Dr Farzahna Mohamed
RESEARCH PROJECT: Glucose and lipid metabolism in severe acute respiratory distress syndrome (SARS-CoV-2)
Dr Mohamed, a Specialist Physician and Endocrinologist and recipient of multiple academic awards, is currently a PhD student in the Faculty of Health Sciences at the University of the Witwatersrand. Her studies are focused on glucose and lipid metabolism in COVID-19.
In the field of non-communicable diseases, diabetes mellitus is a leading cause of mortality: one in every 11 adults has it and someone dies from it every seven seconds. It is surprising to hear that 60% of people who have this condition, remain undiagnosed. Diabetes mellitus is a risk factor for severe COVID-19 and is independently associated with a higher mortality rate. Whether SARS-CoV-2 causes new-onset diabetes is currently uncertain. “Management of these two major pandemics requires greater insight into novel biomarkers for earlier identification of severe disease that will guide therapy; and simple measures including glucose monitoring and judicious use of insulin should become the focus of medical protocols, to reduce morbidity and mortality,” explains Dr Mohamed.
During the first COVID wave in 2020, Farzahna Mohamed and her team conducted a study, evaluating patients hospitalised with moderate to severe COVID-19 infection. Diabetes was confirmed in 58% of the cohort, and 41% of patients were newly diagnosed. The mortality rate was significantly higher in those with diabetes (26%) and hyperglycaemia (54%). Those with hyperglycaemia had worse outcomes, including a 3-fold higher mortality and need for ventilation and a 3.5-fold greater chance for ICU admission compared to those with a normal glucose level. Admission hyperglycaemia was also found to be an independent predictor for ICU admission.
“This study led to me pursuing my PhD. Despite this evidence, an important question that remains is whether COVID-19 induced diabetes has a different pathogenesis and whether SARS-CoV-2 is precipitating a ‘new form’ of diabetes.”
The project faced more than the share of challenges that could be expected when pursuing a PhD during the peak of the COVID-19 pandemic, with its increased workloads, daily work uncertainty and emotional and psychological stress of working, often helplessly, with severely ill patients. Dr Mohamed was working at the Charlotte Maxeke Johannesburg Academic hospital, which burnt during this period and led to months of closure.
Resilience is a key signature of this bright professional, who sees the upside to the disruptions: “These experiences … had a positive impact on my academic and emotional growth as a leader,” she says. “Benjamin Franklin was right when he said that opportunity comes out of adversity.”
Sharing her productive journey is of major importance to Dr Mohamed. She expresses gratitude for the opportunities she has had for collaboration, mentorship and transformation. She is focused on encouraging younger medical students to pursue their own research: “I have been so fortunate in having the opportunity to be mentored by Prof FJ Raal, a world renown lipidologist and NRF A1 rated scientist. My goal is to contribute to the growth of research within my department by inciting a passion for research and innovation. I believe that the greatest good I can do for them is not to only share my knowledge, but for them to discover their own.”
Diabetes mellitus (DM) is a leading cause of mortality among non-communicable diseases.1 One in every 11 adults have DM, with an estimated prevalence of 12.7% in South Africa.2 However, approximately 60% of people with DM are undiagnosed.2 DM and cardiovascular disease (CVD) are risk factors for severe COVID-19. In addition to other predictors of mortality, including older age, chronic liver disease, chronic kidney disease, human immunodeficiency virus and limited resources, DM is independently associated with higher mortality (OR 1.25).3Despite the association between DM and severe COVID-19, whether SARS-CoV-2 causes new-onset DM is currently uncertain. Uncertainty remains in the underlying pathogenesis, as well as the molecular, immunological, cellular and genetic mechanisms involved in new onset DM associated with COVID-19. The relationship between COVID-19, DM and CVD, necessitates that this syndemic be explored.
The aim of this study is to explore the glycaemic and lipid parameters in COVID-19 and the association of these parameters with inflammatory markers and outcomes in an ethnically diverse South African population.
We hypothesize that COVID-19 mediated new onset DM is a complex disease characterized by a combination of indirect viral mediated insulin deficiency and insulin resistance associated with the pro-inflammatory milieu.