The Japan Diabetes Society


新型コロナウイルス(COVID-19)への対応について (Q&A)

新型コロナウイルス(COVID-19)への対応について (Q&A)

(Q) 糖尿病患者が、新型コロナウイルスに関して気をつけることはありますか

(A) 新型コロナウイルスに罹った場合に、重症化するリスクとして、心疾患や呼吸器疾患に加えて、糖尿病もその一つである可能性があると考えられています。糖尿病がある方は、一般的な衛生対策に加えて、不要不急の外出を避けることや人混みを避けるなどの注意をすることは、インフルエンザなどの他の感染症対策と同じです。

糖尿病を治療していて、熱が出るなどの際には、血糖値を下げる薬の調整が必要になることがあります。Sick day (シックデイ:体調の悪い日)対策として一般的なことは国立国際医療研究センターの以下のページをご参照ください。

シックデイ (国立国際医療研究センター 糖尿病情報センターHP)
(Q) 糖尿病患者で新型コロナウイルス感染症へのり患が疑われる場合、診療で留意する点はありますか

(A) 現時点では、糖尿病は他の基礎疾患と同じく、重症化のリスクの一つである可能性が指摘されています。ただし、CDCのガイダンス(2020年4月6日付け)では糖尿病に加えて、高齢、呼吸器疾患、がん罹患、心不全、脳血管疾患、腎疾患、肝疾患、免疫不全状態と幅広い疾患を重症化するリスクの可能性ありとされており、当初の症状が軽微であっても、これら基礎疾患がある場合には肺炎への進行が起こる可能性を念頭に起き、治療にあたるのが望ましいとされています。


Diabetes and COVID-19 (Q&A)

Q&A for general public
(Q) What should I do if I myself or my loved ones have diabetes during this COVID-19 pandemic?

(A) Although majorities of COVID-19 cases are mild, some cases (around 14%) and very few (around 5%) can lead to severe illness, including pneumonia and death. Older people and people with pre-existing medical conditions (such as diabetes, heart disease and pulmonary diseases) appear to be more vulnerable to becoming severely ill with the COVID-19 virus. The recommendations that are being widely issued to the general public are also important for people living with diabetes. Those recommendations include but not limited to; hand hygiene (wash hands, avoid touching your eyes, nose and mouth with unwashed hands) and avoid close contact (avoid close contact with people who are sick, stay home as much as possible, put distance between yourself and other people). People with diabetes who are infected with the virus may see their glycemic control worsen during the illness. They should practice the "Sick day rules" recommended for any stressful situation to improve their diabetes decompensation. For more general information, please refer to the International Diabetes Federation web page " COVID-19 outbreak: guidance for people with diabetes"

Q&A for healthcare professionals
(Q) When treating people with diabetes for suspected or confirmed COVID-19, what particular care should healthcare professionals pay to those patients.

(A) Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. Those at high-risk for severe illness from COVID-19 include (CDC April 6, 2020): people 65 years and older, people who live in a nursing home or long-term care facility, people of all ages with underlying medical conditions (diabetes, chronic lung disease, moderate to severe asthma, serious heart conditions, severe obesity [BMI 40 or higher], chronic kidney disease undergoing dialysis, liver disease), and people who are immunocompromised (Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications). Patients with risk factors for severe illness should be monitored closely given the possible risk of progression to severe illness in the second week after symptom onset.

Corticosteroids have been widely used in hospitalized patients with severe illness in China; however, the benefit of corticosteroid use cannot be determined based upon uncontrolled observational data. In addition, patients with MERS-CoV or influenza who were given corticosteroids were more likely to have prolonged viral replication, receive mechanical ventilation, and have higher mortality. Therefore, corticosteroids should be avoided unless indicated for other reasons, such as management of chronic obstructive pulmonary disease exacerbation or septic shock. When corticosteroids use is indicated, close monitoring of glycemic control and prompt correction of glycemic derangement are highly recommended.