Diabetic deaths in state surged 52 per cent amid Covid pandemic: RTI

Data procured from the state public health department showed that in 2017, a total of 19,702 deaths were attributed to the metabolic disorder in Maharashtra. The next year, it slightly rose to 22,430 deaths. In 2019, it further surged to 25,945 with a surge of 15.67 per cent. However, amid the pandemic, the fatalities surged by 41 per cent in 2020 when a total of 36,651 patients died from diabetes. This further increased to 39,536 in 2021 amid the second wave with over one-fold rise compared to the pre-pandemic year. Between 2017 and 2021, diabetes claimed the lives of 1,44,264 people in Maharashtra.

Although the highest deaths were recorded among male, amid the pandemic, the share of female mortality also increased from 10,673 reported in 2019 to 14,399 in 2020 and further to 15,413 in 2021. This counts a 44 percent surge in deaths among females due to diabetes mellitus.

Between 2017 and 2021, a total of 1,44,264 people have lost their lives to diabetes mellitus in Maharashtra. Most deaths have been recorded among elderly population 70 years and above.

There are several explanations that may account for the substantial increase in fatalities due to diabetes during the Covid-19 pandemic. The primary bi-directional relationship between diabetes and Covid-19 has been well-established.

“Diabetes is an immuno-deficiency disorder, which reduces a person’s immunity. The high blood sugar weakens the immune system and makes it less able to fight off infections, leading to higher mortality,” said Dr Rajiv Kovil, diabetologist and secretary of United Diabetes Forum.

Doctors believe that Covid patients who were on the borderline or were living with undiagnosed diabetes mellitus, could have developed health complications later, which led to their deaths and contributed to the excessive mortality rate in Maharashtra.

“During Covid-19, we had seen that a large number of patients, due to fear of quarantine, lied about testing positive. Hence, there is a possibility that they developed health complications as their sugar levels shot up as post Covid syndrome (PCS), leading to deaths by coronary artery disease (leading to heart attack) or stroke,” said a senior officer from the public health department.

In the Covid-19 pandemic, Maharashtra endured the biggest blow with the maximum number of Covid-19 cases and associated fatalities.

As of April 28, the state witnessed 80,10,995 cases, which is 18 per cent of the nation’s share and 148,511 deaths — 27.9 per cent of India’s Covid fatality. State data showed that of all the deaths, around 18.7 per cent of them were suffering from diabetes — the second most common comorbidity after hypertension observed among patients who died due to Covid-19.

Diabetes is a chronic and progressive disease which occurs when the pancreas doesn’t produce enough insulin or the body is unable to effectively use the insulin it produces. This leads to increased concentration of glucose in the blood and poses serious health risks, including damage to the kidneys, eyes and heart. Now, physicians are witnessing a large number of patients with a history of Covid-19 infection who are being diagnosed with diabetes or the metabolic disease has aggravated in them — another reason for the surge in deaths.

Dr Jalil Parker, a senior pulmonologist with Lilavati Hospital, said he observed some Covid recovered patients are suffering from Hyperglycemia that affects the beta cells that produce insulin, which is the principal hormone that regulates blood sugar levels. “Some patients are even requiring higher doses of insulin… With more cases and unregulated sugar levels, fatalities will certainly increase,” he added. The trend is not only being reported in cities but also in rural parts of the state.

Dr Rahul Baburao, an endocrinologist from Amravati, said, “We are getting patients as young as 30 years from rural regions, who were earlier infected with Covid-19, and now have diabetes.” However, due to lack of awareness about diabetes, rural habitants approach hospitals at a late stage, which further contribute to fatalities, outlined SP Kalantri, director professor of medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha. “Many prefer approaching local healers first,” he added.

Doctors around the world are debating whether Covid-19 itself is causing diabetes in patients with no previous history of suffering from the metabolic disease. This, they say, could be due to the use of steroids in treatment; the cytokine storm when the body’s immune system goes into an overdrive to fight off Covid-19, and the virus itself injuring cells in the pancreas which make insulin. Dr Avinash Supe, former dean of KEM hospital and in-charge of Covid death committee, said, “Corticosteroids cause immune suppression by impairing the innate immunity which can make patients vulnerable to other acute infections. Such patients have a higher risk of death.”

One out of six people with diabetes in the world are in India. Home to an estimated 77 million diabetics, it is second only to China, which has 116 million people living with the disease. But other than long-Covid, screening and treatment of diabetic patients has taken a backseat. Diabetes-related outpatient visits and laboratory testing has fallen noticeably — signifying a gap in healthcare delivery for diabetic patients during the Covid pandemic. “During the national lockdown, a large number of patients couldn’t visit hospitals for follow ups, which delayed diagnosis and medications. They continued with home-remedies. Now, we are seeing patients even from rural Maharashtra,” said Dr Deepak Baid, consultant physician at civic-run Rajawadi Hospital.

Doctors have advised Covid survivors to undergo basic sugar tests regularly as a precautionary measure. “We will have to keep a close eye if the deaths further rise in the coming years,” said Dr Parker.

The reporter/journalist is a recipient of the 2023 REACH Media Fellowships for Reporting on Non-Communicable Diseases’.