The association between circulatory risk factors and pathologies and the COVID-19 pandemic is becoming more obvious as more people affected receive treatment worldwide. Each member of the Global Coalition for Circulatory Health (GCCH), which brings together international, regional and national stakeholders in circulatory health to drive the urgent action needed to combat heart disease and stroke, has been working actively within its own speciality and constituencies to provide relevant and timely information related to the crisis.

There is, however, a unique opportunity for GCCH to provide a comprehensive and global perspective on circulatory risk factors, such as hypertension, diabetes, obesity, and tobacco use, and outcomes, including renal failure, vascular problems, and cardiovascular disease, associated with COVID-19.

We are therefore delighted to invite you to join our upcoming webinar series, moderated by the Past President of the World Heart Federation, Prof David Wood.

COVID visual webinar logos

 

  • Circulatory Risk Factors for COVID-19, 16 June: speakers included Prof Donna Ryan (World Obesity Federation), Prof Vivek Jha (International Society of Nephrology), Prof Claudio Borghi (International Society of Hypertension) and Dr Eduardo Bianco (Framework Convention Alliance). IDF President, Prof Andrew Boulton, presented "Diabetes-related complications of the lower limb in the COVID-19 context”. 
  • COVID-19 and Circulatory Conditions: Mitigating Poor Outcomes, 30 June:  speakers included Prof Marc Fisher (World Stroke Organization), Dr Anuradha Lala-Trindade (World Heart Federation), Dr Peter Libby (International Atherosclerosis Society) and Prof Gianfranco Parati (World Hypertension League).
  • Supporting the Healthcare Workforce: COVID-19 and Public Health in the Circulatory Space, 14 July 15:00 CEST: speakers included Bettina Borisch (World Federation of Public Health Associations), Erica Burton (International Council of Nurses), Vivian Martinez Bianchi (World Organisation of Family Doctors), Taskeen Kahn (World Health Organisation) and Kawaldip Sehmi (International Alliance of Patients' Organisations)

The recordings of all the webinars are available below.

Circulatory Risk Factors for COVID-19 

COVID-19 and Circulatory Conditions: Mitigating Poor Outcomes

Supporting the Healthcare Workforce: COVID-19 and Public Health in the Circulatory Space

For more information, contact This email address is being protected from spambots. You need JavaScript enabled to view it.

In response to the current COVID-19 pandemic, governments in many countries have restricted the movement of their citizens, confining them to the home environment. Public exercise facilities such as gyms, sports centres and swimming pools have been closed.

Regular physical activity is of great benefit to the general population and even more for people living with chronic conditions like diabetes. Daily physical activity is an integral part of diabetes management, helping to maintain blood glucose at recommended levels.

Physical activity should be seen as a hobby and a valuable tool to overcome the monotony of the difficult confinement that many people around the world are currently experiencing.

Below are a series of daily exercises that can be performed at home, provided by ANIAD, the Italian National Association of Athletes with Diabetes. The exercise intensity of each activity is comparable to one hour of brisk walking, resulting in an energy expenditure of 150-200 Kcal.

  • Treadmill: one-hour brisk walking (no need to run), which can also be split into three 20-minute sessions. If possible, the slope should be adapted to individual fitness levels, to simulate an uphill walk.
  • Stationary bicycle (either reclined or classic): two 15-minute sessions at variable intensity (if the equipment allows it). The sessions can be longer on a reclined bicycle since the effort is reduced by the backrest.
  • Bodyweight exercises such as push-ups, squats, deep stationary lunges, sit-ups or crunches (to strengthen the abdomen) and forward flexes (to strengthen the lower-back muscles). These help maintain muscle tone and, when performed correctly, can have excellent results.
  • Joint mobility and stretching exercises that can be sourced from common workout, yoga and pilates’ routines. (Example video)

Other ways to train at home:

  • Walk up and down 8 sets of stairs, for at least 6 floors. This is not recommended for people with type 2 diabetes who do not exercise regularly.
  • Jump rope
  • Use small weights and home fitness accessories such as rubber bands, kettlebells, wrist weights, ankle weights and pockets filled with heavy objects. Makeshift objects can also be used, such as buckets, cases, bottles filled with water or even small backpacks filled with objects of different weight.

These suggestions can be used to develop short, fragmented or continuous training sessions. Here is an example of a series of “total body” exercises involving all main muscle groups, which anyone can do at home:

  • Two series of 20 Jumping Jacks (on-site jumps with synchronized leg and arm spreading and closing)
  • Two series of 15 crunches (abdomen strengthening)
  • Two series of 15 forward flexes (lower back muscle strengthening)
  • Two series of 10 rowing exercises using dumbbells and slight forward flexion (back muscle strengthening)
  • Two series of 8 push-ups (pectoral muscle strengthening – knees to floor for beginners)
  • Two series of 8 sitting/standing hand-weight lifts (shoulder muscle strengthening)
  • Five minutes of treadmill training or stationary/reclined bicycle
  • Three series x 15 squats (lower limb strengthening)
  • 20 minutes treadmill training
  • Final stretching and relaxation.

Make sure to avoid overload and adapt exercise intensity to individual ability and fitness level. It is also important to monitor your health before, during and after exercising.

The recommendations above were developed and kindly made available by the Scientific Council of ANIAD: Drs. Gerardo Corigliano, Giuseppe Pipicelli, Felice Strollo; Alessio Calabro’ and Matteo Vandoni.

COVID-19 and diabetes - Learn more

Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes cases.

It is generally characterized by insulin resistance, where the body does not fully respond to insulin. Because insulin cannot work properly, blood glucose levels keep rising, releasing more insulin. For some people with type 2 diabetes this can eventually exhaust the pancreas, resulting in the body producing less and less insulin, causing even higher blood sugar levels (hyperglycaemia).

Type 2 diabetes is most commonly diagnosed in older adults, but is increasingly seen in children, adolescents and younger adults due to rising levels of obesity, physical inactivity and poor diet.

The cornerstone of type 2 diabetes management is a healthy diet, increased physical activity and maintaining a healthy body weight. Oral medication and insulin are also frequently prescribed to help control blood glucose levels.

Risk factors

IDF risk factors T2D infographicSeveral risk factors have been associated with type 2 diabetes and include:

  • Family history of diabetes
  • Overweight
  • Unhealthy diet
  • Physical inactivity
  • Increasing age
  • High blood pressure
  • Ethnicity
  • Impaired glucose tolerance (IGT)*
  • History of gestational diabetes
  • Poor nutrition during pregnancy

*Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people living with type 2 diabetes.

Symptoms of type 2 diabetes

t2dsymptomsThe symptoms of type 2 diabetes are similar to those of type 1 diabetes and include:

  • Excessive thirst and dry mouth
  • Frequent urination
  • Lack of energy, tiredness
  • Slow healing wounds
  • Recurrent infections in the skin
  • Blurred vision
  • Tingling or numbness in hands and feet.

These symptoms can be mild or absent and so people with type 2 diabetes may live several years with the condition before being diagnosed.

Management of type 2 diabetes

The cornerstone of managing type 2 diabetes is a healthy lifestyle, which includes a healthy diet, regular physical activity, not smoking, and maintaining a healthy body weight.

Over time, a healthy lifestyle may not be enough to keep blood glucose levels under control and people with type 2 diabetes may need to take oral medication. If treatment with a single medication is not sufficient, combination therapy options may be prescribed.

When oral medication is not sufficient to control blood glucose levels, people with type 2 diabetes may require insulin injections.

Medications for type 2 diabetes

The most commonly used oral medications for type 2 diabetes include:

  • Metformin: reduces insulin resistance and allows the body to use its own insulin more effectively. It is regarded as the first-line treatment for type 2 diabetes in most guidelines around the world.
  • Sulfonylureas: stimulate the pancreas to increase insulin production. Sulfonylureas include gliclazide, glipizide, glimepiride, tolbutamide and glibenclamide.

Prevention of type 2 diabetes

There are a number of factors that influence the development of type 2 diabetes. The most influential are lifestyle behaviours commonly associated with urbanisation. Research indicates that a majority of cases, up to 80% according to some studies, of type 2 diabetes could be prevented through healthy diet and regular physical activity. A healthy diet includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

Know your risk of type 2 diabetes

Risk assessment 966pxBrief questionnaires are simple, practical and inexpensive ways to quickly identify people who may be at a higher risk of type 2 diabetes and who need to have their level of risk further investigated.

The Finnish Type 2 Diabetes Risk Assessment Form, developed in 2001, is an example of an effective questionnaire that can be used as the basis for developing national questionnaires which take into account local factors. It has eight scored questions, with the total test score providing a measure of the probability of developing type 2 diabetes over the following 10 years. The reverse of the form contains brief advice on what the respondent can do to lower their risk of developing the disease, and whether they should seek advice or have a clinical examination. The test takes only a couple of minutes to complete and can be done online, in pharmacies or at various public campaign events.

IDF has developed a type 2 diabetes online diabetes risk assessment that aims to predict an individual’s risk of developing type 2 diabetes within the next ten years. The test is based on the Finnish Diabetes Risk Score (FINDRISC) developed and designed by Adj. Prof Jaana Lindstrom and Prof. Jaakko Tuomilehto from the National Institute for Health and Welfare, Helsinki, Finland. 

COVID-19 is a new and potentially serious coronavirus. The World Health Organization (WHO) has declared the COVID-19 outbreak to be a public health emergency of international concern.

There are many coronaviruses, ranging from the common cold to much more serious viruses such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). They are viruses that have been transmitted from animals to people. In severe cases, coronaviruses can cause infection in the lungs (pneumonia), kidney failure and even death. At present there is no vaccine against COVID-19.

Common signs are typical flu-like symptoms: a fever, cough, breathing difficulties, tiredness and muscle aches. Symptoms usually start within 3-7 days of exposure to the virus, but in some cases it has taken up to 14 days for symptoms to appear.

People of all ages can be infected. For many (more than 80% of cases), COVID-19 is mild, with minimal flu-like symptoms. Some have not shown symptoms or only very mild symptoms, more like a common cold. The majority of people who have caught the virus did not need to be hospitalised for supportive care. However, in approaching 15% of cases COVID-19 has been severe and in around 5% of cases it has led to critical illness. The vast majority (around 98%) of people infected to date have survived.

Corona guidelines 800pxOlder people and people with pre-existing medical conditions (such as diabetes, heart disease and asthma) appear to be more vulnerable to becoming severely ill with the COVID-19 virus. When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications. There appear to be two reasons for this. Firstly, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period. Secondly, the virus may thrive in an environment of elevated blood glucose.

Like any other respiratory disease, COVID-19 is spread through air-droplets that are dispersed when an infected person talks, sneezes or coughs. The virus can survive from a few hours up to a few days depending on the environmental conditions. It can be spread through close contact with an infected person or by contact with air droplets in the environment (on a surface for example) and then touching the mouth or nose (hence the common advice circulating on hand hygiene and social distancing).

What can people with diabetes and their loved ones do?

For people living with diabetes it is important to take precautions to avoid the virus if possible. The recommendations that are being widely issued to the general public are doubly important for people living with diabetes and anyone in close contact with people living with diabetes.

  • Wash hands thoroughly and regularly.
  • Try to avoid touching your face before you have washed and dried your hands.
  • Clean and disinfect any objects and surfaces that are touched frequently.
  • Don’t share food, glasses, towels, tools etc.
  • When you cough or sneeze, cover your mouth and nose with a tissue or use the crook of your arm if you don’t have a tissue to hand (dispose of the tissue appropriately after use).
  • Try to avoid contact with anyone showing symptoms of respiratory illness such as coughing.
  • Think whether you can make changes that will help protect yourself or loved ones. For example, can you avoid unnecessary business travel? Can you avoid large gatherings? Can you avoid public transport?
  • If you are ill with flu-like symptoms, stay at home.
COVID perspectives 800pxIf you have diabetes:
  • Prepare in case you get ill.
  • Make sure you have all relevant contact details to hand in case you need them.
  • Pay extra attention to your glucose control. Regular monitoring can help avoid complications caused by high or low blood glucose.
  • If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a healthcare professional. If you are coughing up phlegm, this may indicate an infection so you should seek medical support and treatment immediately.
  • Any infection is going to raise your glucose levels and increase your need for fluids, so make sure you can access a sufficient supply of water.
  • Make sure you have a good supply of the diabetes medications you need. Think what you would need if you had to quarantine yourself for a few weeks.
  • Make sure you have access to enough food.
  • Make sure you will be able to correct the situation if your blood glucose drops suddenly.
  • If you live alone, make sure someone you can rely on knows you have diabetes as you may require assistance if you get ill.
  • Keep a regular schedule, avoiding overwork and having a good night's sleep.

Healthy nutrition is an essential component of diabetes management. It is therefore important for people with diabetes to eat a varied and balanced diet to keep their blood glucose levels stable and enhance their immune system. It is recommended to:

  • Give priority to foods with a low glycaemic index (e.g. vegetables, whole wheat pasta/noodles)
  • Avoid excessive consumption of fried foods
  • Limit consumption of foods high in sugar, carbohydrates and fat
  • Choose lean proteins (eg. fish, meat, eggs, milk, beans after fully cooked).
  • Eat green, leafy vegetables
  • Eat fruits in two or three servings

Home based exercise squareIn response to the COVID-19 pandemic, governments in many countries have restricted the movement of their citizens, confining them to the home environment. Regular physical activity is of great benefit to the general population and even more for people living with diabetes. View a series of daily exercises that can be performed at home.

In some countries, restrictions imposed to tackle the spread of the COVID-19 pandemic are disrupting the supply chain for insulin and other essential diabetes medicines. IDF is actively monitoring where issues are arising and helping to determine what assistance can be offered. Learn more.

IDF has also joined a global effort, together with the world’s leading diabetes organizations, to reduce risk for people with diabetes during the COVID-19 pandemic. Learn more.

COVID-19 is a new coronavirus. Keep informed of the latest developments by looking out for updates and advice from your government, national diabetes association and other reliable sources.

Useful links:

Several IDF national members have published guidance and advice on managing and preventing COVID-19 for people with diabetes and health professionals in their countries. A selection of links is available below.

Argentina: CUI.D.AR; FAD | Australia | Bangladesh - Guidelines for people with diabetes (Bangla) - Guidelines for HCPs | Belgium - DutchFrench | Brazil - ANADSBD | Costa RicaFrance | Germany | Greece - EDEHDA Guidelines | IndiaInterview with Chair, IDF South-East Asia Region (Hindi) | Iran | Italy | Japan | Mexico | Morocco (pdf) | New Zealand | Poland | PortugalAPDP webinar 6 April 2020 (YouTube) | SloveniaSpain | Sweden | Turkey | USA - ADAJDRF

Articles in Diabetes Voice

Articles in Diabetes Research and Clinical Practice (DRCP)

IDF's official journal, Diabetes Research and Clinical Practice (DRCP), is committed to playing a positive role during the COVID-19 crisis. It aims to serve as a quick, trusted and authoritative platform for disseminating new diabetes research relating to the pandemic, with the aim of better serving people with diabetes all around the world. Articles currently published on the topic include:

COVID-19 and diabetes - Learn more

Around 10% of all people with diabetes have type 1 diabetes.

Type 1 diabetes is caused by an autoimmune reaction where the body’s defence system attacks the cells that produce insulin. As a result, the body produces very little or no insulin. The exact causes of this are not yet known, but are linked to a combination of genetic and environmental conditions.

Type 1 diabetes can affect people at any age, but usually develops in children or young adults. People with type 1 diabetes need daily injections of insulin to control their blood glucose levels. If people with type 1 diabetes do not have access to insulin, they will die.

The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

Symptoms of type 1 diabetes

The most common symptoms of type 1 diabetes include:

  • Abnormal thirst and dry mouth
  • Sudden weight loss
  • Frequent urination
  • Lack of energy, tiredness
  • Constant hunger
  • Blurred vision
  • Bedwetting

Diagnosing type 1 diabetes can be difficult so additional tests may be required to confirm a diagnosis.

Management of type 1 diabetes

People with type 1 diabetes require daily insulin treatment, regular blood glucose monitoring and a healthy lifestyle to manage their condition effectively.

Insulin

All people with type 1 diabetes need to take insulin to control their blood glucose levels. There are different types of insulin depending on how quickly they work, when they peak, and how long they last. Insulin is commonly delivered with a syringe, insulin pen or insulin pump.

Types of insulin include:

  • Rapid-acting: usually taken just before or with a meal. These insulins act very quickly to limit the rise in blood sugar, which follows eating. It is essential to avoid overdosage to minimize the risk of low blood sugar (hypoglycemia). Rapid-acting insulins include Asparat, Glulisine, Lispro.
  • Short-acting: usually taken before meals. These insulins are also called regular or neutral insulins. They do not act as quickly as rapid-acting insulins and therefore may be more appropriate in certain people. Short-acting insulins include Actrapid, Humulin R, Insuman Rapid.
  • Intermediate-acting: often taken together with a short-acting insulin. Intermediate-acting insulins start to act within the first hour of injecting, followed by a period of peak activity lasting up to 7 hours. Intermediate acting insulins include Humulin NPH, Protaphane, Insulatard.
  • Long-acting: insulins that are steadily released and can last in the body for up to 24 hours. They are commonly taken in the morning or in the evening, before going to bed. Long-acting insulins include Detemir, Glargine.

Two common insulin treatment plans include:

  • Twice-daily insulin: using both short-acting and intermediate-acting insulin.
  • Basal bolus regimen: short-acting insulin taken with main meals (usually three times a day) and intermediate-acting insulin given once or twice daily (evening or morning and evening).
Self-monitoring

People with diabetes who require insulin need to check their blood glucose levels regularly to inform insulin dosage. Self-monitoring of blood glucose (SBMG) is the name given to the process of blood glucose testing by people with diabetes at home, school, work or elsewhere. SMBG helps people with diabetes and their healthcare providers understand how their blood glucose levels vary during the day so that their treatment can be adjusted accordingly.

People with type 1 diabetes are usually advised to measure their blood glucose level at least four times a day. 

Healthy nutrition

Healthy nutrition — knowing what and when to eat — is an important part of diabetes management as different foods affect your blood glucose levels differently.

A healthy diet for all people with diabetes includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Physical activity

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

Prevention of type 1 diabetes

No effective and safe intervention currently exists to prevent type 1 diabetes despite a large number of clinical trials aimed at halting the on-going autoimmune destruction of pancreatic beta cells. However, there is some evidence that overweight and a high growth rate in children are weak risk factors, indicating that a healthy lifestyle that avoids both over-eating and a sedentary lifestyle is recommended for high-risk groups such as the siblings of children with type 1 diabetes. However, this is just one of a number of factors that have also been implicated. These include not being breast-fed, being the first-born, being born by caesarean section and having an older or obese mother.

Although a ‘cure’ for type 1 diabetes is being actively sought, preventing or delaying it in those known to be at risk or, in those already diagnosed, slowing down the auto-immune destruction of beta cells and protecting those cells that are still active are likely to be more achievable goals in the foreseeable future. Neither has been convincingly achieved as yet. However, several studies are underway using interventions such as oral insulin in people known to have markers of islet autoimmunity, trialling drugs already used, for example in psoriasis, to prolong beta cell life and the use of peptide immunotherapies to ‘retrain’ killer T cells, the lymphocytes that are closely involved in the underlying mechanism of type 1 diabetes.

[Last updated: January 20, 2020]

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