Diabetes: The Chronic, Ongoing Pandemic

A nurse practitioner expert speaks about new breakthroughs and the importance of communication in treating patients with diabetes.

Diabetes mellitus, or simply diabetes, is — like Parkinson’s Disease — an affliction that has been a part of medical literature “since antiquity,” according to the article “Milestones in the history of diabetes mellitus: The main contributors.” In the authors’ abstract, they write that “Descriptions [of diabetes] have been found in the Egyptian papyri, in ancient Indian and Chinese medical literature, as well as, in the work of ancient Greek and Arab physicians.”

The authors also note the incredible amount of progress made in just recent decades when it comes to understanding and treating the disease. Nurse practitioners (NPs) working or interested in endocrinology have a great deal of literature and new advancements to help them treat patients. One NP expert, Eligio David P. Soliman Jr., DNP, APRN, FNP-BC, CDCES, CMSRN, shared his perspective on the disease and treatment with the American Association of Nurse Practitioners^® (AANP) on NP Pulse: The Voice of the Nurse Practitioner^®. Read more about Soliman’s thoughts about the relation between COVID-19 and diabetes, the importance of clear communication and more.

COVID-19 and Diabetes

Soliman is a clinical associate professor for the DNP program at the Hahn School of Nursing and Health Science at the University of San Diego. He completed his Doctoral degree from the University of Pennsylvania and is a nationally recognized speaker on the topics of diabetes care and endocrinology. One of the topics he spoke about on NP Pulse was the increase of diabetes diagnosis during the COVID-19 pandemic. Soliman notes that “when Covid first hit — that was four years ago — it met head on with an existing pandemic. Diabetes is a chronic pandemic that’s been ongoing, and we have 500 million cases around the world.”

In part, Soliman states that the increase in diagnosis was due to patients having undiagnosed diabetes that was recognized when they saw a health care provider during the pandemic. “When COVID hit, everybody who got sick was seeking treatment. This included the people who were staying away from their primary care providers, who hadn’t seen a doctor for many years. And all of a sudden, they need to see a provider to treat their COVID, and it unmasks an existing metabolic problem.”

Another factor, he notes, was the change in lifestyle that accompanied being locked indoors. “Everybody stayed home — we significantly altered our way of life. You know, the way we eat or, people who are going to the gym every day — all of a sudden, the gyms are closed, right? There's this lifestyle component that was triggered by the pandemic.” Soliman also explains “there's also this factor in steroid therapy. A lot of our COVID patients are required to take a certain length of steroid therapy, which we all know induces hyperglycemia.”

Finally, “the actual pathology of COVID-19…can directly affect the beta cells. There is what they call cellular stress from the virus itself. There is what we call cellular transdifferentiation, which means the beta cells don’t function as they are supposed to. Instead of producing insulin, some of these beta cells actually start producing glucagon, which spikes the blood sugar. Or, in worst-case scenarios, it kills the beta cells. All of these things are playing into consideration. But now, four years later after the pandemic, we have enough data to show that COVID-19 itself is an independent factor in increasing the risk of the likelihood of diabetes, because we now can conduct studies among patients with no risk factors of diabetes — but who only had COVID-19 — and compare the rate of diabetes.”

“Our Words Matter”

With the increase in diabetes diagnosis after the pandemic came an opportunity for Soliman to utilize his favorite tool to combat diabetes — patient education. He says that “education for me — diabetes self-management education — is the cornerstone of diabetes care.”

Soliman emphasizes that patients must feel connected to the continuum of care recommended by their NPs or other health care providers. “My friend and first mentor in the diabetes education realm, her name is Beverly Tomasi, and she runs this business in training diabetes educators. That’s where I got my first training, and I always resonate with her phrase: ‘Our words matter.’ One of the key points in terms of helping [patients] navigate and hit our goals and targets is by reconstructing the way we communicate with our patients. I avoid saying to ‘control’ your blood sugar…because control connotes a negative aspect in human behavior. It’s so hard to control anything. I focus on blood sugar goals or targets. ‘We're not yet on target’ versus ‘we're not controlling your blood sugar’. It's like a whole different aspect of seeing things, and they can solidify their efforts and hit that target versus controlling something.”

To Soliman, that often means couching the language of diabetes into terminology his patients can comprehend. “In terms of blood sugars, I would tell [patients], ‘Your body can survive on almost any nutrient. But now, your body can't process carbohydrates. It's like buying a new car that requires a new kind of fuel. If you drive something that was diesel before, and now you drive an unleaded car and try putting in diesel, what will happen? It won’t start. And that's the same reason why when your blood sugar is so elevated, you feel sluggish because your body can't burn that fuel.’ It lights a light bulb…now, it's not about restricting. It's not about punishing myself. It’s about making my system work better because now I understand how it works.”

Diabetes Resources

If you are interested in more information related to diabetes management, visit AANP’s endocrinology resources page. AANP members may also join the AANP Endocrine Community for just $20 annually. A continuing education (CE) activity featuring Soliman, “Effects of COVID on Diabetes Management,” is available in the AANP CE Center through Oct. 15, 2025, and features 1.05 contact hours of CE credit; 0.37 of which may be applied toward pharmacology.