Diyabet ve COVID-19
Özet
Diyabet, dünya genelinde hızla artan ve COVID-19 enfeksiyonunun seyrini olumsuz etkileyen en önemli kronik komorbiditelerden biridir. SARS-CoV-2 virüsü, hücre yüzeyindeki ACE2 reseptörlerine bağlanarak hücreye girer; diyabetli bireylerde bu reseptörlerin seviyesindeki artış ve immün sistemdeki fonksiyon kayıpları, enfeksiyona yatkınlığı ve hastalığın şiddetini artırır. Pandemi sürecindeki karantinalar ve kısıtlamalar, diyabet hastalarının sağlık hizmetlerine, ilaçlara erişimini zorlaştırmış; beslenme düzenlerinin bozulmasına, fiziksel aktivitelerin azalmasına ve obezite riskinin artmasına yol açmıştır. Ayrıca, enfekte olma korkusu ve psikososyal stres, hiperglisemik hormonları tetikleyerek kan glikozunu yükseltmiş ve komplikasyon riskini artırmıştır. Diyabetli bireylerde hastaneye ve yoğun bakıma yatış ile mortalite oranları daha yüksek olduğundan, bu popülasyon COVID-19 aşılamasında yüksek öncelikli grup olarak tanımlanmıştır. Bu süreçte hemşireler, multidisipliner ekibin bir parçası olarak hastaların öz yönetim becerilerini (dengeli beslenme, ilaç uyumu, kan şekeri takibi vb.) geliştirmede, enfeksiyondan korunma eğitimleri vermede ve tele-sağlık yoluyla danışmanlık sağlayarak komplikasyonları önlemede kritik roller üstlenmektedir.
Diabetes is one of the most critical chronic comorbidities that is rapidly increasing globally and adversely affects the course of COVID-19 infection. The SARS-CoV-2 virus enters cells by binding to ACE2 receptors on the cell surface; the elevated levels of these receptors and impairments in the immune system of individuals with diabetes increase both susceptibility to infection and the severity of the disease. Quarantine measures and restrictions during the pandemic have hindered diabetes patients' access to healthcare services and medications, leading to disrupted dietary habits, decreased physical activity, and an increased risk of obesity. Furthermore, the fear of infection and psychosocial stress have triggered hyperglycemic hormones, thereby elevating blood glucose and accelerating the risk of complications. Since hospitalization, intensive care admission, and mortality rates are significantly higher among individuals with diabetes, this population has been designated as a high-priority group for COVID-19 vaccination. In this process, nurses, as vital members of the multidisciplinary team, assume critical roles in enhancing patients' self-management behaviors (balanced nutrition, medication adherence, blood glucose monitoring, etc.), providing infection prevention education, and preventing complications through telehealth counseling.
Referanslar
International Diabetes Federation. Turkey Diabetes Report 2000-2045 (01/06/2022 tarihinde https://diabetesatlas.org/data/en/country/203/tr.html adresinden ulaşılmıştır.)
Abdi A, Jalilian M, Sarbarzeh PA, et al. Diabetes and COVID-19: A systematic review on the current evidences. Diabetes research and clinical practice. 2020; 166, 108347. doi.org/10.1016/j.diabres.2020.108347
Lee A. Wuhan novel coronavirus (COVID-19): why global control is challenging?. Public health. 2020; 179, A1. doi: 10.1016/j.puhe.2020.02.001
Çalıca Utku A, Budak G, Karabay O, et al. Main symptoms in patients presenting in the COVID-19 period. Scottish medical journal. 2020; 65(4), 127-132. doi.org/10.1177/0036933020949253
Li Q, Guan X, Wup, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected pneumonia. The New England Journal of Medicine. 2020; 382(13),1199-1207. doi: 10.1056/NEJMoa2001316
Pranata R, Henrina J, Raffaello WM., et al. Diabetes and COVID-19: the past, the present, and the future. Metabolism. 2021; 121, 154814. doi.org/10.1016/j.metabol.2021.154814
Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID‐19. Diabetes/metabolism research and reviews. 2020; 36(7), e3319. doi.org/10.1002/dmrr.3319
Pinchera B, Scotto R, Buonomo, AR, et al. Diabetes and COVID-19: The potential role of mTOR. Diabetes Research and Clinical Practice. 2021; 109813. doi.org/10.1016/j.diabres.2022.109813
Topçuoğlu GP, Avdal EÜ. COVID-19 Pandemisinde Diyabet Yönetimi ve Diyabet Hemşirelerinin Sorumlulukları. Başkent Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2021; 6(2),122-131.
Carey IM, Critchley JA, DeWilde S, et al. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes care. 2018; 41(3), 513-521. doi.org/10.2337/dc17-2131
Lim S, Bae JH, Kwon HS, et al. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nature Reviews Endocrinology. 2021; 17(1), 11-30. doi.org/10.1038/s41574-020-00435-4
Korkmaz H. COVID-19 ve Diabetes Mellitus Yönetimi. SDÜ Tıp Fakültesi Dergisi Özel Sayı. 2021; 28(1)171-175. doi.org/10.17343/sdutfd.904540
Jafar N, Edriss H, Nugent, K. The effect of short-term hyperglycemia on the innate immune system. The American journal of the medical sciences. 2016; 351(2), 201-211. doi.org/10.1016/j.amjms.2015.11.011
Beydoğan AB, Çolak DK, Bilge BN, et al. COVID-19’un İmmün Sistem ve Diyabet Üzerine Etkileri. Cerrahpaşa Medical Journal. 2020; 44(2), 65-73. doi.org/10.5152/cjm.2020.20016
Doğan K, Bolat S, Doğan HO. Obezite, metabolik sendrom, diyabet ve COVID-19 ilişkisi. COVID-19 pandemisinde tıbbi biyokimyanın artan rolü, Türkiye Klinikleri. 2021;1, 63-70.
Sarkar S, Das D, Wann SB, et al. Is diabetes mellitus a wrongdoer to COVID-19 severity?.Diabetes Research And Clinical Practice. 2021;178, 108936. doi.org/10.1016/j.diabres.2021.108936
Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. The Lancet Diabetes & Endocrinology. 2020; 8(6), 546-550. doi.org/10.1016/S2213-8587(20)30152-2
Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020; 75(7), 1730-1741. doi.org/10.1111/all.14238
Bradley SA, Banach M, Alvarado N, et al. Prevalence and impact of diabetes in hospitalized COVID‐19 patients: A systematic review and meta‐analysis. Journal of Diabetes. 2022; 14(2), 144-157. doi.org/10.1111/1753-0407.13243
Arslan K, Baş S. COVID-19 and Diabetes-Prevalence and Prognosis: A Single-Center Experience. Türkiye Diyabet ve Obezite Dergisi. 2021; 5(2), 180-185. doi.org/10.25048/tudod.904249
Landstra CP, de Koning, EJ. COVID-19 and diabetes: understanding the interrelationship and risks for a severe course. Frontiers in Endocrinology. 2021; 12, 599. doi.org/10.3389/fendo.2021.649525
Suwanwongse K, Shabarek N. Newly diagnosed diabetes mellitus, DKA, and COVID‐19: Causality or coincidence? A report of three cases. Journal of medical virology. 2021; 93(2), 1150-1153. doi.org/10.1002/jmv.26339
Mallik R, Huda MS. COVID-19 and Type 2 Diabetes Mellitus In: Manal Mohamad Baddour (Ed.), Fighting the COVID-19 Pandemic. Intech Open. 2021;p.173-184. https://doi.org/10.5772/intechopen.99647
Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 - Metropolitan Atlanta, Georgia, March-April 2020. Morbidity And Mortality Weekly Report. 2020; 69(25), 790–794. https://doi.org/10.15585/mmwr.mm6925e1
Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and metaregression. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020 Jul-Aug; 14(4):395- 403. doi.org/10.1016/j.dsx.2020.04.018
Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. The Lancet Diabetes & Endocrinology. 2020; 8(10), 823-833. doi.org/10.1016/S2213-8587(20)30271-0
Fleming N, Sacks LJ, Pham CT, et al. An overview of COVID‐19 in people with diabetes: Pathophysiology and considerations in the inpatient setting. Diabetic Medicine. 2021; 38(3), e14509. doi.org/10.1111/dme.14509
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020; 395(10229), 1054-1062. doi.org/10.1016/S0140-6736(20)30566-3
Peric S, Stulnig TM. Diabetes and COVID-19. Wiener Klinische Wochenschrift. 2020; 132(13), 356-361. doi.org/10.1007/s00508-020-01672-3
de Almeida-Pititto B, Dualib PM, Zajdenverg L, et al. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetology & Metabolic Syndrome. 2020; 12(1), 1-12. doi.org/10.1186/s13098-020-00586-4
Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. The Lancet Diabetes & Endocrinology. 2020; 8(10), 813-822. doi.org/10.1016/S2213-8587(20)30272-2
Wei SQ, Bilodeau-Bertrand M, Liu S, et al. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. Canadian Medical Assosication Journal. 2021; 193(16), E540-E548. doi.org/10.1503/cmaj.202604
Panaitescu A, Ciobanu AM., Popa M, et al. Screening for Gestational Diabetes during the COVID-19 Pandemic—Current Recommendations and Their Consequences. Medicina. 2021; 57(4), 381. doi.org/10.3390/medicina57040381
La Verde M, Torella M, Riemma G, et al. Incidence of gestational diabetes mellitus before and after the Covid‐19 lockdown: A retrospective cohort study. Journal of Obstetrics and Gynaecology Research. 2022; 48(5), 1126-113. doi: 10.1111/jog.15205.
Wang, C., Pan, R., Wan, X., et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal Of Environmental Research And Public Health. 2020; 17(5), 1729. doi:10.3390/ijerph17051729
Fisher L, Polonsky W, Asuni A, et al. The early impact of the COVID-19 pandemic on adults with type 1 or type 2 diabetes: A national cohort study. Journal of Diabetes and its Complications. 2020; 34(12), 107748. doi.org/10.1016/j.jdiacomp.2020.107748
Rabbone I, Schiaffini R, Cherubini V,et al. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?. Diabetes Care. 2020; 43(11), 2870-2872. doi.org/10.2337/dc20-1321
Pellegrini M, Ponzo V, Rosato R, et al. Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency. Nutrients. 2020; 12(7), 2016. doi.org/10.3390/nu12072016
Grabia M, Markiewicz-Żukowska R, Puścion-Jakubik A, et al. The nutritional and health effects of the COVID-19 pandemic on patients with diabetes mellitus. Nutrients. 2020; 12(10), 3013. https://doi.org/10.3390/nu12103013
Purković M, Vukašinović D, Radak U, et al. The importance of physical activity in diabetes. Biomedicinska istraživanja. 2021; 12(2), 125-138. doi:10.5937/BII2102125P
İdiz C. Diyabetli Bireylere Hangi Beslenme Modeli Önerilmeli?. Beslenme ve Diyet Dergisi. 2019; 47, 44-51. doi.org/10.33076/2019.BDD.1314
Saraçoğlu E, Avcı İA. Diyabet Hastalarının COVID-19 Salgınıyla İlgili Endişelerinin ve Bakım İhtiyaçlarının Belirlenmesi. Türkiye Diyabet ve Obezite Dergisi. 2021; 5(2), 202-209. doi:10.25048/tudod.901442
Joensen LE, Madsen KP, Holm L, et al. Diabetes and COVID‐19: psychosocial consequences of the COVID‐19 pandemic in people with diabetes in Denmark—what characterizes people with high levels of COVID‐19‐related worries?. Diabetic Medicine. 2020; 37(7), 1146-1154. doi.org/10.1111/dme.14319
Wang A, Zhao W, Xu Z, et al.. Timely blood glucose management for the outbreak of 2019 novel coronavirus disease (COVID-19) is urgently needed. Diabetes research and clinical practice. 2020; 162. doi.org/10.1016/j.diabres.2020.108118
Forde R, Arente L, Ausili D, et al. The impact of the COVID‐19 pandemic on people with diabetes and diabetes services: a pan‐European survey of diabetes specialist nurses undertaken by the foundation of European nurses in diabetes survey Consortium. Diabetic Medicine. 2021; 38(5), e14498. doi.org/10.1111/dme.14498
Pal R, Bhadada SK, Misra A. COVID-19 vaccination in patients with diabetes mellitus: Current concepts, uncertainties and challenges. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021; 15(2), 505-508. doi.org/10.1016/j.dsx.2021.02.026
Yıldırım Baş F. Pandemide Aşılamanın Önemi ve Covid 19 Aşılama Çalışmaları. SDÜ Tıp Fakültesi Dergisi. 28 (Özel Sayı), 2021;245-248. doi: 10.17343/sdutfd.902436
T.C. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Resmi Yazısı, COVID-19 Hastalığı İçin Risk Grubunda Olan Kronik Hastalıklar (01/06/2022 tarihinde https://dosyamerkez.saglik.gov.tr/Eklenti/37458,COVID-19-hastaligi-iustyazi47a0af17-2c6a-45a6-88c5-eaeff2d6b8b8pdf.pdf?0&_tag1=C3D6A395CBA0D50C452C3B20B286BDC5D1C496DB adresinden ulaşılmıştır.)
Dünya Sağlık Örgütü, Who Sage Roadmap For Prioritizing Use Of COVID-19 Vaccines (05/06/2022 tarihinde https://apps.who.int/iris/bitstream/handle/10665/351138/WHO-2019-nCoV-Vaccines-SAGE-Prioritization-2022.1-eng.pdf?sequence=1&isAllowed=y adresinden ulaşılmıştır.)
Mencütekin YK, Gençtürk N. COVID-19'lu diabetic hastanın bakımı. Sağlık ve Yaşam Bilimleri Dergisi. 2021; 3(1), 105-110. doi.org/10.33308/2687248X.202131217
American Association of Diabetes Educators. AADE7™self-care behaviors. (05/06/2022 tarihinde https://www.diabeteseducator.org/education/online-courses/adces7-self-care-behaviors-courses adresinden ulaşılmıştır.)
Canbolat Ö, Ekenler Ş, Polat Ü. Diyabet Özyönetiminde Engeller Ve Kolaylaştırıcılar. Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi. 2022; 29(1), 143-148. doi.org/10.17343/sdutfd.1008149
Szymczak-Pajor I, Śliwińska A. Analysis of association between vitamin D deficiency and insulin resistance. Nutrients. 2019;11(4),794. https://doi.org/10.3390/nu11040794.
