For Life interviewed Dr Michael MacDonald, senior consultant cardiologist from the Harley Street Heart and Vascular Centre to learn how the pandemic, and its quarantine measures, have promoted unhealthy diets and lifestyles, and impacted non-communicable diseases such as diabetes, heart attacks and strokes. This is part two or a two-part article.

Q: What kind of effect has the Covid-19 pandemic, and measures, had directly on the diagnosis of type 2 diabetes and the people who suffer from the disease?

The Covid-19 pandemic and quarantine measures put in place to curb its spread have had a significant impact on non-Covid-19 related illnesses. We have seen big drops in acute presentations of strokes and heart attacks around the world, and this is likely due to patients’ fear of attending hospitals. Diabetes is often picked up incidentally with screening and given that screening was temporarily suspended during Singapore’s circuit breaker (CB), we will have seen a fall in the diagnosis rate, however screening has now resumed and these cases will be picked up as usual. If infected with Covid-19, patients with diabetes are more likely to have a severe form of the illness and are at greater risk of death. There have also been cases of diabetes and its complications that appear related to Covid-19, and there is increasing research being done on these presentations. In addition, it has been noted in many countries that diabetes control has worsened during lockdown measures for a number of reasons relating to access to medical supplies and change in diet and exercise. The true impact of lockdown measures on diabetes will become apparent in the coming months.

Q: Have you seen more MONW phenotype patients presenting with diabetes during the CB period and do you expect the numbers to increase?

We have seen a fall in patients will all conditions during the CB. As measures have been gradually lifted, patients are increasingly seeking medical advice for their conditions that they have put off during the CB. The initial symptoms of diabetes such as thirst, weight loss and fatigue can often come on slowly so it is likely if patients began experiencing these during the CB, they will have waited until after restrictions are lifted to have these investigates. Time will tell if we will see a spike in the diagnosis rate of diabetes over the next few months.

Q: What specific repercussion have the medical community observed from stay-home/ quarantine/ lockdowns leading to unhealthy diets and lifestyles?

Lockdown measures globally have had a significant impact on lots of areas of health. Job insecurity and lack of social engagement are two of the factors that have led to an increase in anxiety/ depression and stress-related complaints. People have generally been moving less, and using home desk set-ups with poor posture, leading to an increase in musculoskeletal complaints. A UK study found that 48% of people gained weight during lockdown and 29% drank more alcohol. This may have a bearing on multiple aspects of health. Many countries have predicted that the number of diabetes patients will increase, and in addition, the number presenting with acute cardiovascular events. The next six months to a year, we will begin to get a true picture as to how these measures have led to changes in the patterns of disease.

Q: How worrying will this trend be if the virus continues to worsen globally till the end of the year and people continue to be locked down?

I think we will see an increase in illnesses presenting to hospital at a later stage. For example, the drop in heart attacks and strokes across the world suggests that people have had illnesses and not sought treatment. These patients will potentially present within the next year with late-stage complications of the initial illnesses such as heart failure. Usually at that stage, the condition is more difficult to treatment, and the patient will have less chance of recovering.

Q: What can people do to avoid getting diabetes – or worsening their condition – during extended lockdown? Do you have any advice for those who suspect they may have the MONW phenotype?

The advice on diabetes prevention is relatively straightforward. However, it may be more difficult to implement during a lockdown situation given the limitations imposed. People should still try and exercise as much as they can during lockdown, aiming for around 150 minutes of moderate exercise per week, i.e. brisk walking. From a diet point of view, the key areas are:

1. Avoidance of saturated fats (butter, coconut oil, animal fat) and unhealthy trans fats (often in junk food).

2. Avoid sweet snacks and sugar – one of the commonest mistakes is taking sweet drinks like bubble tea that are often loaded with simply sugars.

3. Avoid white rice and noodles as much as possible. Replace with brown rice and fresh vegetables.

4. Less red meat and pre-made or processed foods such as fast food.

5. Moderate your alcohol intake.


Dr Michael MacDonald from The Harley Street Heart and Vascular Centre

Dr Michael MacDonald is a senior consultant cardiologist at the Harley Street Heart and Vascular Centre in Gleneagles Hospital, Mount Elizabeth Novena Hospital, and Mount Elizabeth Medical Centre.