COVID-19 Update: Diabetes and the Merck Pill

By Dr. Bryan Alsip
COVID-19 Update: Diabetes and the Merck Pill

Dr. Bryan Alsip discusses good news and bad in the COVID-19 pandemic, like the proposed treatment pill developed by Merck, plus new evidence that links COVID-19 to the development of diabetes.

How would molnupiravir, the new pill developed by Merck, help COVID-19 patients?

We’re still waiting on the official data that they have submitted to the FDA, but from what has been released to the media, we anticipate that this is an oral medication that people could take at home. When prescribed, it would enable them to treat a COVID infection and hopefully prevent hospitalizations.

How does Merck’s new COVID-19 pill work?

Supposedly, it’s an oral medication you would take twice a day for four or five days, so something like Tamiflu. It’s a pill you could take at home. From what we’ve seen in the early releases to the media, it interferes with replication. It doesn’t prevent COVID infection, but it would prevent the replication of the virus in your body. You would be less likely to get really ill or progress to very severe symptoms.

Who would get Merck’s new COVID-19 pill and when?

We don’t know yet. That will be determined once the FDA makes a decision around an emergency use authorization for the medication. Merck has indicated they feel it’s most appropriate for those at a high risk of severe disease from COVID.

It may be limited to populations of a certain age group, perhaps older patients, or those with underlying medical conditions. We’ll have to see what the official recommendations are, but that’s a category we would anticipate.

What is the practical benefit of Merck’s new COVID-19 pill?

It’s another tool in our toolbox to fight COVID. We have vaccinations, which are probably the best way to bring down the pandemic, reduce the course of illness and prevent infections.

In some cases, we have therapies for patients who are admitted to hospitals. However, for the most part, we don’t have a readily available and easy-to-use therapy for people who aren’t in the hospital and that is not preventative like a vaccine; molnupiravir is a medication that would fit that category. We could offer it to individuals, particularly at the outset of therapies that are more difficult for patients to access.

Right now, the only thing that really fits that category is monoclonal antibodies. That requires infusion over a certain period of time and might require a location that’s harder to get to. It certainly requires a physician’s orders for that therapy. So Merck’s new pill is more easily available, something you can take at home and would prevent severe disease.

What other new COVID-19 treatments are on the way?

We know that there are many other companies working on similar anti-COVID therapies. I think Roche and Pfizer also have medications in the pipeline. Each of those can be very helpful because we don’t know the supply of this medication even once it is authorized and recommended. We don’t know how much will be available at what time.

The more we have in terms of options the better I think it is for us to be able to fight COVID in many different ways.

What is the connection we are seeing between COVID-19 infection and the development of diabetes?

We know that COVID infection can affect the body in many different ways. There are many studies now ongoing to look at the effects of long COVID, which is what happens to your body after you have resolved the infection. Those can adversely affect your mood and could promote long-term fatigue.

We’ve seen the effects of blood clots from COVID, which often affect some of the small blood vessels in your body. Because of that and the inflammation that occurs in your body when you fight the infection, you can see organ damage. We’ve seen organ damage in various places like the brain, lungs, liver, kidneys, and in some cases, the pancreas. The pancreas actually has the ability to regulate our glucose levels in our body. When that’s disrupted, that can lead to an exacerbation of diabetes or can cause diabetes in patients who hadn’t had it previously.

Why is the connection between COVID-19 and diabetes a concern?

Anything that would increase the prevalence of diabetes is of concern, and we certainly have challenges here in San Antonio and Bexar County with a high prevalence of diabetes. If we have additional contributions to that, from COVID infections that would exacerbate the burden on our own health care system and individuals who might be infected with COVID.

In what other ways has COVID-19 worsened the diabetes situation?

Diabetes is a chronic illness, and successful management requires routine care between a patient and their primary care provider. We know that has been disrupted because of COVID. We know that people have delayed going to their physician for routine maintenance or preventive care and immunizations. That’s certainly affected even more disproportionately pediatrics.

We know children who have fallen behind in their immunizations. It would make sense that diabetics who would benefit from regular visits to their physician and better monitoring of their therapy could also be adversely affected by the disruptions that COVID has caused.


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