India: Diabetes scourge looms large in Kerala amid Covid

Doctors and health experts are worried about an even more frightful prospect on the diabetes front amid Kerala’s struggle to tackle Covid-19, which continues to increase rapidly as about 12,000 new cases are being reported daily for over a month.

Kochi, the commercial hub, has been dubbed the ‘diabetes capital of India’ and even Thiruvananthapuram, the state capital, has a growing number of diabetics.

While the national average for diabetes is eight per cent, in Kerala it is 20 and 16 per cent in Kochi and Thiruvananthapuram, respectively.

In comparison, the corresponding figures are much lower in other major Indian cities: nine per cent in Mumbai, 10 per cent in New Delhi and 12 per cent each in Bangalore and Kolkata.

Dr Jothydev Kesavadev, a prominent research diabetologist, vice-president, Kerala for the All India Association for Advancing Research in Obesity, and chairman and managing director, Jothydev Diabetes Research Centre, told Khaleej Times in an interview that a major consequence of Covid-19 in the state is the likelihood of a massive increase in the number of people with diabetes and requiring lifelong treatment.

“My main concern is the spurt in the number of diabetes cases in Kerala, especially of patients recovering from Covid-19,” said Dr Kesavadev.

“We realised from the start of the Covid crisis in February-March 2020 that it affects beta cells in pancreas, which produce insulin. The stress caused by drugs used for Covid-19 patients has resulted in a sudden surge in the state of the number of patients with diabetes,” he said.

India had 76 million diabetics, but the Covid-19 crisis has seen this rise to 90 million, he said.

“It was estimated that in the normal course, the figure would have reached 100 million in about a decade, but I’m afraid it would have already crossed that figure by now,” he said.

While many of the Covid-19 patients get cured, up to 30 per cent of them will have diabetes as the use of corticosteroids results in a significant rise in glucose levels.

Many also experience mild to severe mucormycosis, a serious fungal infection that has been ravaging Covid-19 patients across India.

Dr Kesavadev warned that patients recovering from Covid-19 will have to proactively go for regular checkups and monitor high glucose levels. Diabetes, chronic kidney diseases, retinopathy and heart problems are ailments that many of these people are prone to, he added.

According to him, there is international consensus on the importance of blood glucose measurement in all patients admitted to hospitals regardless of being diabetic. Blood glucose levels are an important determinant of morbidity and mortality especially among patients in hospitals. Even a slight elevation of the levels may increase mortality among Covid-19 patients, Dr Kesavadev said.

And since it takes just five to 10 seconds for blood glucose measurement, it can be done by nurses while measuring the patient’s temperature with a thermometer.

“This recommendation has been widely endorsed, especially in the wake of Covid-19,” he said.

“It has been realised that blood glucose is the main culprit in increasing severity and contributing to infections such as mucormycosis and also leading to death,” he added.

Asked about the prevalence of diabetes among dependents and relatives in Kerala of non-resident Indians (NRIs) living abroad, Dr Kesavadev said it is widespread. “There is anxiety, depression and mental agony when close relatives are living in a different country for long,” he explains.

“It increases the chances of the person getting diabetes and other health complications.”

There are a large number of patients with relatives in the Arabian Gulf and other countries who are being treated at his facilities in Kerala, he said. “While Covid-19 is a physical ailment, the mental and stress elements have to be taken care of,” he added.

Emphasising on the importance of continuing education for doctors and nurses on how to manage and remotely monitor glucose levels of Covid-19 patients every three to four hours, Dr Kesavadev also referred to newer techniques including multiple injections of rapidly-acting analogue insulins. “It’s challenging and extremely difficult to manage high glucose levels in Covid-19 patients,” he added.

• India