COMMENTARY

Improving Cardiometabolic Health in the COVID-19 Era

Jay H. Shubrook, DO, FAAFP, FACOFP

Disclosures

August 25, 2021

Editorial Collaboration

Medscape &

This transcript has been edited for clarity.

Hi. I'm Jay Shubrook, a family physician, professor at Touro University of California, and a primary care diabetologist. I'm delighted to be here today to give a COVID update as it relates to cardiometabolic health.

We've been through so much in the past 18 months, and we've learned so much as it relates to this very serious infectious disease and its relationship to cardiometabolic health. Utilizing the wisdom and the things we've gained to date, I'd really like to talk about five things that we can do to help the cardiometabolic health of our patients as it relates to COVID-19.

Number one, please continue to encourage your patients to get vaccinated. We have seen amazing benefits in the distribution and the provision of vaccines, and we know that these vaccines, one, work and two, they even work with the newer variants. However, not everyone has been vaccinated. Currently, 48% of Americans have been vaccinated. We've had no problem with the quantity of vaccines needed.

This is really something that we can optimize, because when we're looking at serious infections today and hospitalizations and death, they're almost entirely in unvaccinated people. We really need to continue our hard work and try to make sure that every person who wants to be vaccinated can be vaccinated.

Number two, we need to make sure that our patients do not skip their care. We've really seen the repercussions of people skipping their care over the past year, not getting necessary screenings, not getting cancer screenings, not refilling medications, and not getting routine testing. As a result, we're seeing new cancers. We're seeing conditions that have destabilized, and understandably, many patients have been afraid to access healthcare.

We need to really let our patients know that, one, we're here and available. They can access us in person. There are often other ways, including telehealth or telephone medicine. We need to make sure that they're getting the needed care so that they can continue to prevent or receive early intervention for conditions. Certainly, that's something we've seen as a repercussion of this past year.

Number three, we want to make sure that our patients maintain their metabolic control. What does that mean? We know that outside of vaccination, maintaining good blood pressure control, staying on your statins, and having excellent glucose control are probably the best things you can do to reduce the risk for serious COVID-19 infection.

This is the most important time to tell our patients, "Please do not stop your medications. I realize that you're getting all kinds of messages about medicines. If you have questions, reach out to us. We would be happy to talk with you about the safety and the benefit of each of these medicines. By default, please don't stop medicines unless we touch base, because those medicines, even though they have nothing to do with COVID-19 infection, may have a lot to do with the severity of the infection that you experience."

Next — this is maybe a little bit more specific to diabetes — make sure your patients have a diabetes sick-day plan. We're seeing patients who suddenly have their glucose ratings change, and they don't know why they're climbing. They're not sure what's going on. This might actually be an indicator that they have some kind of infection or other condition going on, such as COVID-19.

If someone's glucose reading suddenly changes, we recommend they contact us and we engage the sick-day plan. The sick-day plan may vary depending on the symptoms, but sometimes it means stopping certain medications. It often means increasing the frequency of testing and increasing your insulin dose. This is something we could do even before we see the patients. Having a sick-day plan allows them to activate the healthcare team earlier in a condition so that they can have a timely response.

Finally, it's really important, as we get mixed messages about COVID-19 and the safety of all of its treatments, that we are consistent in our recommendations and we're open for questions. There are lots of people that are questioning the science, questioning the value of treatments, and even the legitimacy of the virus. By being open for questions, this allows us to be a resource for our patients.

I'll often ask, if I see someone who's unvaccinated, "Are there any questions that I could answer for you?" By being a partner with our patients, letting them know I can be a source of information for them, someone that they can trust, and we can work with together, I think that will separate those who are truly vaccine hesitant vs those who just want more information.

We've seen so much information come across in the past 18 months, so it is really important that as we continue to learn, we're transparent with our patients and we let them know that we will provide the best treatment and the best science for them given the information we have today.

Today, we talked about five things to help our patients maintain their cardiometabolic health in the time of COVID-19. Please continue to encourage your patients to get vaccinated. Please encourage your patients to not skip care; it is safe to engage in the healthcare setting. Make sure that they maintain their metabolic control of blood pressure, statins, and glucose control, because it's probably the second-best thing they can do to prevent severe infection.

Please make sure that all your patients with diabetes have a sick-day plan, and then be open for questions and discussion with your patients so that we can be trusted partners in their healthcare needs. Thank you very much.

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