Diabetes, dialysis patients must remain vigilant in pandemic

diabetes in men

First we flattened the curve. Now we’ve had a prolonged spike in infections. For some of the most medically vulnerable residents of San Antonio, precautions will always remain in place, even after a COVID-19 vaccine is developed.

Diabetes impacts one in every seven people in San Antonio (14%) compared to one in every nine in Texas (11.4%) and one in every 10 nationwide (10.5%).

Carolina Solis-Herrera, MD
Carolina Solis-Herrera, MD

“The population of patients with diabetes in San Antonio is higher than the national prevalence,” said diabetes specialist Carolina Solis-Herrera, MD, assistant professor in the Long School of Medicine at UT Health San Antonio. “During this continuing pandemic, we are concerned for these individuals. Patients with diabetes have a compromised immune system, which means fighting viral infections takes longer and can be more toxic for the body.”

Case studies from China have demonstrated that about a fourth of patients hospitalized with COVID-19 have diabetes. “Early findings suggest that if patients who are hypertensive, obese and/or have diabetes contract this viral disease, their outcomes are worse,” Dr. Solis-Herrera said.

She urges people with diabetes to continue to social distance, and she reminds family members who serve as support networks to disinfect areas of the house, cover coughs and sneezes, wear masks when going out and avoid touching the face.

“Avoid infecting your loved ones who have diabetes,” she said.

In addition to traditional in-office visits, the UT Health Physicians practice of the Long School of Medicine is seeing patients through telemedicine to closely monitor medications and take care of their diabetes, Dr. Solis-Herrera said.

Kidney disease is a major complication of diabetes, and about 470,000 people with kidney failure nationwide are dependent on dialysis, which filters wastes and water from the blood. Texas has a higher proportion of patients on dialysis than much of the nation.

Shweta Bansal, MD
Shweta Bansal, MD

“We have a rate of about 1,400 patients on dialysis per million population in Texas, compared to many states that have 700 to 900,” said nephrologist Shweta Bansal, MD, associate professor of medicine in the Long School of Medicine. She treats dialysis patients as part of UT Health San Antonio’s clinical partnership with University Health System.

COVID-19 is a real challenge for these patients and their care providers.

“We can’t do dialysis through telemedicine,” Dr. Bansal said. “Dialysis is three times a week for four or five hours at a time. It is difficult to avoid being in close proximity with others.”

Nurses and technicians monitor the patients for hours. From the beginning, the team adopted the best practices of hand hygiene and wearing personal protective equipment (PPE) in the dialysis unit. Additional social distancing while in the community is another key step for prevention.

In the past couple of months, the team worked to obtain masks for all patients coming for dialysis.

“The dialysis population, like the nursing home population, is the most vulnerable to widespread infection, Dr. Bansal said. “The good news is there has not been a surge of COVID-19 cases among our patients.”

These seriously ill patients understand how important dialysis is in their lives and the effects of missing even one session, she said. They are educated at every treatment about safety measures.

The pandemic hasn’t hit San Antonio as hard as New York or Seattle. Most people with diabetes in South Texas are sheltering in place, social distancing and steering clear of COVID-19. But with diabetes itself, vigilance can never end. As the pandemic continues, diabetes patients and their families mustn’t backslide on these action steps, Dr. Solis-Herrera said:

  • Continue monitoring and controlling sugars.
  • Have a two- to three-month supply of all diabetes medications and supplies on hand. This includes insulin, test strips, glucose meters and glucose tablets.
  • Continue taking medications. Don’t stop them or modify them (such as rationing to make them stretch further).
  • Don’t modify other medications such as those for cholesterol and blood pressure.
  • Check each person’s temperature regularly.
  • Have lists of medications and doctors’ office numbers ready.

Many patients face significant economic challenges in obtaining their medications. “Because there are health care disparities in our communities, it’s important that patients know they have programs to help them,” Dr. Solis-Herrera said. One source of aid is the American Diabetes Association website insulinhelp.org.

One pharmaceutical company in April announced it was capping the out-of-pocket copay on insulin at $35 for some patients.

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Data sources: University Health System, U.S. Centers for Disease Control and Prevention, National Institute of Diabetes and Digestive and Kidney Diseases.

The Long School of Medicine at The University of Texas Health Science Center at San Antonio is named for Texas philanthropists Joe R. and Teresa Lozano Long. The school is the largest educator of physicians in South Texas, many of whom remain in San Antonio and the region to practice medicine. The school teaches more than 900 students and trains 800 residents each year. As a beacon of multicultural sensitivity, the school annually exceeds the national medical school average of Hispanic students enrolled. The school’s clinical practice is the largest multidisciplinary medical group in South Texas with 850 physicians in more than 100 specialties. The school has a highly productive research enterprise where world leaders in Alzheimer’s disease, diabetes, cancer, aging, heart disease, kidney disease and many other fields are translating molecular discoveries into new therapies. The Long School of Medicine is home to a National Cancer Institute-designated cancer center known for prolific clinical trials and drug development programs, as well as a world-renowned center for aging and related diseases.

The University of Texas Health Science Center at San Antonio, also referred to as UT Health San Antonio, is one of the country’s leading health sciences universities and is designated as a Hispanic-Serving Institution by the U.S. Department of Education. With missions of teaching, research, patient care and community engagement, its schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have graduated more than 37,000 alumni who are leading change, advancing their fields, and renewing hope for patients and their families throughout South Texas and the world. To learn about the many ways “We make lives better®,” visit www.uthscsa.edu.

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