What people with diabetes should know about mpox

The resurgence of mpox, a viral infection previously known as monkeypox, in the Democratic Republic of Congo (DRC) and other African countries has led the World Health Organization (WHO) to declare it a “public health emergency of international concern”. Following this declaration,  cases outside of Africa have been reported in Sweden and Pakistan.

Although the current situation remains fluid, it has left a significant portion of the global population, including people with diabetes, vulnerable to infection. As with the Covid-19 pandemic,  people with diabetes are a particularly at-risk population. However, there are steps they can take to protect themselves.

How the mpox virus spreads

Mpox is caused by the monkeypox virus (or MPXV). It is a viral infection initially found in animals, especially rodents, in Africa. Today, it also affects humans and is considered an emerging zoonotic disease. It is a mild form of smallpox with less severe symptoms and a lower mortality rate.

The virus spreads from person to person mainly through bodily contact—touching or kissing, talking or breathing close to someone with the virus, or touching textiles, objects, electronics and surfaces infected with mpox through touch. Avoiding close contact with infected people or wearing a mask, cleaning and disinfecting surfaces/objects and regular hand washing can help prevent transmission.

Diabetes and susceptibility to mpox

Not only are people with diabetes more prone to contracting mpox, they also face a greater risk of developing severe complications. People with type 2 diabetes sometimes have weaker immune systems caused by high glucose levels, making it harder for the body to tackle pathogens. Because the function of key immune cells, such as T cells and neutrophils, is impaired, the severity of viral infections increases.

DNA sensors, a component of the immune system, also function and react differently in people with diabetes, thus increasing their susceptibility to mpox, a DNA virus. This immune system imbalance can lead to a heightened inflammatory response, which can exacerbate mpox symptoms and increase the likelihood of serious complications, such as pneumonia, encephalitis and sepsis.

Know the signs of mpox

Accurate and early diagnosis of mpox ensures access to a treatment plan and prevents further transmission. However, distinguishing mpox from other skin conditions, such as chickenpox, herpes and eczema, can be challenging, particularly in the early stages of the infection.

The first sign is a painful rash that can progress into fluid-filled blisters and, eventually, scabs. For people with diabetes, the slow-healing lesions and increased susceptibility to skin infections can complicate the management of these lesions, potentially leading to secondary bacterial infections and further compromising their overall health.

If symptoms consistent with mpox, such as a rash, fever, or swollen lymph nodes appear, a healthcare provider can perform the necessary tests, including PCR analysis of skin lesions, to confirm a diagnosis and adapt diabetes treatment plans.

While PCR testing is the preferred method for detecting the mpox virus, the availability and quality of these tests may vary, particularly in resource-limited settings.

Specific mpox treatment and management for people with diabetes

Treating mpox in people with diabetes requires a multifaceted approach, focusing on controlling the viral infection and managing underlying metabolic conditions related to diabetes. First and foremost, symptoms should be addressed to prevent complications. This includes managing fever, pain, and skin lesions, drinking enough water and eating regularly to support the body’s healing process.

Although no specific antiviral medicines are approved for mpox treatment, some medicines developed for smallpox, such as tecovirimat, can be used to treat people affected. Healthcare providers sometimes prescribe these medicines if their patients are at a higher risk of developing severe complications.

Some diabetes oral medications, such as metformin, SGLT2 inhibitors and DPP-4 inhibitors, may have potential immunomodulatory properties that improve the immune system’s effectiveness and could treat viral infections, including mpox. This promising research area offers hope for better management of mpox in people with diabetes.

Preventive strategies for people with diabetes

Given the heightened susceptibility of people with diabetes to mpox, prioritising preventive measures can help reduce the risk of infection and transmission. Steps such as practising good hygiene, including frequent handwashing, avoiding close physical contact with infected people, and covering skin lesions can prevent the transmission. Furthermore, maintaining blood glucose levels within the target ranges reduces the risk of contracting the virus and can keep the immune system strong.

While mpox vaccine availability may be limited, high-risk populations, such as people with diabetes, healthcare workers or those with multiple sexual partners, should consider getting vaccinated. It is important to discuss the potential benefits and risks of vaccination with healthcare providers, as the effectiveness of these vaccines against the specific strains of mpox circulating may vary.

Importance of global cooperation

As the mpox outbreak evolves, advocating for the equitable distribution of resources, including vaccines and treatments, can ensure that people with diabetes and other vulnerable populations access the necessary treatments to manage and prevent infection.

Addressing the mpox outbreak requires a collaborative effort among healthcare providers, policymakers and public health authorities worldwide. The global community can work towards a more effective and inclusive response to this emerging public health challenge by sharing knowledge, resources and best practices.