“Effects of COVID-19 on Diabetic Patients and its financial impacts”

Abstract

Background: COVID-19 increases the blood sugar level by developing diabetic ketoacidosis to approximately 40% patients and this virus increases the risk of developing type 1 diabetes In patients. Viral infection increases the production of anti-pancreatic anti -bodies which restrict the production of insulin from beta cells of pancreas and develop insulin dependent diabetes and type 1 diabetes in an individual. Autoimmune process is triggered by the penetration of COVID-19 virus which destruct the islets and beta cells of pancreas. Insulin level is reduced by COVID-19 which contribute to induce diabetes and deteriorate its control in an existing diabetes. Sugar level in the blood is increased by the stress hormone, glucocorticoids which induced by the infection of this virus. Infection of this virus disturb carbohydrate metabolism which increase insulin resistance, leads to increase the sugar level in blood of diabetic patients as well as in normal persons. Deregulation in metabolism and hyperglycemia by long-term COVID-19 infection may lead to general malaise and fatigue. Health sector budget of Himachal Pradesh is Rs. 3,139 crore as compare to the union budget Rs. 89,155, for the financial year 2023-24 whereas combined expenditure on health sector is 1.18%. India is lagging far behind to reach target of expenditure of health budget. ₹ 14,217 crore was spent for COVID-19 emergency response and health system preparedness package and COVID-19 vaccination for healthcare and frontline workers. 18% of total outpatient care and 44% of total inpatient care is encompassed in Indian public health sector. 

Objective: Analysis of effects of COVID-19 on diabetic patients and its financial impacts.

Material and Method: A cross-sectional descriptive study is conducted at various institutional levels and by visiting randomly in different selected areas with help of well -developed questionnaire. The research work is conducted by collecting the data of diabetic and diabetic with hypertension patients during COVID-19 in the years 2020, 2021, 2022 and 2023. Sample size is  947 participants and total investigations done, are 5498.

Results: Total persons investigated are 5498, normal persons are 4551(82.78%), diseased persons with diabetes and other NCDs are 947 (17.22%), out of these 368 are of diabetic and diabetic with hypertension patients and 579 are other NCDs like hypertension. From these 368 diabetic patients, 296 patients show major increase in blood sugar level and 72 patients have minor impact in blood sugar level. Out of these 368 patients, 87 patients show more than 200 mgdl variation in blood sugar level, 115 shows variation from 100-200 mgdL and 94 patients show variation from 50-100 mgdl. and remaining 72 patients have less than 50 mgdl variations. This variation has increased the financial load on the diabetic patients which in average initially  was expected as Rs.1,099,125 but it is now raised to Rs. 1,314,568. Total government price for purchase of allopathic medicines for the calendar years 2020-23 for 368 diabetic patients is expected as Rs. 1,099,125/- but it is raised to Rs. 1,314,568 and market price expected as Rs.11,184,358/- but it is raised to Rs. 14,075,112/- and actual expenditure is expected as Rs. 3,089,198/- but it is raised to Rs. 4,989,876/- now. The government cost for traditional medicines for these patients is expected as Rs. 138,448/- but it is raised to Rs. 289,789/-, market price is expected as Rs. 326,737/- but it is raised to Rs. 498,879/- whereas actual expenditure is Rs. 498,879/-. The total actual expenditure is Rs. 5,488,935/- The average cost of treatment for the patients taken for sample is Rs.1329428/-, Rs. 1370678/-, Rs. 1408764, Rs.1379885 and for population of Himachal Pradesh is Rs. 61153688/-, Rs. 63051188, Rs. 64803144, Rs, 63474710, respectively for 2020 to 2023 calendar years.

Conclusion: The cost of treatment for 368 patients of diabetic mellitus [sample size] of modern allopathic medicines has increased from expected expenditure of government price Rs.1099125/- to 1314568/-, market price from Rs. 11184358/- to. Rs,14075112/- and actual expenditure from Rs.3089198/- to 4989876/- and for traditional herbal medicines for government price 138448/- to 326737.-, market price and actual price from Rs. 289789/- to 498879/-. The total expenditure of both the systems has increased from Rs. 3415935/- to 5488755/-