Concerted effort towards metabolic health to be extremely high-value during COVID-19: Interview

A Stanford-trained physician, Dr. Casey Means is an entrepreneur on a mission to improve human health and longevity, which led her to co-found the metabolic health startup Levels, of which she is now Chief Medical Officer.

She was recently interviewed by Viveka Roychowdhury on Express Healthcare on COVID-19 in India. To read the full interview, visit here.

Since we do not yet have a cure for SARS-nCoV2 yet, the COVID-19 pandemic has focussed attention on the need for long term preventive strategies, especially for chronic lifestyle-related conditions like hypertension, diabetes, etc. India has a high disease burden of such conditions so do you feel the right strategies are in place to help these patient populations cope with their conditions during COVID-19 lockdowns?

India is estimated to have over 77 million people living with diabetes and around 30 billion with obesity, both diseases that have been linked to increased mortality  from SARS-CoV-2. It is also known that improved glucose control is significantly associated with better COVID-19 outcomes, so anything a government can do to support widespread glucose control may impact COVID-19 mortality. Given that food choices are a major contributor to glucose levels, support of programmes that increase access to metabolic health-promoting foods at scale (like vegetables, low-glycemic fruits, nuts, seeds, beans, and legumes), is likely to be a high-value intervention.

To date, the Indian government has taken many strong policy steps to respond to the virus, including travel advisories, social distancing and hand hygiene campaigns, a Containment Plan based on zones of COVID-19 impact, surveillance through swabs and serum testing, contact tracing, instatement of a curfew, and designating specific public health facilities for COVID-19 case management.  A recent policy report [5] from June 2020 assessing India’s response to COVID-19 highlighted a number of challenges still facing the country, including a doubling of cases since May 1st, low testing rates early on in the pandemic, and slow (but growing) domestic production of testing kits.

In addition, there is some evidence that the COVID-19 response has disrupted other healthcare services, like inpatient and outpatient treatment of many common diseases including diabetes and high blood pressure. Furthermore, research suggests that surveys of people with type 2 diabetes show that only 28 per cent of the surveyed individuals are checking their blood glucose levels regularly. Other papers have speculated on barriers to self-management of diabetes including poor access to diabetes resources, limited adoption of telemedicine due to lack of definite legislation on this medium of practice, culturally entrenched food preferences, and lack of confidence in importance in home-based care in diabetes management. Unfortunately, researchers in India have modelled that due to lockdown, there is expected to be a significant worsening of glycemic control and diabetes-related complications such as retinal disease, kidney disease, diabetes-related amputations, heart attack, and stroke.

Any country facing comorbid epidemics of diabetes, obesity, and COVID-19 will benefit from a swift and coordinated effort focused on fundamentally improving metabolic health. This includes strategies for optimising nutrition, exercise, sleep hygiene, stress management, and toxin exposure, all of which have been shown to be involved in improving metabolic health. Additionally, rapidly increasing access to continuous glucose monitoring technology, which makes glucose monitoring significantly more granular and simple, and telehealth medicine and coaching, and can contribute to increased metabolic fitness, is another important step. Researchers in India recently published that for individuals with diabetes in India, their “blood sugars need to be better controlled and their health condition needs to be better monitored, even in the face of lockdown, through measures such as teleconsultation and telemedicine.” Type 2 diabetes and obesity are both largely preventable, and often reversible with healthy living strategies, so a concerted effort towards improving foundational metabolic health may prove to be an extremely high-value approach during the COVID-19 pandemic.

What are the strategies that policymakers as well as practising physicians in India need to put in place to ‘nudge’ patient populations to make these changes?

India — along with every other nation in the world facing obesity, diabetes, and cardiovascular disease epidemics — will benefit from multifaceted approaches that promote sustainable healthy living, which may span addressing and optimising health systems, economic incentives, school and workplace environments, quality and labelling standards, and innovation and entrepreneurship. This might include supporting the production of “protective foods” such as minimally processed, phytochemical-rich fruits, vegetables, legumes, nuts, and seeds, and disincentivising production of disease-promoting foods like refined grains, sugars, and processed meats.  An additional approach could include increasing access to technology to allow individuals to make smarter food choices, such as continuous glucose monitors which can help guide a person to choose a metabolically-optimised diet. As of the last couple of years, India has recently upped its subsidies for sugarcane.

To read the full interview on Express Healthcare, visit here.