A group of endocrinologists has recently published a series of recommendations for people with diabetes, and other hormone disorders, during the COVID-19 pandemic. They say that doctors should pay special attention to this group.
The new article is the result of a collaboration between three experts in endocrine disorders, including diabetes. It begins by stating:
“In our professional lives, we have not witnessed a healthcare crisis of this magnitude and severity.”
The COVID-19 pandemic is unlike anything that most people have ever seen. It presents unique challenges to doctors working to treat high risk groups, such as those with existing respiratory conditions and those whose immune systems are compromised.
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This article, which appears in The Journal of Clinical Endocrinology & Metabolism, addresses COVID-19’s risks for patients with adrenal insufficiency. It also includes some general advice for people with diabetes.
The adrenal glands sit above the kidneys and produce hormones that, alongside the pituitary gland and hypothalamus, regulate blood pressure, the immune response, and the body’s response to stress.
Healthcare professionals consider people with diabetes at higher risk of severe illness, according to the Centers for Disease Control and Prevention (CDC). The same goes for people with autoimmune conditions that lead to adrenal insufficiency.
More than 10% of the United States population (around 34.2 million people) have diabetes, making it a significant group of at risk individuals.
Though rarer, the consequences for people with primary (otherwise known as Addison’s disease), secondary, and tertiary adrenal insufficiency could be even more serious.
Primary adrenal insufficiency affects around 100–140 people per million. Secondary or tertiary insufficiency affect around 150–280 people per million.
However, the authors of the new article advise that the same caution should extend to the 5% of the population who take long-term steroids for inflammatory conditions — half of whom would have some degree of insufficient adrenal response in a crisis.
Early data from Wuhan, China, where the pandemic originated, show that people with diabetes were more likely to become severely ill from COVID-19.
Senior author Prof. Paul Stewart, a professor of medicine at the University of Leeds in the United Kingdom, explains in the new article:
“There is early evidence from China that those patients who have endocrinological disorders face additional risks from COVID-19. The scientific picture indicates that these people need to self-isolate, to try and reduce the chance of infection in the same way as the background population.”
People with diabetes are no more likely to contract SARS-CoV-2, which is the virus that causes COVID-19, but if they do, the severity of the disease is likely to be greater.
It is therefore important that healthcare providers be vigilant in assessing people with diabetes who show symptoms, the article states.
This is in line with recent information from the American Diabetes Association, who explain that people with diabetes are more likely to experience severe symptoms when they contract any virus. They are therefore likely to face worse outcomes from COVID-19.
They remind people with diabetes to be alert for symptoms of the disease, such as a fever, a dry cough, and shortness of breath.
The authors go on to recommend that people with adrenal insufficiency and those taking long-term glucocorticoids follow their “sick day rules.” This is a series of procedures agreed on with a physician for when they feel unwell, including drinking plenty of fluids and doubling their daily dose in line with the doctor’s recommendations.
Glucocorticoids are steroid hormones that help the body fight infection. They are insufficient in the bodies of people with adrenal gland disorders.
The article also recommends that people taking glucocorticoids who develop symptoms of COVID-19 should immediately double their daily dose. The authors reiterate that health professionals should consider everyone taking corticosteroids in the high risk category for COVID-19.
The authors say that although “glucocorticoid treatment has no role to play in the treatment of COVID-19 per se,” in people who have previously taken glucocorticoids and are deteriorating due to COVID-19, it may be necessary to deliver high doses — perhaps even via an intravenous route.
However, they note that people must take glucocorticoids very carefully, because at large doses, the treatment can actually suppress the immune system and weaken the body’s ability to fight the novel coronavirus.
Importantly, these recommendations apply to specific groups, and it is important that people do not change their medication or other care regimens without first talking to their doctor.
The authors are also keen to provide hope that a treatment will soon be available for COVID-19. The article discusses a number of exciting potential treatments for the disease, all with endocrine-related targets.
One such target is ACE2, a receptor for the new coronavirus. Clinical trials for a treatment that can slow the entry and spread of the virus are currently under way.
Another potential drug is a compound called camostat mesylate, which reduces viral transmission. Recent tests show that the treatment can stop the virus from entering the lungs.
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