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Sunday , February 5 2023

Patients with diabetes more at risk of developing complications from Covid

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Call for a government-led plan to fight obesity and diabetes

KUWAIT CITY, April 6: Diabetes is a ruthless chronic illness affecting the lives of millions across the world. It is very prevalent in the Arab world and also in the Gulf countries. Kuwait is not an exception to that. According to tenth report by International Diabetes Federation (IDF), numbers of diabetic patients around the world are expected to rise from 537 million adults to 784 million by 2045.

Dr Thamer Alessa and Dr Walid Al-Dahi

With the resurgence of COVID-19, people with diabetes are more at risk of developing complications from the virus leading to death. In an interview with the Arab Times, Dr. Thamer Alessa, a consultant physician and Head of Endocrinology and Diabetes Division at the Jaber Al-Ahmad Hospital and a Clinical Staff at Dasman Diabetes Institute in Kuwait and Dr Walid Al-Dahi, President of the Kuwait Diabetes Society (KDS) share their insights on diabetes.

ARAB TIMES: How would you describe the extent and nature of diabetes in Kuwait?

Dr. Thamer Alessa: Unfortunately, diabetes is very prevalent in the Arab world and also in the Gulf countries. Kuwait is not an exception to that. The prevalence of Type 2 diabetes which is a disease caused by different factors – some of them are genetic and some are environmental, Kuwait is one of the leading countries in terms of the prevalence of Type 2 diabetes.

AT: Isn’t it interesting that countries which are wealthy are strongly diabetic?

Dr. Thamer: There is actually an association with that. The more wealthy the country is the more modern the lifestyle they actually live in. If people use machines more, use cars more, live a less active lifestyle and consume more processed food that adds to the prevalence of diabetes. So more industrialized countries, higher income actually triggers the development of diabetes. This modernization is affecting many populations.

AT: How closely is weight gain linked to diabetes? Is it right that 75 percent of Kuwait is overweight and diabetic?

Dr. Thamer: Oh that’s too little. Majority of Kuwaitis are actually overweight and obese. Last estimation from some of the surveys done by the Ministry of Health estimated that more than half of the population are actually overweight or even obese reaching to 70 percent to 90 percent especially in women more than men. That is linked a lot to the development of diabetes.

AT: Does diabetes differ with age and gender of a person?

Dr. Thamer: In gender there’s not really much difference. But in age it does. Diabetes can develop because of age. With aging, organs’ effective function is less as compared to the younger population. So it’s expected that the function of the pancreas and insulin could be less effective. People can develop diabetes just because they are getting older. Now the interesting part is that those patients who are diabetic just because they got older are the lowest in terms of developing complications. Their disease has not developed because they are less active or poor lifestyle.

AT: Has diabetes planning improved in Kuwait in recent years?

Dr. Thamer: In general there is much improvement in screening and management of diabetes. But this hasn’t been done in an orchestrated manner. It needs a government-led plan to fight obesity and diabetes.

AT: Is there a relation between stress and diabetes?

Dr. Thamer: There are generally different types of stress. You can have stress because of emotional factors. So we don’t look at stress as a chronic condition. We look at stress as an event that happened that triggers some of the changes related to chronic health. We don’t look at stress as a cause of diabetes or any other medical condition. We look at stress as a factor to affect the outcome of patients.

AT: If you are diabetic, are you more at risk of getting COVID-19 disease?

Dr. Thamer: Good question. Yes, definitely yes. What we’ve seen so far since the pandemic started in February 2020, three papers have been published in Kuwait describing the association between chronic illnesses and COVID-19 outcome. Patients with diabetes are not really at the increased risk of getting the virus but they are at risk of developing complications from the virus. So if you have a person with diabetes and a person without diabetes, the risk of getting infected is almost the same. Given that they are of the same age and other general factors. But, the person with diabetes seems to be more at risk of developing complications, more at risk of being at the emergency room, more at risk of being hypoxic (low oxygen level in the blood), more at risk of being admitted to the Intensive Care Unit. And unfortunately, more are at risk of dying because of COVID-19. So that’s why when the vaccine campaign started, we were pushing that patients with diabetes should be front row in getting the vaccine because they are at the highest risk of developing complications from the Coronavirus.

AT: Do we need to take medication for diabetes throughout our lives?

Dr. Thamer: It depends on the type of diabetes. There are certain types of diabetes that can be reversible, especially the one that are related to very poor lifestyle and obesity. Improving the lifestyle factors and controlling obesity can manage diabetes in a way we call remission. Meaning they are non-diabetic at this moment. But whenever they start accumulating weight, then probably their diabetes will come back. Other than that, vast majority of people with diabetes do have it as a chronic illness. They need to be on therapy.

AT: How often should a diabetes patient check his blood sugar?
Dr. Walid Al-Dahi: Each diabetic patient has a different aim in checking his blood glucose on daily basis. Patient using insulin need to check their glucose 2-3 times a day at least, patient on oral medications needs to check his glucose 1-2 times a day, and people who are well controlled on oral medication don’t need to test their blood glucose everyday once or twice a week is enough.

AT: How important is diet in diabetes management?

Dr. Walid: Diet or nutritional management is very very important as a part of Type 1 and Type 2 diabetes management in general, and plays a very big role in their management, we advise the patients to reduce the calorie intake over the day and to avoid food with high glycemic index and try to avoid unnecessary sugar during the day. With no dietary control it is difficult to manage diabetic patient with medications only as nutrition is integral part in diabetes management.

AT: Is it true that if you like sweets, you are in danger of becoming diabetic?

Dr. Walid: People who have tendency to be diabetic may have tendency to like sweets because early in the development of Type 2 diabetes there is a little bit of hunger after food, because of the release of insulin, so if anybody have the risk to develop diabetes, (sedentary lifestyle, obesity or family history) or people with prediabetes or a little bit elevated blood sugar they will continue eating sweets, so sweets and high sugary food put the patient in the risk to develop diabetes in the future

AT: If you get diabetes, do you stop having sweets?
Dr.Walid: If you are diagnosed with diabetes it is better to avoid sweets and have low glycemic index good. And we must be smart in choosing our sweets. We don’t stop our patients from eating sweets, but we advise them not to eat sweets frequently in a big amount and to go for sweets with low sugar content or sweets with sugar alternatives. The most important thing is the amount and frequency.

AT: Can diabetes lead to depression?

Dr. Walid: Depression and diabetes are two diseases that may coexist with each other, people with diabetes who are not well controlled they usually have tendency to have high rate of depression, we know from several trials that depression is associated with diabetes and basically it is overlooked in diabetic patients, when they are visiting us, we screen them for depression.

AT: What is meant by diabetic foot?

Dr. Walid: It is a disease in the foot related to diabetes, people with diabetes might have multiple problems with their feet one of them is lack of sensing which we call it neuropathy, in the tip of toes which lead to tendency of injury as they don’t feel surroundings, the other thing is low blood supply which we call it peripheral vascular disease that will lead to death of the part of feet or toes which may lead to gangrene. Also, skin problems like rash and fungal infection in the feet and also advanced foot problems which is called charcoal joints where the joints of the feet are actually smashed and lose its function. So, patients must examine his feet frequently and to take care of his feet, not to cut his nails very short and to walk bare feet and not to expose it not to heat and visit the foot specialist frequently.

AT: Can we prevent diabetes?

Dr. Walid: Diabetes is preventable as Type 2 diabetes doesn’t start immediately it goes from normal to what we call pre-diabetes, and then diabetes. So, if the patient is in the state of pre-diabetes there is a big chance that he prevents the development of diabetes, but once the patient developed diabetes he is diabetic for life long he may be controlled but he still is called by definition diabetic.

AT:What is prediabetic?

Dr. Walid: Is when the fasting blood glucose is between 5.6 and 6.9 or HbA1c which is the average glucose is between 5.6 and 6.4 if you are in this state you have a big chance to revert to normal. What are things to do? Is to improve lifestyle by doing regular exercise at least 150 mins a week plus 7% weight loss and that is proven by evidence to reduce risk of development diabetes by 60 %. Some patients need to take medication which is metformin which reduces the risk by 30%.

By Marlon Aquino Malinao Arab Times Staff

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