ALARMING

PROF NEBOJŠA LALIĆ, ACADEMICIAN, FOR KURIR: 'Still 50 percent more Covid deaths among diabetics than the healthy'

"There are still 50 percent more deaths among Covid patients suffering from diabetes than among those who don't. Diabetes is one of the most common reasons for a bad Covid outcome and long Covid-related complications. A full vaccination, with two doses and a booster shot after a specific time period is what ensures all diabetes patients get a successful treatment and survive this epidemic. No question about that," Professor Nebojša Lalić, academician and Chief Physician at the Endocrinology, Diabetes, and Metabolic Diseases Clinic, said in his interview with Kurir.

Why is diabetes so dangerous in Covid?

"Because the two diseases share a bit of their developmental paths, including the effects of cytokines and triggering a cytokine storm. Diabetes itself doesn't directly cause a cytokine storm, but when these two processes join hands, the likelihood of it happening goes up."

Diabetes is often linked with obesity. We have had cases of obese children who died of Covid, right?

"Yes, because of the overlap in cytokine mobilization routes and activating the inflammation, which is very similar in the two diseases. With Type 1 diabetes, obesity is rarer, so this inflammation is less frequent in Covid. Another interesting thing about the pandemic – if they're good at managing their illness, young patients with Type 1 diabetes are at the same risk of getting Covid as healthy people – not higher, as is the case with other diabetes patients. But that doesn’t mean that they shouldn't adhere to epidemiological measures or get vaccinated. It's important to vaccinate children as well. The European Medicines Agency (EMA) has approved vaccination of children over five as well."

Does this mean that patients with Type 2 diabetes fare worse with coronavirus?

"Once corona gets going and hyperglycaemia, or high blood sugar, occurs, all the dangerous mechanisms get activated. But if diabetes patients manage their illness well, those who have Covid stand a good chance of ending up in the same position as healthy people, on condition that all the measures are adhered to."

'GETTING IN FRONT OF GUNS WAS OUT OF THE QUESTION'

Have we become too relaxed, acting like corona wasn't there?

"We're the generations with no memory of the war. But we shouldn't forget that people survived four years of war, and getting in front of guns was out of the question once they knew someone was going to shoot at them. So they stayed in and didn't go anywhere. We even go vacationing in the summer and winter. The point is exactly the same, but we have relativized the danger and exposed ourselves to a very dangerous narrative that comes with a high price. If the number of infections goes up, the likelihood of mutations increases and we can get a mutation for which there is no vaccine."

Is Type 2 diabetes linked with obesity?

"Type 2 is linked with obesity but, because obesity is on the rise in the general population, there are many obese patients with Type 1 diabetes as well. Obesity is definitely one of the major risk factors for a bad Covid outcome and is tightly linked to Type 2 diabetes."

Ana Paunković

Why is it that diabetics with Covid mostly end on dialysis?

"The renal function is already compromised in a third of diabetics, and the whole inflammation process in Covid can jeopardize it even more."

Last year, the number of diabetics here was estimated at around 700,000. Has the pandemic increased this number?

"The number is estimated at 770,000, and perhaps it's already at 800,000, but no direct links with Covid have been confirmed."

Of the 800,000, how many are registered diabetics?

"Just over 470,000."

So, over 300,000 people in Serbia have diabetes and don't know it?

"That's likely the case."

What should people pay attention to in order to check if they have diabetes?

"The standard signs of diabetes – frequent urination, increased thirst, general weakness, fatigue, dry mouth. They should visit their local healthcare centre or wherever else they can get a screening to check for diabetes and increased risk of diabetes."

Is that everyone or just those who have symptoms?

"Everyone, every three years at the very least."

What does the screening mean specifically?

"You fill out a form to provide all the information – whether you have high blood pressure, whether you've had high blood sugar, if there's a history of diabetes in your family, your diet, the level of physical activity, etc."

Why is blood pressure important?

"It's important because it is linked to diabetes. They are the so-called comorbidities, or co-occurring conditions. The mechanism isn't the same – high blood pressure can develop as a result of diabetes, but there is a higher incidence of patients with diabetes among those with a high blood pressure. Someone who's had a heart attack or a stroke is at a higher risk of diabetes. Moreover, if diabetes developed during pregnancy and then disappeared, there's a higher risk of reoccurrence."

When will innovative diabetes medications finally become available?

"They are two groups of medications which at the same time regulate diabetes by decreasing high blood sugar and protect the heart and kidneys as important organs, preventing or delaying complications affecting them. The financial and other aspects are being worked on intensively to make these medications available."

'AS ANY POWERFUL MEDICINE, THE VACCINE CARRIES RISKS BUT REMAINS NECESSARY'

We are still having a lot of difficulty explaining to people that the vaccine can save us.

"Someone getting Covid even though they've been vaccinated is the sort of thing that can be observed with any medication people take for any disease. You could say that a diabetic was on insulin, didn't get the right dose, and died. And then you conclude that insulin is dangerous and shouldn't be administered. These are very unscientific and circumstantial conclusions found used for vaccination as well. Without the vaccine, there will be no success in treating Covid. As everyone has pointed out, it has shortcomings, like any other medication."

Such as?

"First off, it was made for a specific virus conformation. This conformation can change, but as yet there hasn't been a changeso drastic as to make the vaccine ineffective. The vaccine does reduce the severity of the disease, which is a big deal. It is a powerful medicine, and every powerful medicine can have side effects, which depend on the individual response. So, the vaccine isn't a simple medicine, or a risk-free medicine, but the risk is about the same as risks associated with other powerful medications. No one will ever consider saying, 'Don't take that powerful medication that's used to treat a severe disease.' "

Kurir.rs/Jelena S. Spasić

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