Kyazze Andrew Peter, Bongomin Felix, Ninsiima Sandra, Nattabi Gloria, Nabakka Winnie, Kukunda Rebecca, Odanga Henry, Ssekamatte Phillip, Baluku Joseph Baruch, Kibirige Davis, Andia-Biraro Irene
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, UgandaDepartment of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.
Ther Adv Infect Dis. 2021 Apr 26;8:20499361211009380. doi: 10.1177/20499361211009380. eCollection 2021 Jan-Dec.
Diabetes mellitus (DM) is an important risk factor for both severe disease and death due to coronavirus-2019 (COVID-19). About 19 million of the 463 million persons living with DM (PLWD) globally are found in sub-Saharan Africa (SSA). The dual burden of DM and poverty in SSA, coupled with the rising number of cases of COVID-19 in this region, predisposes PLWD to inadequate care and poor glycemic controls due to the disruption to the economy and the healthcare system. The risk of acquisition of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) among PLWD is the same as those in the general population. Therefore, the standard preventive measures outlined by the World Health Organization must be strictly adhered to. In addition, maintaining adequate glycemic control is associated with better outcomes in DM patients with COVID-19. In SSA, adequate supply of DM medication while patients stay at home is crucial to minimize routine hospital visits since DM clinics are usually overcrowded and have longer waiting times, which may maximize risk of SARS-CoV-2 transmission to PLWD across the region. Psychosocial support to improve adherence to anti-hyperglycemic medications may improve COVID-19 outcomes. Trained healthcare professionals should diagnose and evaluate severity comprehensively as well as evaluate the need for in-patient care for PLWD with COVID-19 irrespective of disease severity. Due to the increased risk of severe disease, a multi-disciplinary approach to the management of COVID-19 in PLWD should preferably be in a setting where close monitoring is available, typically a health facility, even for mild disease that may require home management according to local guidelines. In conclusion, DM complicates COVID-19 outcomes and the on-going COVID-19 pandemic adversely affects DM care at individual and global public health levels. PLWD should be prioritized as COVID-19 vaccines are being rolled out.
糖尿病（DM）是导致2019冠状病毒病（COVID-19）引发重症和死亡的重要风险因素。全球4.63亿糖尿病患者（PLWD）中，约1900万位于撒哈拉以南非洲（SSA）。SSA地区糖尿病与贫困的双重负担，再加上该地区COVID-19病例数不断上升，由于经济和医疗系统受到干扰，使糖尿病患者面临护理不足和血糖控制不佳的问题。糖尿病患者感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的风险与普通人群相同。因此，必须严格遵守世界卫生组织概述的标准预防措施。此外，维持适当的血糖控制与COVID-19糖尿病患者的更好预后相关。在SSA，患者居家期间糖尿病药物的充足供应对于尽量减少常规医院就诊至关重要，因为糖尿病诊所通常人满为患且等待时间较长，这可能会使整个地区糖尿病患者感染SARS-CoV-2的风险最大化。提供心理社会支持以提高对抗高血糖药物的依从性可能会改善COVID-19的预后。训练有素的医疗专业人员应全面诊断和评估严重程度，并评估COVID-19糖尿病患者的住院护理需求，无论疾病严重程度如何。由于重症风险增加，对于糖尿病患者的COVID-19管理，多学科方法最好在能够进行密切监测的环境中进行，通常是医疗机构，即使是根据当地指南可能需要居家管理的轻症患者。总之，糖尿病使COVID-19的预后复杂化，而持续的COVID-19大流行在个体和全球公共卫生层面上对糖尿病护理产生不利影响。在推出COVID-19疫苗时，应优先考虑糖尿病患者。
