Diabetes and the Coronavirus: The coronavirus poses a significant risk to diabetics. Learn about the outcomes of the disease, how to prepare for it and more....
The coronavirus (COVID-19) has been recognized by nearly all major medical organizations as a serious threat to public health, and it’s a disease that most everyone in the general public should be aware of. Diabetics, however, ought to be especially aware of the virus and their corresponding risk exposure. For, the coronavirus poses a substantially increased risk to people with type-1 and type-2 diabetes.
In fact, people with diabetes form one of the most vulnerable groups with regard to the coronavirus. By one measure, they’re second only to those with cardiovascular disease in risk exposure.
The threat that the coronavirus poses to diabetics is immediately evident in reports from Hong Kong, where the first person to die from the virus was a 39-year-old male with diabetes and the second fatality was a 70-year-old diabetic male. While anecdotal, there’s plenty of evidence that corroborates what these two cases suggest — the coronavirus is a potentially fatal threat to diabetics, and it can affect both young and old persons who have the underlying medical condition.
Diabetes Makes Fighting Viral Infections Difficult
For all that’s still unknown about the coronavirus, it’s clear from the regions where the virus has broken out that diabetics who contract COVID-19 have increased rates of critical complications.
While serious, this news isn’t surprising because diabetics are known to have more difficulty fighting many viral infections than people who don’t have diabetes do. For example, consider the standard flu:
- People with gestational, type-1 and type-2 diabetes are all at increased risk of complications from the flu
- Even when diabetes is managed well, the flu can still cause complications such as pneumonia, bronchitis, sinus infections and ear infections
- Diabetes can make fighting the flu more challenging, and the flu can make managing diabetes more difficult
Most striking, 30 percent of adult hospitalizations for the flu in recent years have involved patients who had diabetes according to the Centers for Disease Control.
These details for the flu can’t be directly applied to the coronavirus, for the two diseases are caused by distinct viral infections. The general link between diabetes and increased complications from viruses was expected to be true with the coronavirus, however.
(Data for people who have prediabetes is less defined, but many of the same considerations would likely apply to one extent or another.)
Diabetics Have Higher Critical Complication and Morbidity Rates from Coronavirus
With specific regard to COVID-19, multiple official statistics and findings have demonstrated how serious a threat the coronavirus is to diabetics.
Researchers at the University of Maryland have identified diabetes as the “single biggest risk factor for increased disease severity and death” from the Middle East Respiratory Syndrome (MERS). MERS is distinct from the COVID-19 strain of coronavirus that’s spreading so quickly right now, but MERS is caused by another strain from the coronavirus family. This is an ongoing study that’s trying to determine why diabetes is such a big risk factor for MERS complications and fatalities, but simply to identify the underlying condition as the single most significant risk factor is quite a significant statement.
A summary report published in the Journal of the American Medical Association (JAMA) showed an increased mortality rate for diabetics who contract the COVID-19 strain of coronavirus. Among the 44,672 confirmed cases that were reviewed, the case-fatality rate (CFR) was 2.3 percent overall. For patients with underlying medical conditions, however, the corresponding CFRs were substantially higher. The CFR for various conditions was as follows:
- 7.3 percent for diabetes
- 10.5 percent for cardiovascular disease
- 6.3 percent for chronic respiratory disease
- 6.0 percent for hypertension
- 5.6 percent for cancer
These are the statistics that suggest diabetes is the second-biggest risk factor for COVID-19 (behind cardiovascular disease), and roughly one in every 13.69 diabetic people who were confirmed to have the virus unfortunately did not survive. (Importantly, these figures don’t reflect any diabetic persons who contracted coronavirus but did not have a confirmed case.)
More broadly, Chinese researchers found that having a single existing illness (known as a “comorbidity”) increased the likelihood of critical complications by 79 percent. Having two or more comorbidities increased that change by 2.5 fold. With specific regard to diabetes, the increased rate of critical complications according to this research was 60 percent.
These researchers looked at diabetes, cardiovascular disease, hepatitis B, chronic obstructive pulmonary disease, cancer and chronic kidney disease altogether as comorbidities, and they measured critical complications by the number of confirmed cases that required intensive care, required a respirator or proved fatal.
Overall, these various findings are relatively comparable to what’s known about the avian flu (H7N9), MERS and Severe Acute Respiratory Syndrome (SARS). Research from the other diseases offers general corroboration with these various findings and everything seems to confirm what medical professionals expected — the COVID-19 strain of coronavirus is more threatening to people who have diabetes.
Type-1 Diabetes Might Compromise Immune Systems and Lead to More Complications
Thus far, the COVID-19 strain of coronavirus is too new to show precisely why diabetes has the impact it does on the outcomes of patients who contract the virus. While the above-cited studies demonstrate a strong correlation, that correlation isn’t the same as causation and doesn’t provide a demonstrable mechanism.
It’ll likely be several years before researchers can show in controlled studies why diabetes and COVID-19 have such an increased confirmed fatality rate. Just now, the study at the University of Maryland that’s investigating diabetes and MERS and a recently published study from Johns Hopkins are looking at the mechanism of interaction between diabetes and MERS — which first appeared in 2012.
What is known at this point is how diabetes contributes to mortality in MERS infection. (Once again, MERS isn’t identical to COVID-19 but both come from a form of coronavirus.)
In order to fully appreciate the insights from the Johns Hopkins study, it’s first necessary to understand how COVID-19 causes death in cases where the infection is fatal. In serious cases, the infection manifests in the respiratory tract and lungs. From these cells, the infection enters the mucus as the disease progresses — and it can cause pneumonia. In turn, pneumonia can result in severe lung damage that leads to acute respiratory distress syndrome (ARDS) and septic shock. ARDs and the resulting septic shock are the most common causes of death from COVID-19.
In light of this, the Johns Hopkins (animal-based) study found that diabetic mice had a slower response to lung infections caused by MERS than their non-diabetic counterparts. Specifically, the diabetic mice showed lower levels of immune system chemicals and cells that would help fight the infection as it manifested in the lungs. Thus, MERS was able to more prominently infect the respiratory system, lungs and mucus. (The specific immune system components that were low were inflammatory macrophages, inflammatory cytokines and T cells.)
Even though this finding examined a different strain of coronavirus, it still provides an insight that’s likely helpful. MERS didn’t infect the diabetic mice faster than the non-diabetic ones. Instead, the diabetic mice had a weaker and slower immune system response that allowed the virus to manifest itself more and cause an increased number of critical complications. Thus, the increased morbidity rate among diabetics who contracted MERS was likely due to a compromised immune response.
These conclusions probably also hold true with COVID-19 even though there aren’t any studies to confirm such suspicions yet. Assuming the conclusions do hold true, diabetics are likely at an increased risk of experiencing critical complications from the COVID-19 coronavirus because their immune systems are low in essential components.
This has implications for all diabetics, but it’s especially significant for people who suffer from type-1 diabetes. Type-1 diabetes often results in heightened blood sugar levels, and those are known to compromise the immune system. Therefore, a logical conclusion is that people with type-1 diabetes may experience higher rates of critical complications from COVID-19 because elevated blood sugar levels have diminished their immune system’s ability to fight the viral infection in their lungs.
Importantly, this conclusion must be accompanied by three significant disclaimers. The conclusion:
- Hasn’t been proven by researchers but seems to be logical based on what studies are available and what’s known about type-1 diabetes.
- Doesn’t indicate that everyone with type-1 diabetes will experience critical complications, as many cases still resolve without becoming serious or critical
- Doesn’t mean patients with type-2 diabetes aren’t also at an increased risk, for the studies that show diabetes results in an increased risk of critical complications cover both type-1 and type-2 diabetic patients
Type-1 and Type-2 Diabetes Make Treating Any Viral Infection a Two-Fold Challenge
At a broader level, diabetes (including both type-1 and type-2 diabetes) often makes treating any viral infection more challenging in two distinct ways.
First, having diabetes generally diminishes the body’s ability to fight infection — and this isn’t limited to just those with type-1 diabetes. Both consistently elevated glucose levels and constantly fluctuating glucose levels can negatively impact the immune system.
Second, illness can make managing glucose levels more difficult. If patients lose their appetite, aren’t able to keep food down or become too dehydrated, their blood sugar levels can drop as a result. This leads to fluctuations, and a negative-feedback loop can ensue if there’s no intervention.
Of course, all of this naturally brings up questions about how diabetics can prevent the norovirus and what they should do if they contract it. The remainder of this piece will take up several issues related to questions like these.
How to Prevent the Coronavirus
The precautionary measures that diabetics should take to mitigate the risk of contracting the coronavirus are the same as what everyone else should be doing.
First, most people are advised to get the flu shot if they haven’t already. Having a flu shot could prove helpful if someone were to contract both the flu and the coronavirus simultaneously. Even when the two aren’t contracted together, reducing risks posed by the flu can help keep the body healthier and less worn-down so that it can better fight the coronavirus if contracted.
Second, people who have diabetes should discuss pneumococcal vaccines with their healthcare provider. A vaccine for pneumonia won’t prevent the coronavirus, but it may help deter the pneumonia that’s responsible for so many coronavirus deaths. This is recommended for certain groups (primarily the young and elderly), but its efficacy against COVID-19-related pneumonia is questionable because there are different strains of pneumonia. A healthcare provider can provide the most knowledgeable advice based on a patient’s individual considerations and the latest known research.
Third, everyone should be practicing good basic hygiene — the most important part of which is handwashing.
It’s hard to understate how important handwashing is, as it helps protect both individuals and the general populace as a whole. By one estimate, there’d be a nearly 70-percent slowdown in the spread of infections if 60 percent of people in airports maintained clean hands (only 20 percent of people currently do). Similar slowdowns in disease spread would probably be seen in other contexts if more people washed their hands regularly.
In addition to handwashing, the CDC recommends these everyday practices:
- Avoid close contact with persons who are ill
- Cover your mouth and nose when sneezing or coughing
- Avoid touching your eyes, mouth and nose
Practicing good health habits can also help keep your body ready to fight infection. Make sure you’re eating well, remaining hydrated, getting enough sleep, exercising and managing stress.
In dry climates and homes, a humidifier may also help prevent the spread of disease. Increased at-home humidity won’t do anything to fight a virus itself, but a relative humidity that’s high enough to keep the skin, lips and nose from cracking will reduce how many places a virus is able to enter the body.
(At the time of writing, the CDC is not recommending that the general public wear masks unless they’re showing symptoms of the coronavirus, in which case they should seek medical attention.)
How to Prepare for Coronavirus with Type-1 or Type-2 Diabetes
In addition to the preventative measures that everyone ought to be taking, people with type-1 or type-2 diabetes must also consider what impact the outbreak could have on their diabetes care. There are a few preparatory steps to take.
First, now is the time for everyone (including both diabetics and non-diabetics) to make sure they have all the medical information they need. Specifically, everyone should make sure they have the contact information for their:
- Primary care provider
- Specialist providers
- Insurance company
Should any issues arise during a time of quarantine or isolation, having these phone numbers and email addresses on hand will make it easy to get information and navigate issues without increasing potential exposure for anyone.
It may also be helpful to list medications and doses so that they can be quickly referenced during a time of illness and so other caregivers have a record of what medications are normally taken.
Second, diabetics who don’t already have their diabetes well-managed should proactively work on this with their healthcare provider. A good baseline glucose management system can make the management of an infection easier, and this is a proactive approach that will have lasting benefits even for those who don’t contract the coronavirus.
Finally, patients should ensure they have an adequate amount of diabetic supplies on hand.
There’s currently no indication of an imminent shortage of diabetic supplies. Although the Food and Drug Administration has warned of potential medical supply shortages, manufacturers ELI Lilly and Omnipod have both published statements that they don’t currently anticipate any shortages of their diabetic supplies. Other suppliers are expected to follow suit.
The biggest risk right now to the supply chain of diabetic devices and drugs is the suspension of FDA inspections at Chinese manufacturing facilities. These suspensions could lead to eventual shortages, but that risk remains fairly distant and probably won’t be an unexpected shortage. Instead, it should be an issue that companies, providers and patients can prepare for if it does occur.
Rather than worrying about a supply shortage, diabetics ought to stock up on supplies in case they can’t get out to procure more supplies. Illness, quarantine and isolation could all potentially make accessing supplies difficult for some patients.
Before stockpiling supplies, patients should consult their healthcare provider to find out what’s appropriate to keep on hand. The recommendations may vary from person to person and locale to locale. As a general guideline, however, the following list may be used:
- One month’s worth of insulin
- Additional glucose monitoring supplies
- Multiple daily injections (for those on pumps to use as backups)
- Extras of any other needed diabetes supplies
Some patients may have trouble sourcing these additional supplies affordably. Those without insurance might need to pay more than they budget in a given month for supplies, and those with insurance might find that their policy limits how many supplies they can get in a given timeframe.
Anyone who has trouble affording additional supplies should talk with their healthcare provider, pharmacy and insurance company to find out whether anything can be done to mitigate the cost. Local grassroots organizations are also helping diabetics manage the costs in some areas. A healthcare provider or insurance company ought to know of any organizations that operate in a particular area.
Additionally, many companies in the medical industry are actively monitoring the coronavirus outbreak and sending assistance where it’s needed. Members of the industry trade group AdvaMed have formed a Coronavirus Task Force, and they have made supply and cash donations equalling $30.9 million to the China Red Cross by the end of February.
How to Manage a Case of the Coronavirus
If diabetics contract the coronavirus or show symptoms of the disease, they should follow the current guidelines and consult their healthcare provider. The spread is evolving too quickly to put specific recommendations for diagnoses, COVID-19 tests, quarantines and isolations. Information is readily available, however, from a number of sources:
- The CDC and National Institute of Health have details and recommendations on a national level
- State coronavirus hotlines are being created for statewide information and specific questions
- Local health officials and authorities have the most localized information
- Healthcare providers can diagnose, recommend testing and treat the virus as appropriate
Most importantly, anyone who shows symptoms (which include fever, cough and shortness of breath) should limit contact with others, avoid public places and seek medical attention. A healthcare provider may recommend testing blood sugar more frequently and checking urine for ketones, depending on a patient’s particular situation.
What to Tell an Employer About a Coronavirus Case
Everyone who contracts the coronavirus should limit exposure to others, and part of that includes not leaving the house for work. People who can use sick days certainly should if they need to, and those who don’t have sick days ought to be aware of what other protections they have under the law. Diabetics may be entitled to two main benefits under federal law.
First, diabetics are entitled to “reasonable accommodations” at work so that they can better manage the condition. What constitutes a reasonable accommodation is open to some interpretation, but it may include medical leave or alternative accommodations. These rights don’t disappear during a health crisis or if diabetes becomes more difficult to manage because of an infection.
Second, the Family Medical Leave Act (FMLA) requires applicable employers to let their employees take time off if the employee experiences a serious health condition or needs to care for a family member who does. Under FMLA, the coronavirus qualifies as a “serious health condition” and employees who contract it (or have a family member contract it) must be allowed to take time off if necessary.
FMLA isn’t a perfect protection, as it doesn’t apply to all employers and doesn’t provide paid leave, but it at least eliminates concern over possible consequences at work for taking time off due to the disease.
Diabetics (And Everyone) Should Prepare for the Coronavirus
The coronavirus is a serious threat to everyone and especially people who have type-1 or type-2 diabetes. Panic isn’t an appropriate response, but preparation certainly is. Learn how to reduce your risk of contracting the COVID-19 coronavirus, know how to recognize its symptoms and make the appropriate diabetic preparations. With preparation, comes peace even as the outbreak progresses.