How do endocrinologists fight the “epidemic” war in special times!

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Recently, the epidemic of the new crown pneumonia affects everyone’s heart, and doing a good job of prevention and control is the top priority of this “battle”.On February 7, the results of the New Coronary Pneumonia Case Study paper published in “JAMA” showed that 41.3% of patients were infected in hospitals [1], and patients with diabetes belonged to high-risk groups. How should endocrinologists take precautions?Professor Shi Yongzheng, director of the Department of Endocrinology, Shanghai Long March Hospital, and Professor Hu Bijie, director of the Department of Infectious Diseases, Zhongshan Hospital affiliated to Fudan University, gave a wonderful sharing.Question 1: According to recent data analysis, nosocomial infection is the main transmission channel of new coronary pneumonia. How should medical staff and patients in the endocrinology department protect themselves from risks?Professor Hu Bijie: To raise awareness, we must have practical prevention and control measures.The proportion of nosocomial infections in new crown pneumonia varies with different stages of epidemic development and disease awareness. The proportion of nosocomial infections in 41.3% of new crown pneumonia case studies published in “JAMA” is not constant.For respiratory, infectious, and fever clinics, the risk of serious nosocomial infections is relatively small because of the higher awareness of risk prevention.However, departments including the endocrinology department usually have lower risks, and the early symptoms of patients with neocoronavirus infection are hidden, and the autoimmune function of diabetic patients is weak, so clinicians must raise awareness of disease prevention and control.Raising awareness is not only a cognitive emphasis, but also needs to be accompanied by practical prevention and control measures, including the following four aspects.● Early identification of high-risk patients. For patients with cough and fever, even if they do not have an epidemiological history in Hubei and key regions, they should be recommended for CT and nucleic acid testing if necessary.● In principle, endocrinologists do not need to wear protective clothing when receiving consultations, but they need to wear masks, and minimize face-to-face communication with patients, patient visitors, and even other department doctors. If they do not wear masks, they should maintain 1A safe social distance above meters to effectively prevent droplet transmission.● Strengthen hand hygiene, wash your hands properly and use quick-drying liquid soap containing alcohol to reduce the mucosal contact and transmission of the virus.When washing your hands, pay attention to rubbing your palms, fingers, etc., which are more important than the back of your hands.● Avoid extra beds during the epidemic and reduce staff gathering.Professor Shi Yongzheng: For medical personnel, first of all, they must strengthen their awareness of self-protection, and secondly, identify patients with the possibility of new coronary pneumonia as soon as possible.From the perspective of the whole medical behavior, the following aspects are mainly included: ● The checkpoint is moved forward. When medical staff encounters a diabetic patient, they should pay more attention to the identification of new crown infection or suspected patients.● Set up triage and fever treatment area.Fever patients, even if new coronary pneumonia is ruled out, need to design a special area for treatment.● Strengthen measures and procedures for infection control according to national needs.● The operation in special areas should be more standardized and strictly disinfected.For example, patients with diabetes need blood drawing, clinical examination, blood glucose monitoring, etc. This is related to the problems of exposure and cross infection.● Increasing training on new coronary pneumonia related prevention and control, diagnosis and treatment knowledge (real-time update, combining online and practice).Professor Shi also mentioned that a case of diabetic ketosis accompanied by fever was encountered in an outpatient clinic recently. According to the above measures, triage was performed according to the fever, and he was immediately sent to the emergency room to contact an expert on new coronary pneumonia for further examination and analysis.After three tests were negative, eventually the possibility of new coronary pneumonia was ruled out.Question 2: In the analysis of death cases of new coronary pneumonia, many patients have diabetes mellitus. How to treat and manage blood glucose in patients with diabetes who have new coronary pneumonia?Professor Hu Bijie: Maintain normal immune function and be alert to hormone and antibiotic abuse.As we all know, the population is generally susceptible to the new coronavirus, but the elderly and people with underlying diseases (such as diabetes and COPD) are more susceptible and are more likely to progress to severe illness.On January 29, The Lancet reported that of the 41 patients infected with neocrown virus early in Wuhan, 8 had diabetes, accounting for 20% [2].Early identification and treatment of those who are prone to severe illness has become the focus of Shanghai New Crown Pneumonia experts when fighting the epidemic.One of the cores of treatment lies in maintaining the normal immune function of patients.First, it is necessary to maintain a good mentality and adequate sleep, and secondly to strengthen nutritional support. For some special populations, thymosin and gamma globulin may be given to improve their immune function.Last but not least, do not abuse glucocorticoids and antibiotics.High-dose glucocorticoids currently do not show clear benefits during the treatment of new coronary pneumonia. They can reduce fever in the short term, reduce C-reactive protein levels and inflammatory symptoms, but they will delay the elimination of the virus, which is unfavorable in the long run and may even beIncrease mortality.In addition, the abuse of antibiotics can cause intestinal microecological disorders, which also requires extra vigilance.Prof. Yongyong Shi: Assess the condition and stratify the target of blood glucose management.For the management of blood glucose in patients with diabetes combined with new coronavirus pneumonia, the Diabetes Division of the Chinese Medical Association refers to the “Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2017 Edition)” [3] and the “Consultation of Experts on Blood Glucose Management in Inpatients in China” [4], and “New Coronavirus Pneumonia Diagnosis and Treatment Plan (trial version 5 for trial) [5] drafted “Management Recommendations for Diabetes Patients Complicated with New Coronavirus Pneumonia” [6].Assess the condition at admission and then stratify goals for glycemic management (Table 1).(1) Young, newly diagnosed or short-term diabetic patients without chronic complications, low-risk groups with hypoglycemia, and strict control targets.(2) In elderly patients, who cannot tolerate hypoglycemia, who have organ dysfunction, or who have severe cardiovascular or cerebrovascular disease, the control targets are loose or average.(3) For patients with severe or critically ill coronary pneumonia, control targets are loose.(4) If the patient has a higher risk of hypoglycemia, it is recommended that individualized control goals be based on clinical conditions and comorbidities.Patients with a diabetes course of ≥15 years, a history of unperceived hypoglycemia, large fluctuations in blood glucose throughout the day, repeated hypoglycemia, severe complications or associated disease (such as liver and kidney insufficiency) are at high risk of hypoglycemia.Question 3: During the epidemic, everyone is encouraged not to go out or go to the hospital as much as possible. How to eliminate cold symptoms in diabetic patients? Do they need to go to hospital for treatment?Prof. Hu Bijie: Weigh the risks. Generally, you can temporarily observe the isolation at home.During the epidemic, it is really a “tangled” question whether a diabetic patient needs to seek medical treatment immediately. It is necessary to balance the risk of infection with the benefits of medical treatment. Especially the diabetic patients themselves are high-risk groups of infection. The treatment after infection is relatively complicated.At present, hotline telephones or Internet diagnosis and treatment channels have been opened in various places. If diabetic patients have symptoms such as cough and fever, they can consider online consultation first.For cases with no epidemiological contact history and no clustered cases in the family, the patient can be isolated at home (see the Home Isolation Prevention and Control Guide issued by the Chinese Center for Disease Control), and observe the condition 1 to 2 days after the cold treatmentProgress, if not aggravated, you can temporarily maintain home treatment, if aggravated, go to the hospital as soon as possible.This approach is an expedient measure in the case of limited medical resources and a more severe epidemic situation.Professor Shi Yongzheng: It is recommended that patients be comprehensively analyzed according to the epidemiological history and clinical manifestations in the 5th edition of “New Coronavirus Pneumonia Diagnosis and Treatment Program” [5].(1) Epidemiological history ● Travel history or residence history of Wuhan City and surrounding areas or other communities with case reports within 14 days before the onset of illness; ● Patients with new-type coronavirus infection (positive nucleic acid test) within 14 days before the onset of illnessContact history; ● Patients with fever or respiratory symptoms from Wuhan and surrounding areas or from communities with case reports in the 14 days before the onset of the disease; ● Aggressive onset.(2) Clinical manifestations ● Fever and / or respiratory symptoms; ● It has the imaging features of neo-coronary pneumonia; ● The total number of white blood cells is normal or decreased in the early stage of onset, or the lymphocyte count is decreased.Have any one of the epidemiological history and meet any two of the clinical manifestations.If there is no clear epidemiological history, it meets 3 of the clinical manifestations.It is a suspected case.If the symptoms are atypical, there is no history of exposure.That is, common cold, mild fever, and catarrhal symptoms. Patients are advised not to go to the hospital for treatment, drink more water at home, and take common cold medicine to solve it.If the fever is higher than 38.5 ℃, or the symptoms are more serious, you need to go to the hospital for treatment, but the risk of cross infection in large hospitals is greater. It is recommended that patients choose community hospitals, but also need to take out protection measures.Question 4: Diabetes patients need to take medication regularly, and they should not adjust the medication without authorization. If the patient’s postprandial and fasting blood glucose are not well controlled during the epidemic, in this case, what factors should patients consider when adjusting the treatment plan?Professor Shi Yongzheng: Analyze the cause and adjust the dosing schedule if necessary.The cause of poor blood glucose control must be found from the perspective of treatment. Is it because the current epidemic is tense, the doctor’s order is poorly implemented, and medication, diet, and exercise are not well done?If yes, remind the patient to do these 4 aspects: ● It is recommended that the patient take the medicine on time and according to the dose. If there is not enough medicine, you can order the medicine online to renew the medicine, especially some well-controlled and stable patients.A few days ago, the National Medical Insurance Bureau clearly implemented the “long prescription” reimbursement policy, and the prescription dose for patients with diabetes was relaxed to 3 months.● Do a good job of diet management. If the diet management is not good, or the patient is not self-disciplined, it is recommended to adjust the treatment and choose some drugs to reduce weight, such as metformin and GLP-1 receptor agonist.● Patients are advised to maintain a moderate amount of exercise. If outdoor sports are selected, software can be used to check whether there are patients with infections around them, and then select nearby or sparsely populated areas and take protective measures.● Launch online education, push WeChat and video, and provide psychological counseling to patients with high psychological pressure.If it is indeed due to the progression of diabetes, poor glycemic control, the patient should be adjusted in time to choose a drug treatment plan, choose a formulation that has a strong effect on reducing blood sugar, is safe, durable, and can control weight, such as the once-weekly GLP-1 receptor agonist dulaGlycopeptide [7]..
Summary During the epidemic, prevention of coronavirus infection is of paramount importance, especially for medical personnel exposed to high-risk risks, they must protect themselves; blood glucose management for diabetic patients should not be dropped, maintain good living habits, adhere to reasonable medication, and make timely adjustmentSafe, potent, and durable formulation.Work together to win an early battle without smoke.The above content is only authorized for exclusive use by, please do not reprint without the authorization of the copyright party.


The author ouyangshaoxia