There is a risk for diabetic patients to develop coronavirus disease 2019 (COVID-19) in dental clinics. The risk is high and may be life-threatening if the blood glucose level is greater than 13.5 mmol/L (240 mg/dL). Unfortunately, dentists do not have enough information to determine the degree of risk for uncontrolled diabetes. In normal conditions, it is acceptable for dentists to treat diabetic patients who have fasting blood glucose levels of 8.1–10.0 mmol/L (145–180 mg/dL) or random blood glucose (2 h after a meal) levels of 10.1–13.0 mmol/L (181–234 mg/dL). Based on the risk level assessment of fasting blood glucose, the value of 181–240 mg/dL is considered high and dental treatment cannot be provided unless the blood glucose level is lowered, while the value of >13.1 mmol/L (235 mg/dL) is associated with the sign of uncontrolled diabetes and high risk of systemic complications.1
With the COVID-19 pandemic sweeping the world,2,3 uncontrolled diabetic patients are also in alarming conditions. Higher the blood glucose levels, the greater the incidence of coronavirus infection.2 There are common points between coronavirus disease and diabetes, both of which cause chronic inflammation, an increase in coagulation activity, weak immune response, and the possibility of direct pancreatic damage by COVID-19.4,5 A study by Singh et al.,6 reported that the degree of severity and mortality was increased in COVID-19 patients with poorly controlled diabetes. Experts from the Chinese University of Wuhan found that people with higher blood glucose levels are more likely to get infected with more severe strains of the deadly virus. COVID-19 enhances metabolism of glucose through a phenomenon called “cytokine storm.” This storm often occurs in the lungs when huge numbers of leukocytes are stimulated and excrete inflammatory cytokines, causing pneumonia, difficulty in breathing, and death.4,7,8
A systematic review conducted by Gazal1 indicated that a blood glucose level of more than 240 mg/dL forms the starting point for the accumulation of high ketone levels in diabetes. Ketone bodies can cause physiological changes that affect hemostasis. These alterations consist of fluctuation in the clotting protein concentrations, overactivation of platelets, disturbances of the metal ion balance, increases in lipid metabolism, presence of coagulation-inducing substances, and endothelial dysfunction.9 A study by Erem et al.,10 demonstrated that the activation of coagulation with a reduced fibrinolytic activity is caused by vascular disease in poorly controlled diabetic patients. Therefore, COVID-19 infection in diabetic patients is likely to expose them to poses a higher risk of blood thrombosis, ketoacidosis, pulmonary capillary leak syndrome, multiple organ failure, and death. This can worsen, corresponding to dehydration, fluctuating blood glucose levels, and generalized inflammation of the blood vessels. Depending on the above facts, diabetic patients with fasting blood glucose levels (145–180 mg/dL) or random blood glucose levels (181–234 mg/dL) are still at risk of developing COVID-19 infection in dental offices. These patients should be strictly prohibited from attending dental clinics and advised to seek immediate medical attention once the teleconsultations are completed.
Conclusion
Patients with fasting blood glucose levels (181–240 mg/dL) or random blood glucose levels (235–300/mg/dL) are at higher risk of infection. Dental consultations are recommended over the phone, with an emphasis on work to lower blood glucose levels. Patients with fasting blood glucose levels >240 mg/dL are at a very high risk of getting infections and increased coagulation activity. Emergency dental treatments are advised to be provided by sending a mobile dental clinic to their place of residence.
Source of funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors have no conflict of interest to declare.
Ethical approval
Ethical approval is not required for the letter to the editor.
Authors’ contribution
GG conceived the idea, and wrote the initial draft of the article, WE and MSZ wrote a part of the article and critically revised the final draft. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.
Footnotes
Peer review under responsibility of Taibah University.
References
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