Mitigating Risk Post COVID-19

Over the course of the COVID-19 pandemic, a number of groups have been identified to be at increased risk of severe infection, including people with respiratory illness and those living with diabetes.

With public adherence to hand hygiene, social distancing and public health guidelines, the risk of contracting COVID-19 appears to have been reduced. However, a recent review study describes how people living with diabetes have experienced worse outcomes and subsequent complications following a natural disaster or emergency in the past, and suggests some measures we can take to mitigate the risk of similarly disruptive circumstances occurring in the near future¹.

According to Jamie Hartmann-Boyce who was involved in this study, “COVID-19 poses a number of serious direct and indirect risks to people with diabetes”, contributing to heightened stress levels, as well as causing unexpected changes to dietary routine and physical activity and an increase in HbA1c; a measure of blood-sugar levels which is used in tests as a predictor for diabetes.

Unfortunately living with diabetes can lead to a number of complications including Diabetes-related Eye Diseases (DEDs). According to the International Diabetes Federation, 415 million people live with diabetes worldwide², with a third of these people expected to develop a diabetes-related retinopathy in their lifetime³.

Hartmann and colleagues acknowledge in their study that worse diabetes outcomes are more common in people with lower economic status^”5  and that “a lack of access to routine health care is a leading cause of morbidity and mortality after disasters; stroke, acute myocardial infarctions and diabetes complications are all shown to increase after the immediate threat has dissipated”.

This is consistent with reports from the International Diabetes Federation that an estimated 75% of people with diabetes live in low and middle-income countries where health care facilities and resources for managing diabetes are poor and public awareness is low. In this way, the likelihood of undiagnosed and challenging blood-sugar levels is much greater and increases the chance of Diabetes-related Eye Diseases developing and progressing to advanced vision threatening stages.

In an effort to address these inequities and the disproportionate impact of disease worldwide, the International Agency for the Prevention of Blindness (IAPB) organised and chaired a webinar in mid June titled “Eye Health and COVID-19: the Response at the United Nations”⁶.

A message of “inclusive recovery” and “leaving no one behind” was central in the panellists discussion, who viewed the current situation as an opportunity to increase cross-sector collaboration within the healthcare system and ensure equitable access to information, care and treatment for patients all across the globe.

It is imperative that we as a community understand the importance of working together with government organisations and other partners to eliminate the disparities in access to healthcare on a global scale and continue reducing the number of people living with preventable visual impairments and blindness worldwide.

References:

1. Hartmann-Boyce, J., Morris, E., Goyder, C., Kinton, J., Perring, J., Nunan, D., Mahtani, K., Buse, J.B., Del Prato, S., Ji, L. and Roussel, R., 2020. Diabetes and COVID-19: Risks, Management, and Learnings From Other National Disasters. Diabetes Care.
2. The International Agency for the Prevention of Blindness. Diabetic Retinopathy. Available at https://www.iapb.org/knowledge/what-is-avoidable-blindness/diabetic-retinopathy/ Accessed July 2020.
3. Wild, S., Roglic, G., Green, A., Sicree, R.
   & King, H. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 27, 1047–1053 (2004).
4. Barometer, D.R., 2017. The Diabetic Retinopathy Barometer Report: Global Findings. International Federation on Ageing. Toronto, ON. Canada.
5. Ng J, Atkin SL, Rigby AS, Walton C, Kilpatrick ES. The effect of extensive flooding in Hull on the glycaemic control of patients with diabetes. Diabet Med 2011;28:519–524
6. The International Agency for the Prevention of Blindness. UN Response to COVID19 and Eye Health Webinar: Round up. Available at https://www.iapb.org/news/un-response-to-covid19-and-eye-health-webinar-round-up/. Accessed July 2020.