Endocrinology and Covid-19: A Multifaceted Interaction
Women with diabetes, obesity and other endocrine or metabolic disorders form a distinct vulnerable group, who are at increased risk during the COVID-19 pandemic, either due to increased risk of severe infection or due to challenges in healthcare delivery during the pandemic.
Diabetes is a major risk factor for increased morbidity and mortality from COVID-19. Optimal cardiometabolic control and preventive measures to reduce risk of infection are needed in people afflicted with diabetes. Women with diabetes are at greater risk as they have limited access to diabetes care facilities even outside the time frame of a pandemic and this gender gap in care is likely to widen during the pandemic. Moreover, the care of pregnant women with pre-existing diabetes or gestational diabetes mellitus (GDM) also cannot be compromised. While alternate screening strategies for GDM such as the use of fasting plasma glucose and glycosylated hemoglobin are being considered, telemedicine services can offer a platform for remote monitoring and delivery of optimal diabetes care to pregnant women.
Telemedicine services can also be used for delivery of long-term care for other endocrine disorders. Elective surgery or evaluation of endocrine disorders that are not immediately life-threatening can be deferred till appropriate safety precautions can be taken. At the same time, there is a need ensure that care of endocrinopathies such as diabetes, obesity, thyroid disorders and osteoporosis, all of which affect women more severely, is not compromised during the pandemic.
Many endocrine organs, including pancreas, thyroid, testis, ovary, adrenals and pituitary, express the angiotensin-converting enzyme 2 (ACE2) that is the receptor for SARS-CoV-2 virus. Since ACE2 expression is different in men and women, there is a need to evaluate the impact of the virus on endocrine system and assess whether this is gender-specific.
Keywordsadrenal insufficiency - COVID-19 - diabetes - endocrine disorders - glucocorticoids - thyroid disorders - women
22 September 2020 (online)
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