Diabetes is dynamite for person with COVID: Ex-WHO advisor

Agencies
June 30, 2020

Between 30-40 per cent of deaths from studies in intensive care units from different countries are people with diabetes, said Paul Zimmet, Professor of Diabetes, Monash University, Australia.

Zimmet, who is President International Diabetes Federation, added that the actual mechanism as to why COVID-19 may cause diabetes is as yet unknown, however, several possibilities exist. "COVID-19 is a very destructive and cunning virus and causes terrible damage to tissues including the lungs and pancreas," said Zimmet. Below are excerpts from an exclusive chat with IANS.

Why do you say Diabetes is dynamite if a person has been infected with COVID-19?

There have been many deaths in many countries, e.g. Italy, China, the UK and US among people with diabetes after infection with COVID-19 (SARS-Cov-2).

The mortality tends to be mainly in older Type 2 diabetics. Between 30-40 per cent of deaths from studies in intensive care units from different countries are people with diabetes. This outcome and other complications from the virus, particularly pneumonia, are more likely in people with diabetes which is poorly controlled with high blood sugars (poor metabolic control).

Diabetes is often associated with other chronic conditions, including obesity, hypertension and heart disease compounding the risk. These latter conditions all convey higher risk to COVID-19 infections.

ACE-2, which binds to SARS-Cov-2 and allows the virus to enter human cells is also located in organs and tissues involved in glucose metabolism. Is there solid evidence that virus after entering tissues may cause multiple and complex impairment of glucose metabolism?

The actual mechanism as to why COVID-19 may cause diabetes is as yet unknown.

However, several possibilities exist. Firstly, COVID-19 is a very destructive and cunning virus and causes terrible damage to tissues, including the lungs and pancreas.

A new study just published showed that in miniature lab-grown pancreas, and other cells such as liver, made using human stem cells, COVID-19 caused destruction of the pancreas beta cells that produce insulin.

It is possible that the virus causes disruption of the cells by disrupting cellular metabolism. This is possibly the way it brings about new-onset diabetes. ACE-2 exists in high concentration in the lung as this also explains the terrible lung side effects of COVID-19 infections.

Can COVID-19 lead to a new mechanism of diabetes? Probably a new form of diabetes or a new form of disease?

The COVID-19 virus has only been with us for about 5 months and there is a huge amount that we still must learn about its cunning and devastating ways. The purpose of the Global COVIDIAB Diabetes Registry, a joint initiative of Monash University in Australia, and King’s College London is to gain a much better understanding of how common is the appearance of COVID-19 related diabetes, what form does it take be it type 1 or type 2 or a new form, and how common are the complications that we already know e.g. diabetic keto-acidosis, hyperosmolar coma and high insulin requirements are causing high rates of ill health and mortality worldwide. The knowledge gained will aid our understanding for developing strategies to prevent and treat this terrible virus that has caused destruction globally.

Diabetes is one of the most prevalent chronic diseases in India. According to a recent study, sugar levels of diabetic persons increased by 20 per cent during nationwide lockdown in India to contain COVID-19 outbreak. Even after lockdown was lifted, many people are confined within their home. Do you think lack of physical activity will create more problems for diabetics?

My own major research has been on studying populations with high rates of diabetes, including ethnic Indian communities including India, Mauritius, and Fiji so I am very well aware of this. It is now well established that along with diabetes, that associated poor metabolic control of their diabetes places these people at the highest risk for COVID infection and its devastating complications and the associated morbidity and mortality. And these communities have high prevalence of heart disease as well.

Lockdown not only has deleterious effects on metabolic control of the diabetes through reduced opportunities for exercise to be protective serious consequences of SARS-CoV-2 infection, lockdown usually results in disruption of the regular medical care and the regular monitoring of metabolic control. This may also be partly due to the stress and poor compliance, or inability to afford their medications such as insulin. It may also be compounded by inability to access the care during the pandemic. Nevertheless, we now know that poor metabolic control heightens their risk as described above.

You have said diabetes is itself a pandemic just like Covid-19, and the two pandemics could be clashing. How could governments address this problem?

These are “The Times of COVID-19”. Most nations of the world were totally unprepared for a pandemic of this magnitude. They underestimated its potential impact and the destructive nature of the viral infection. This should prompt all countries to upgrade their guidelines to take into account the lessons learnt on infection control including training of staff specialising in infectious diseases and improved public education and taking their communities into their confidence about the terrible nature of COVID-19. The risks of COVID-19 infection need a much higher priority in the general community, particularly for people with chronic conditions such as diabetes, obesity, and cardiac conditions.

Governments are faced with chronic diseases (NCDs) like diabetes and communicable diseases (CDs) like viral and enteric diseases and TB. In general WHO gives the highest priority to communicable diseases and much less attention and funding to chronic diseases like diabetes (I was an adviser to WHO for many years (about 30) on diabetes and obesity and it was very frustrating to deal with this situation).

This attitude to diabetes, for example, has a flow down effect so that diabetes funding in countries by governments, rich and poor, suffered and was insufficient.

So now we have a COVID-19 pandemic and who are those at highest risk, yes people with diabetes and other NCDs, it is very important that now the two, Diabetes and COVID-19 are clashing face-to-face. This is a major issue that WHO and national governments have to face with equal priority’

Stressed people suffering from diabetes run a greater risk of poor blood glucose levels, what do you suggest to these people?

As mentioned in the answer above, stress is an important factor in upsetting the blood sugar (metabolic) control of diabetes. Additive to this is poor compliance with medications and diet. These and potential associated comorbidities due to other chronic conditions are part of the dynamic dynamite mixture.

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Agencies
January 5,2020

Washington D.C., Jan 5: After a woman filed a lawsuit against a diet soda company, the California court has declared that the beverage does not promise to help buyers in losing weight.

The woman had gulped down the drink for over a decade but did not lose inches as a result.

The three-judge panel declared during the hearing: "The prevalent understanding of the term in (the marketplace) is that the 'diet' version of a soft drink has fewer calories than its 'regular' counterpart."

However, the members of the US 9th circuit court have felt that the consumers tend to make out something of their own that is unreasonable and eventually hamper the reputation of brands through a deceptive allegation, reports Fox News.

The response was due to a misleading case filed against Diet Dr Pepper by Shana Becerra from Santa Rosa, California. Shana claimed that she has been addictively purchasing the low-calorie beverage for the past 13 years hoping for losing some fat but failed to lose even a single inch.

The woman also stated that the attractive and fit models misled her into believing that drink will help her in perfecting her body like them.

However, the court's decision was that advertisements are for representational purposes only. "Cannot be reasonably understood to convey any specific meaning at all," as written by Judge Jay Bybee.

Shana had last week made such allegation against Diet coke as well where the court came to a similar verdict. She claimed that she had found various studies where it is evident that the artificial sweetener aspartame used in diet beverages actually boosts weight gain.

But the artificial sweetener is approved in by the concerned administrative department and thus is used in most American drinks.

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Agencies
July 2,2020

The American pharmaceutical giant Pfizer Inc. and the European biotechnology company BioNTech SE have conducted an experimental trial of a COVID-19 vaccine candidate and found it to be safe, well-tolerated, and capable of generating antibodies in the patients.

The study, which is yet to be peer-reviewed, describes the preliminary clinical data for the candidate vaccine -- nucleoside-modified messenger RNA (modRNA), BNT162b1.

It said the amount of antibodies produced in participants after they received two shots of the vaccine candidate was greater than that reported in patients receiving convalescent plasma from recovered COVID-19 patients.

"I was glad to see Pfizer put up their phase 1 trial data today. Virus neutralizing antibody titers achieved after two doses are greater than convalescent antibody titers," tweeted Peter Hotez, a vaccine scientist from Baylor College of Medicine in the US, who was unrelated to the study.

Researchers, including those from New York University in the US, who were involved in the study, said the candidate vaccine enables human cells to produce an optimised version of the receptor binding domain (RBD) antigen -- a part of the spike (S) protein of SARS-CoV-2 which it uses to gain entry into human cells.

"Robust immunogenicity was observed after vaccination with BNT162b1," the scientists noted in the study.

They said the program is evaluating at least four experimental vaccines, each of which represents a unique combination of mRNA format and target component of the novel coronavirus, SARS-CoV-2.

Based on the study's findings, they said BNT162b1 could be administered in a quantity that was well tolerated, potentially generating a dose dependent production of immune system molecules in the patients.

The research noted that patients treated with the vaccine candidate produced nearly 1.8 to 2.8 fold greater levels of RBD-binding antibodies that could neutralise SARS-CoV-2.

"We are encouraged by the clinical data of BNT162b1, one of four mRNA constructs we are evaluating clinically, and for which we have positive, preliminary, topline findings," said Kathrin U. Jansen, study co-author and Senior Vice President and Head of Vaccine Research & Development, Pfizer.

"We look forward to publishing our clinical data in a peer-reviewed journal as quickly as possible," Jansen said.

According to Ugur Sahin, CEO and Co-founder of BioNTech, and another co-author of the study, the preliminary data are encouraging as they provide an initial signal that BNT162b1 is able to produce neutralising antibody responses in humans.

He said the immune response observed in the patients treated with the experimental vaccine are at, or above, the levels observed from convalescent sera, adding that it does so at "relatively low dose levels."

"We look forward to providing further data updates on BNT162b1," Sahin said.

According to a statement from Pfizer, the initial part of the study included 45 healthy adults 18 to 55 years of age.

It said the priliminary data for BNT162b1 was evaluated in 24 subjects who received two injections of 10 microgrammes ( g) and 30 g -- 12 subjects who received a single injection of 100 g, and 9 subjects who received two doses of a dummy vaccine.

The study noted that participants received two doses, 21 days apart, of placebo, 10 g or 30 g of BNT162b1, or received a single dose of 100 g of the vaccine candidate.

According to the scientists, the highest neutralising concentrations of antibodies were observed seven days after the second dose of 10 g, or 30 g on day 28 after vaccination.

They said the neutralising concentrations were 1.8- and 2.8-times that observed in a panel of 38 blood samples from people who had contracted the virus.

In all 24 subjects who received two vaccinations at 10 g and 30 g dose levels, elevation of RBD-binding antibody concentrations was observed after the second injection, the study noted.

It said these concentrations are 8- and 46.3-times the concentration seen in a panel of 38 blood samples from those infected with the novel coronavirus.

At the 10 g or 30 g dose levels, the scientists said adverse reactions, including low grade fever, were more common after the second dose than the first dose.

According to Pfizer, local reactions and systemic events after injection with 10 g and 30 g of BNT162b1 were "dose-dependent, generally mild to moderate, and transient."

It said the most commonly reported local reaction was injection site pain, which was mild to moderate, except in one of 12 subjects who received a 100 g dose, which was severe.

The study noted that there was no serious adverse events reported by the patients.

Citing the limitations of the research, the scientists said the immunity generated in the participants in the form of the T cells and B cells of their immune system, and the level of immunity needed to protect one from COVID-19 are unknown.

With these preliminary data, along with additional data being generated, Pfizer noted in the statement that the two companies will determine a dose level, and select among multiple vaccine candidates to seek to progress to a large, global safety and efficacy trial, which may involve up to 30,000 healthy participants if regulatory approval to proceed is received.

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Agencies
April 28,2020

As the world grapples with the impact of the novel coronavirus, daily interaction with the outside world --- public and retail spaces, restaurants, educational institutions, and even with each other has been and will continue to be reoriented prioritising personal hygiene and public health.

The sensibilities are building towards and leading to major changes in how the country's food service industry is expected to operate.

Based on a recent consumer survey by restaurant tech platform, Dineout, Indian diners are now ranking safety assurances and premier hygiene as top factors when it comes to choosing a restaurant to dine in.

The survey by Dineout conducted across 20 cities revealed that in a post-COVID-19 era, 81 per cent diners will prefer digital menus at restaurants, while 77 per cent of people will continue to want to dine out.

The survey found that 23 per cent people would prefer continuing with delivery/takeaway and online payment becomes the most preferred option with 60 per cent votes.
 
Diner's response to Contactless Dining:

 

Over 96 per cent demand better waitlist management
 
81 per cent consumers would rather scan a QR on their phone to place an order instead of handling physical menus or tablet-based digital menus.
 
After a dining experience, 60 per cent prefer seamless wallet-based digital payments over cash/cards 85 per cent would choose a digital valet over waiting in possibly contaminated public spaces and 84 per cent would prefer offering digital feedback over physical feedback collection.

 

What do people want to eat?
 
The report also revealed that most of India has been craving Pizza since the lockdown, except in Chennai, Hyderabad and Kolkata where their popular and indigenous Biryani recipes reign supreme. 
 
Which restaurants are diners waiting to go to?
 
77 per cent respondents claimed that they are waiting to dine out with friends and family once the lockdown is lifted.
 
Big Chill, Barbeque Nation and Social emerged as favourites in Delhi, while Mumbaikars picked Global Fusion, Poptates and Asia Kitchen. Bangaloreans miss going to pubs like Toit, Vapour and Barbeque Nation.
 
Aminia, Arsalan and Momo I Am emerge as the top picks in Kolkata.
 
Contrary to popular belief, Delhitties picked vegetarian over non-vegetarian food.
 
Bangaloreans and Lucknowis would rather have their drinks over food.
 
Besides the new parameters for restaurant selection, the factors deciding consumer delight have also seen a major overhaul as hygiene takes precedence. Consumers would prefer that the total number of reservations in a certain period be limited with the option to pre-select the seating, ample amounts of sanitisers at tables along with UV sanitised utensils whenever possible.
 
Hygiene ratings with detailed hygiene information, regular hygiene checks & usage of mask and disposable gloves by waiters are likely to be the new standard, with diners expecting service personnel to sanitise tables & chairs after every use.
 
Dineout recently unveiled the �contactless dining suite' to help restaurants survive and thrive in a post-COVID-19 world. The brand will also provide PPE Safety Kits to Restaurants to help ensure hygiene measures and is facilitating COVID free certification for restaurants through a licensed lab to ensure all microbiological tests are in place before restaurants restart post the lockdown.

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