By Betty M. Drees, MD, FACP, FACE, Professor and Dean Emerita
University of Missouri-Kansas City School of Medicine
President 2020, Kansas City Medical Society
Diabetes mellitus is a chronic disease that has a tremendous impact on the lives of the 34 million Americans living with diabetes every day. But in November each year, we take the opportunity to formally recognize this impact and reflect on how we can make a difference. This year, the coronavirus pandemic reminds us of the imperative to continue to improve ways to prevent and treat diabetes. Although people with diabetes are not more likely to catch the SARS-CoV-2 virus that causes the COVID-19 infection, they are much more likely to develop severe illness or die from the infection. Forty percent of the people who have died from COVID-19 had diabetes.
Throughout the year, day-in and day-out, we can make a difference for people living with diabetes and at increased risk of developing diabetes. Here are some suggestions for action:
Prevention: Encourage people to take the diabetes risk test through the ADA https://www.diabetes.org/risk-test or the CDC at https://www.cdc.gov/prediabetes/takethetest/. Most people with prediabetes or metabolic syndrome do not know they have it, and yet are at increased risk of developing heart disease. Lifestyle intervention is both clinically and economically effective. Even though some lifestyle programs are limited right now due to the coronavirus pandemic, we can encourage our patients to eat healthier (limit sugary beverages, increase daily vegetables, and limit highly processed foods), move more, and get enough sleep. Not only may these measures reduce long-term risk of developing diabetes and heart disease, improved metabolic health may reduce morbidity and mortality risk due to coronavirus in the short term.
Clinical Care: For people with diagnosed diabetes, encourage them to continue to seek acute care when needed and not avoid urgent care. Have a sick day plan for patients, especially regarding how to manage medications and when to seek urgent care. Keep up ongoing chronic care, including immunizations, cardiovascular risk management and glucose control. (There was early concern about use of ACE inhibitors during the pandemic, but current guidelines recommend continuing ACE inhibitors and ARBs for blood pressure as safe.) Use telemedicine technology where appropriate. Be alert for depression, social isolation and increased risk of food insecurity during the pandemic.
Advocacy: Physician voice in advocating for people with diabetes is critical for policies for equity, access to care, insurance coverage for COVID-19 and affordable insulin. A quarter of people who take insulin for diabetes ration their insulin. Insulin is a unique medication because it is essential for life for people with type 1 diabetes. Many states have passed legislation capping insulin prices, and more will be considering legislation in 2021.
Volunteer: The Kansas City Medical Society Foundation is the charitable arm affiliated with the Kansas City Medical Society. They coordinate millions of dollars of charitable care annually throughout the metropolitan region, largely provided by physician volunteers. In 2019, there were three dozen cases of eye care for diabetes-related eye disease and over five dozen cases of care for people with diabetes with other conditions. If you are interested in volunteering care for patients in need in our area, please contact Karole Bradford of the Foundation at firstname.lastname@example.org, or 913-907-7271.
Physician Self-Care: Higher quality and safer care is provided by doctors and nurses who are healthy themselves, both physically and emotionally. Please take care of yourselves, especially during this pandemic as we all need all of you to be at your best. Eat well, exercise, sleep and stay connected to family, friends and colleagues.
* * *
The theme of this year’s American Diabetes Month from the American Diabetes Association (ADA) is “We Stand Greater than Diabetes.” I encourage physicians to visit the campaign website for resources and join in activities to improve prevention and treatment for people with diabetes: https://www.diabetes.org/greaterthan