Mucormycosis, commonly known as black fungus in Covid-19 recovered patients, is posing a serious threat to the Indian population. The disease has an overall mortality rate of 50 per cent and is believed to be triggered by the use of steroids, according to medical experts. However, people already living with uncontrolled diabetes have been found to be affected in large numbers by mucormycosis.
Diabetes is a global epidemic projected to be affecting an estimated 570.9 million people worldwide by 2025 with the annual death toll touching 1.6 million. The World Health Organization (WHO) projects that “diabetes will be the 7th leading cause of death by 2030.”
In a recent study titled ‘Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India’, researchers looked at 101 Covid-19 patients with mucormycosis and found diabetes mellitus as the single most important risk factor in 80 per cent of them. While the study noted global prevalence rate of mucormycosis at 0.005 to 1.7 per million people; in India, it was 80 times more. The authors concluded that the combination of pre-existing diabetes and injudicious use of corticosteroid coupled with Covid-19 appears to increase chances of contracting mucormycosis.
Diabetes and mucormycosis: A complex interplay
Incidence of pre-diabetes and diabetes is growing exponentially in India. A recent study assessed 69 survey records involving 1,778,706 adults in India. Authors reported the prevalence of diabetes increased in rural and urban India from 2.4% and 3.3% in 1972 to 15.0% and 19.0% between 2015-2019.
The higher prevalence of mucormycosis among people living with uncontrolled diabetes is well studied worldwide — between 36 and 38 per cent of the cohort under investigation.
In 2003, a study published in the Indian Journal of Ophthalmology analysed 34 cases retrospectively of patients with a histopathological diagnosis of rhino-orbito-cerebral mucormycosis (ROCM) and found uncontrolled diabetes in 30 patients (88.2%).
Another retrospective analysis of 35 ROCM patients found 29 had type 2 diabetes mellitus, and one had secondary diabetes.
A 2012 review in the journal Clinical Infectious Diseases stated that “mucormycosis remains a threat in patients with diabetes mellitus in the Western world. Furthermore, this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma.”
Covid-19, diabetes and mucormycosis:
Mucormycosis has been increasingly found in Covid-19 patients and is most common in patients living with uncontrolled diabetes. But the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are still undergoing research.
A March 2021 review in the Journal of Fungi, which studied 41 Covid-19 associated mucormycosis cases, reported prevalence of diabetes mellitus in 94 per cent patients.
Type 2 Diabetes – A preventable lifestyle disorder
Type 2 diabetes or diabetes mellitus is a lifelong, most common form of diabetes attributed to genetic predisposition, overweight/obesity, poor diet, smoking, lack of physical activity and stress. The disease is the single most important risk factor for several communicable and non-communicable diseases. A preventive approach targeting changes in lifestyle is advisable and the need of the hour.
Sitting is the new smoking. Prolonged lockdown during the pandemic increased the sedentary time by many folds. Even if it’s only for half an hour, one must engage every day in some activity like walking or exercising to increase the metabolic rate. A good workout regime combines strength training with cardio, for example 3 days lifting weights and 2 days brisk walking or daily 10 minutes of running in treadmill and 30-40 minutes of weight-lifting.
General dietary guidelines to prevent and manage uncontrolled diabetes includes low carbohydrate, higher protein, low trans-fat diet.
- Inclusion of more fibre in the form of low starchy green vegetables, fruits, grains, beans, and pulses help in preventing the onset of diabetes and pre-diabetes.
- Intake of trans fats to be reduced from daily diet. These foods include cake, pastry, biscuits, and fried and junk foods.
- Simple sugar including sugary fruit juices, soda, cold drinks, ice cream, sweets, candy to be avoided as these provide empty calories.
- Lean protein – chicken, fish, egg white — and vegetable proteins like low fat paneer, soy chunk, tofu, nuts to be included for optimum protein intake.
Stress can be a potential barrier to successful glucose control. Chronic and unattended stress triggers release of stress hormones — adrenaline and cortisol that elevates the respiratory rates, heart rate, blood pressure followed by a spike in blood glucose level.
To manage stress, practice 10 minutes of guided meditation in the morning and set the tone of your day. Spending time in nature is therapeutic; it helps manage health stress and anxiety. Take a 30-minute walk in nature to feel rejuvenated.
Sound sleep: Two major benefits of getting a full night’s sleep are achieving strong immunity and prevention of weight gain.
The immune system of people living with diabetes is compromised, making it harder to fight any infection — Covid-19 or associated mucormycosis in current time. Pathogens – virus, fungus, bacteria — thrive in an environment of elevated blood glucose, worsen the disease outcome, thus leading to a longer recovery period.
Covid or no Covid, preventing and/or managing uncontrolled diabetes is the gold standard to avoid thousands of health hazards.
Dr Subhasree Ray is a clinical and public health nutritionist, a certified diabetes educator (International Diabetes Federation), and Group Corporate Dietitian, Reliance Industries Limited. Views are personal.
(Edited by Prashant Dixit)