent blood glucose monitoring. Oral agents, especially metformin and sodium glucose cotransporter-2 inhibitors need to be stopped.
g) Insulin is the preferred agent for the control of hyperglycemia in hospitalized sick patients.

Better blood glucose management strategies for patients suffering both diabetes and COVID-19 are needed

For the COVID-19 patients with diabetes, tailored therapeutic strategy and optimal goal of glucose control should be formulated based on clinical classification, coexisting comorbidities, age and other risk factors. Blood glucose should be controlled for all patients during hospitalization to monitor the progress of illness and avoid aggravation. For critical cases, early identification and timely reduction of adverse drug reaction (for instance, glucocorticoid-induced hyperglycemia) could prevent worse symptoms. During the 4-week follow-up period after discharge, blood glucose homeostasis should be maintained continuously and patients need to avoid infectious diseases due to a lower immune response. Long-term follow-up is still essential for diabetic patients to reduce diabetes-related complications and mortality.

Actions to be taken:
a) Provide remote medical consultation for the patients who are not advised to go to the hospital during the COVID-19 outbreak.
b) Coordinate with nutritionists and hospital canteens to offer a diabetic diet.
c) Provide indoor exercise instructions.
d) The anxiety levels of in-patients should be evaluated. Psychological intervention should be carried out for patients in need.
e) Free educational videos and e-books on diabetes self-management and COVID-19 prevention should be provided for the public via mobile apps.

References:
Bloomgarden ZT. Diabetes and COVID-19. J Diabetes. 2020;12(4):347–348.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;S2213-2600(20)30116-8.
Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr. 2020;14(3):211–212.
Hill M.A., Mantzoros C. and Sowers J.R. Commentary: COVID-19 in Patients with Diabetes, Metabolism (2020)
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;108118.
Zhouand J., Tan J. Diabetes patients with COVID-19 need better care, Metabolism (2020).


The impact of needle diameter... cover

The impact of needle diameter and penetration depth of safety lancets on blood volume and pain perception in 300 volunteers: A randomized controlled trial

The aim of the study is to determine and measure the blood volume as well as level of pain of the study volunteers after being punctured with different safety lancets (varying sizes) from 20 s to 2 m.
Blood sample can be used in a number of ways: for diagnosis, to determine health condition generally and for screening. 300 subjects were punctured 4 times with different safety lancets. After each puncture their blood was collected into the capillary with the volume calculated. After the lancing, the perceived pain was recorded on VAS scale.

It was found that with increased thickness of the needle, the amount of blood sample increases too. Blood volumes obtained after puncturing with different types of safety lancets with the same needle diameter (Gauge) vary depending on the manufacturer. The level of pain in the VASt majority of cases was assessed as minimal or low.

Based on the results obtained from a group of 300 volunteers (1200 punctures) it can be concluded that all types of safety lancets are efficient and safe for both patients and medical personnel.

See full study under this link: https://academicjournals.org/journal/JMLD/article-abstract/The_impact_of_needle_diameter_and_penetration_depth_of_safety_lancets_on_blood_volume and_pain_perception_in_300_volunteers


ikonka

A single-blind, randomized, single-centre study to investigate the characteristics of different personal lancets on blood volume and perceived pain in patients with diabetes mellitus

Randomised controlled trial is a specific type of scientific experiment, and the gold standard for a clinical trial. RCTs are often used to test the efficacy or effectiveness of various types of medical intervention within a patient population. RCTs may also provide an opportunity to gather useful information about adverse effects. In recent years the performance and accuracy of self-monitoring blood glucose (SMBG) devices have been closely watched by regulatory agencies and medical professionals. Mainly, because every day thousands of patients with diabetes lance their fingers many times in order to perform self-monitoring of their blood glucose values.

Material and methods:
Male and female subjects with diabetes type I or II being in good physical and mental health were enrolled in the study. Female subjects were allowed to participate in this study only if they were not pregnant in self reporting. In total 60 diabetic patients were enrolled in the study. The primary objective of this study was to determine and to compare the amount of capillary blood volume collected after a single lancing of the fingertip. In addition, also the perceived pain during the lancing procedure was determined and compared between the lancets.

Results:
The average blood volumes obtained with Droplet® personal lancet 33G and Glucoject® personal lancet 33G used in cooperation with Droplet® lancing device, Microlet 2 lancing device and Glucoject® lancing device were in each case higher than 4 µl except for one puncture. In 50% of pricks the obtained average blood volume was higher than 6 µl. Bleeding time was up to 2 minutes. The study results have also shown that in case of majority of patients the received blood sample volume has been higher than 0.5 µl with a total effectiveness rate of 91.67%.Perceived pain was evaluated as a secondary efficacy variable. The pain perception was measured after each prick. 3 minutes (+/- 1 minute) after pricking the subject noted in his/her worksheet intensity of the perceived pain and.

Conclusions:
As demonstrated by the results of clinical evaluations, Droplet® personal lancets 33G type 560 and Glucoject® personal lancets 33G type 560 manufactured by HTL-STREFA S.A. provide sufficient blood sample for personal blood glucose level measurements with minimal pain perception.

See full study under this link:
http://www.openaccessjournals.com/articles/a-singleblind-randomized-singlecentre-study-to-investigate-the-characteristics-of-different-personal-lancets-on-blood-volume-and-p.html


sharpin

Sharps injuries

Sharp injury is an incident, which causes a needle, blade (such as scalpel) or  other medical instruments to penetrate the skin. This is sometimes called a percutaneous injury. OSHA reports that nearly 55% of all percutaneous injuries are caused by hollow bore needles including phlebotomy needles.

Every day while caring for patients, health care workers are at risk to exposure to bloodborne pathogens potentially resulting in infections such as HIV or hepatitis B and C. Sharp injuries can occur before, during or even after use of a sharp. Injury can affect you and your loved ones.
Sometimes, once is enough…

Needlestick injuries are the number one cause of exposure to HIV and Hepatitis C among health care professionals. This video, prepared by http://www.worksafebc.com/, depicts the emotional impact of needlestick injuries to health care workers and their families.

yt-starter

Health care workers should take the following steps to protect themselves from needlestick injuries:

  • Avoid the use of needles where safe and effective alternatives are available.
  • Help their employer select and evaluate devices with safety features and use devices with safety features provided by employer.
  • Avoid recapping needles.
  • Plan for safe handling and disposal before beginning any procedure using needles.
  • Dispose of used needles promptly in appropriate sharps disposal containers.
  • Report all needlestick and other sharps-related injuries promptly to ensure that you receive appropriate followup care.
  • Tell the employer about hazards from needles that you observe in your work environment.
  • Participate in bloodborne pathogen training and follow recommended infection prevention practices, including hepatitis B vaccination.

Needlestick injuries can be avoided by eliminating the unnecessary use of needles, using devices with safety features, and promoting education and safe work practices for handling needles and related systems. These measures should be part of a comprehensive program to prevent the transmission of bloodborne pathogens.

For more information please visit DOWNLOADS section.


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Sharps injuries. Assessing the burden of disease from sharps injuries to healthcare workers at national and local levels.

Sharps injuries: Assessing the burden of disease from sharps injuries to health-care workers at national and local levels
Environmental burden of disease series No. 11
By E. Rapiti, A. Prüss-Üstün, Y. Hutin

This guide outlines a method for estimating the burden of disease at national or local levels from sharps injuries to health-care workers. Sharps include syringe needles, scalpels, broken glass and other objects contaminated with blood from a source patient. Health outcomes from percutaneous injuries include infections with hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV). Exposure is assessed from the number of sharps injuries in health-care workers each year, and from the infection prevalence in source patients. The immunization rate against HBV, and the post-exposure prophylaxis (PEP) coverage are also needed to assess the disease burden. The assessment provides the incidence of HBV, HCV and HIV infections caused by sharps injuries to health-care workers, and the fractions of the infections attributable to sharps injuries. The number of infections that could be prevented by PEP can also be estimated. The data can be used to assess the distribution of disease burden by category of health-care worker, by ward or by activity, which would allow protection measures to be more-specifically targeted.
See full article under this link:  http://www.who.int/quantifying_ehimpacts/publications/ebd11.pdf


Q&A Diabetes

What is diabetes?

What is diabetes?

Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy.
Diabetes is a disease in which the body is unable to properly use and store glucose. Glucose backs up in the bloodstream — causing one’s blood glucose (sometimes referred to as blood sugar) to rise too high.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is predicted by a clear set of symptoms, but it still often goes undiagnosed.

Diabetes symptoms include:

  • Urinating often
  • Feeling very thirsty
  • Feeling very hungry – even though you are eating
  • Extreme fatigue
  • Blurry vision Cuts/bruises that are slow to heal
  • Weight loss – even though you are eating more (type 1)
  • Tingling, pain, or numbness in the hands/feet (type 2)

Early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes.

In some cases, there are no symptoms — this happens at times with type 2 diabetes. In this case, people can live even for years without knowing they have the disease. This form of diabetes comes on so gradually that symptoms may not even be recognized.

 

What are the types of diabetes?

 

Type 1 (10% of cases) Also known as “insulin dependent” or “juvenile diabetes”, this variation results from the body’s failure to produce insulin. Patients are required to inject insulin daily or wear an insulin pump in order to manage the disease.

Type 2 (about 90% of cases) Also known as “Adult-onset Diabetes” is considerably more common and typically affects people over the age of 45, who are also overweight, results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. Disease management requires daily monitoring of blood glucose levels. The condition can deteriorate requiring daily insulin injections or an insulin pump.

Gestational diabetes During pregnancy (usually around the 24th week) many women develop gestational diabetes. It occurs in 3-5% of all pregnancies (in other words, 1 in 20 pregnant women will develop gestational diabetes).

 

Who gets diabetes?

 

Diabetes can occur in anyone. This disease affects all ages, genders and races. In 2013, 382 million people (8.3% of the population) were suffering with diabetes globally. However, people who have close relatives with the disease are somewhat more likely to develop it.
Other risk factors include obesity, high cholesterol, high blood pressure, and physical inactivity. The risk of developing diabetes also increases as people grow older. People who are over 40 and overweight are more likely to develop diabetes, although the incidence of type 2 diabetes in adolescents is growing. Also, people who develop diabetes while pregnant are more likely to develop full-blown diabetes later in life.

 

How to treat diabetes?

 

Diabetes is a common disease, yet every individual needs unique care. There are certain things that everyone who has diabetes, whether type 1 or type 2, needs to do to be healthy. People with diabetes and their families should learn as much as possible about the latest medical therapies and approaches, as well as healthy lifestyle choices.
First of all people with diabetes need to learn how to monitor their blood glucose. Daily testing will help determine how well their meal plan, activity plan, and medications are working to keep blood glucose levels in a normal range.
People with type 1 diabetes, and some people with type 2 diabetes, also need to take insulin injections. Some people with type 2 diabetes take pills called “oral agents” which help their bodies produce more insulin and/or use the insulin it is producing better. Some people with type 2 diabetes can manage their disease without medication by appropriate meal planning and adequate physical activity.
Everyone who has diabetes should be seen at regular basis a diabetes specialist (an endocrinologist or a diabetologist) and should have regular eye exams (once a year) by an eye doctor expert in diabetes eye care.
Diabetes is a serious disease that you cannot treat on your own – that is why people with diabetes need a healthcare professional to help them to make a diabetes treatment plan (medication; exercise and meal plan) that is right for them. Good communication with a team of experts can help diabetics to feel in control and respond to changing needs.

 

What are the complications of diabetes?

 

Uncontrolled diabetes can lead to a number of short and long-term health complications, the majority of these diabetes-related conditions occur as a result of uncontrolled blood glucose levels, particularly elevated blood sugar over a prolonged period of time.

Diabetes complications:

  • Diabetic cardiomyopathy, damage to the heart, leading to diastolic dysfunction and eventually heart failure.
  • Diabetic nephropathy, damage to the kidneys, which can lead to chronic renal failure, eventually requiring dialysis.
  • Diabetic neuropathy, abnormal and decreased sensation which, when combined with damaged blood vessels can lead to diabetic foot, in some cases requiring amputation.
  • Diabetic retinopathy, severe vision loss or blindness.

It is essential that diabetics are aware of the complications that can occur as a result of diabetes to ensure that the first symptoms of any possible illness are spotted before they develop.

 

How to prevent diabetes?

 

Unfortunately type 1 diabetes cannot be prevented. But up to 58 per cent of cases of Type 2 diabetes can be delayed or prevented by making simple changes in our everyday lives. Modest weight loss (5-10% of body weight) and modest physical activity (30 minutes a day) are recommended goals – so it all can be boiled down to five words: Eat better and move more.
Source:
https://htl-strefa.com
http://www.joslin.org/
http://www.diabetes.co.uk/
http://www.diabetes.org/