# COVID-19 and diabetes



## Eddy Edson (Apr 2, 2020)

New study pre-print from researchers at the NIDDK: https://journals.physiology.org/doi/pdf/10.1152/ajpendo.00124.2020

- Individuals with diabetes, hypertension and severe obesity, and older people, are actually more at risk of getting it, as well as having worse outcomes.

- But unclear to what extent diabetes is an independent risk factor.

_Considering the high prevalence of cardiovascular disease (CVD), obesity, and hypertension in patients with DM, it is unknown whether DM independently contributes to this increased risk. However,  plasma glucose levels and DM are independent predictors for mortality and morbidity in patients with SARS (49). Potential mechanisms that may increase the susceptibility for COVID-19 in patients with DM include: a) higher affinity cellular binding and efficient virus entry, b) decreased viral clearance, c) diminished T cell function, d) increased susceptibility to hyperinflammation and cytokine storm syndrome, and e) presence of CVD _

- Future studies should address the knowledge gaps.


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## mikeyB (Apr 2, 2020)

What they are describing is full bore Metabolic Syndrome. I’m not surprised that causes higher likelihood of complications. Severe obesity, hypertension and diabetes will shorten your life anyway. Covid 19 is just an alternative way of dying early, along with seasonal flu, stroke, heart attack.

Obviously commoner in the US.


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## everydayupsanddowns (Apr 3, 2020)

Not been able to read the whole paper in detail this morning, but I wish they were able to stratify any of these suggestions of additional risk by diabetes type and glucose management, so that people could be reassured, and guidance, support and assistance could be updated to protect the most vulnerable PWD.


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## Inka (Apr 3, 2020)

Interesting read - thank you. I do wish there was more differentiation of diabetes types and control. I looked up one of the studies referred to and it seems to be about metabolic syndrome as said above. I’m definitely not a scientist but that was what I understood it was saying.

I wonder if there are more differentiated studies from SARS and MERS?


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## Eddy Edson (Apr 3, 2020)

everydayupsanddowns said:


> Not been able to read the whole paper in detail this morning, but I wish they were able to stratify any of these suggestions of additional risk by diabetes type and glucose management, so that people could be reassured, and guidance, support and assistance could be updated to protect the most vulnerable PWD.



There's just not enough data. The paper urges that this kind of knowledge gap be addressed in studies.


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## Val14 (Apr 3, 2020)

I am totally confused. I received a letter two days ago from my doctor saying I am in the most vulnerable group . Which means eating and sleeping in separate rooms to my husband separate cutlery etc.  I was diagnosed with type 2 diabetes two years ago but as far as I am aware that is my only condition. My husband is over 70 so we thought we were in the group that needed to self isolate which is what we have done.
 I rang the doctors to double check and they confirmed that they considered me in the most vulnerable group because of my diabetes. 
I know I have to be careful and stay indoors but I cannot see that diabetes is on the governments list of most vulnerable groups. Have I got it wrong or has my doctor?


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## everydayupsanddowns (Apr 3, 2020)

Val14 said:


> I am totally confused. I received a letter two days ago from my doctor saying I am in the most vulnerable group . Which means eating and sleeping in separate rooms to my husband separate cutlery etc.  I was diagnosed with type 2 diabetes two years ago but as far as I am aware that is my only condition. My husband is over 70 so we thought we were in the group that needed to self isolate which is what we have done.
> I rang the doctors to double check and they confirmed that they considered me in the most vulnerable group because of my diabetes.
> I know I have to be careful and stay indoors but I cannot see that diabetes is on the governments list of most vulnerable groups. Have I got it wrong or has my doctor?



Do you have an elevated HbA1c @Val14? (welcome to the forum by the way!)

The official guidance is here: https://www.gov.uk/government/publi...protecting-older-people-and-vulnerable-adults

But GPs are taking other factors into account and tailoring guidance to individuals. If you are still unsure, perhaps call again and ask them to explain the difference if full isolation is making life difficult for you? But keep doing as advised, until you've checked.


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## everydayupsanddowns (Apr 3, 2020)

I’ve been in contact with DUK to see if they are aware of this research and have any comments, unfortunately there isn’t yet a clear-cut answer, but this feedback might be useful for context:

_“We’re keeping a log of all the diabetes related publications and are putting together a blog on what we know so far – it’s just tricky because research is coming out at an unbelievable pace and isn’t always being peer reviewed..._​​_Essentially different studies will end up coming up with different answers depending on the data they’re using._​​_At the moment there just isn’t the right kind of evidence out there to be able draw conclusions about diabetes and CV19 risk yet. We do know that having consistently very high blood glucose levels can have an effect on the immune system, which can put people with diabetes at a higher risk of picking up infections of any kind.”_​
Diabetes UK are also in the process of urgently commissioning new research into Coronavirus/Covid-19 to try to fill in some of the gaps in our understanding.








						We're calling for applications for research into coronavirus (Covid-19) and diabetes
					

It’s never easy living with any type of diabetes. But we know right now many will be especially worried about their own or a loved ones’ health. The global coronavirus pandemic is affecting everyone across the world, but there’s uncertainty about whether or not people with diabetes are at...




					www.diabetes.org.uk


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## Val14 (Apr 3, 2020)

everydayupsanddowns said:


> Do you have an elevated HbA1c @Val14? (welcome to the forum by the way!)
> 
> The official guidance is here: https://www.gov.uk/government/publi...protecting-older-people-and-vulnerable-adults
> 
> But GPs are taking other factors into account and tailoring guidance to individuals. If you are still unsure, perhaps call again and ask them to explain the difference if full isolation is making life difficult for you? But keep doing as advised, until you've checked.


Hi my HbA1c was high last time I visited the doctor two weeks ago it was back up to 95. I had previously got it down to 41 . I am blaming it on Christmas and then a 4 week holiday in New Zealand.
Thanks for the link to the guidance but that is what I had looked up too and could not see diabetes on the highest risk I will do as you suggest and try and get a telephone consult with my doctor.


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## everydayupsanddowns (Apr 3, 2020)

Val14 said:


> Hi my HbA1c was high last time I visited the doctor two weeks ago it was back up to 95. I had previously got it down to 41 . I am blaming it on Christmas and then a 4 week holiday in New Zealand.
> Thanks for the link to the guidance but that is what I had looked up too and could not see diabetes on the highest risk I will do as you suggest and try and get a telephone consult with my doctor.



I suspect your high BG levels are what may have triggered it. We had another member who joined whose practice had used an HbA1 of 75 as the point at which they became more concerned (though this doesn't seem to be nationwide guidance, and I've not been able to establish where that figure came from).

There is a known association between high blood glucose / HbA1c and impaired immune system - so I think they are trying to keep you safe as you could be at increased risk of catching it if you were exposed to the virus.


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## Inka (Apr 3, 2020)

@everydayupsanddowns I linked to a web page on that other thread which gave guidance to GPs. Is that not official guidance? I admit I’m finding it hard to keep up with the various advice and categories.

Edited to add the link:

http://www.pulsetoday.co.uk/news/co...practice-nhs-letter-23-march/20040424.article


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## everydayupsanddowns (Apr 3, 2020)

Inka said:


> @everydayupsanddowns I linked to a web page on that other thread which gave guidance to GPs. Is that not official guidance? I admit I’m finding it hard to keep up with the various advice and categories.
> 
> Edited to add the link:
> 
> http://www.pulsetoday.co.uk/news/co...practice-nhs-letter-23-march/20040424.article



This is what others have been sent by their GPs I think... and it IS confusing. I also think it's been updated...

• Patients with diabetes with HbA1c greater than 75, recent diabetic ketoacidosis or poor medication adherence *[PLEASE NOTE - THIS IS NO LONGER THE CASE. PATIENTS WITH DIABETES SHOULD SELF ISOLATE, BUT ARE NOT CONSIDERED TO BE ‘VERY HIGH RISK’];*​
So they are saying something different to .gov. And now the Pulse article seems to be saying something different to itself. Where PWD are both very-high-risk-enough-to-self-isolate, but also *not very high risk*. No wonder people are getting mixed messages! 

I don't think that is clear at all. And I also don't think it fully appreciates the ramifications of full isolation for almost 5 million people for an unknown length of time, who may (quite rightly by .gov advice) still be being asked to work, or who may live alone or with children as a single parent and without the categorisation to receive any additional help in getting shopping etc.

Diabetes UK's sumary of the official advice is currently still 'social distancing' not full 'self isolation' for the majority of people with diabetes, except where HCPs have given specific instructions.


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## Inka (Apr 3, 2020)

Thank you very much for that @everydayupsanddowns It _is_ very confusing - and contradictory. It just adds to any stress to not know what the official advice is and what the risks are.

I tried looking at some studies today but even they are confusing at times, particularly when talking about Type 1 and Type 2. There are sentences which are very ambiguous.


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## NotWorriedAtAll (Apr 3, 2020)

I know I am probably quite privileged in being able to do this but my husband and I have decided to go full on isolated from the world and we made that decision about three weeks ago.

Since then he's been out of the house once to the supermarket to get meds and food and we've been once to drop food off to my mum who is late 80s with health conditions and also has been full on isolated for at least that long already.

I had read the WHO guidance about diabetes and high blood pressure as a high risk factor back then and we decided to work according to their information.  Apart from visiting my mum to drop food and necessities onto her doorstep and then wave to her from the car parked on the pavement once every ten days or so we will be trying not to leave the house for any reason whatsoever.


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## Clever_cloggs (Apr 3, 2020)

NotWorriedAtAll said:


> I know I am probably quite privileged in being able to do this but my husband and I have decided to go full on isolated from the world and we made that decision about three weeks ago.
> 
> Since then he's been out of the house once to the supermarket to get meds and food and we've been once to drop food off to my mum who is late 80s with health conditions and also has been full on isolated for at least that long already.
> 
> I had read the WHO guidance about diabetes and high blood pressure as a high risk factor back then and we decided to work according to their information.  Apart from visiting my mum to drop food and necessities onto her doorstep and then wave to her from the car parked on the pavement once every ten days or so we will be trying not to leave the house for any reason whatsoever.


I’m doing the same - I’m not leaving my flat and my family are doing the same. We get our food deliveries from an online supermarket and bits and bobs from Amazon, so we are staying in for as long as we can. Thankfully, we have a garden so have been getting fresh air that way.


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## sambda (Apr 16, 2020)

I am now totally confused.  They've just had a medical expert on Breakfast (16/4/20) and she said that diabetes sufferers will/should have received a letter from their GP and that they are in the vulnerable category.  I have had no letter, and the government's online vulnerability sign-up won't take diabetes.  What is going on?  Can somebody advise.  The front page of this site says that should a diabetes patient get Coronavirus they have a 1-in-14 risk of dying!  Those are not stats I want to play with.

I am type 2, managed with metformin/empagliflozin combination, and simvastatin.  Last HbA1C was 46 mmol/mol with no special diet. No other medical problems, but also on Venlafaxine. What should I be doing?


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## Inka (Apr 16, 2020)

Do you remember the expert’s name @sambda Its strange they mentioned getting the letter. I’ve often heard people mix up vulnerable and extremely vulnerable (the shielded) which is frustrating and confusing.

Did they imply all people with diabetes or just some (ie those with poor control or additional conditions)? Shielding everyone with diabetes would add millions of people to the numbers. My guess would be clumsy language when they actually meant _some_ people with diabetes.


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## sambda (Apr 16, 2020)

Inka said:


> Do you remember the expert’s name @sambda Its strange they mentioned getting the letter. I’ve often heard people mix up vulnerable and extremely vulnerable (the shielded) which is frustrating and confusing.
> 
> Did they imply all people with diabetes or just some (ie those with poor control or additional conditions)? Shielding everyone with diabetes would add millions of people to the numbers. My guess would be clumsy language when they actually meant _some_ people with diabetes.



No, I'm afraid I don't remember her name.  She was on Breakfast about 45 mins ago, or so, via Skype.  An Indian lady.  She was on there in a general capacity to answer questions about Coronavirus.  She didn't distinguish between types or severity of diabetes.


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## Inka (Apr 16, 2020)

If I get a chance, i’ll have a look on iPlayer later. Personally I’d assume she got it wrong, so don’t worry. I think we’re vulnerable but not the next step up (extremely vulnerable).

All we can do is keep our blood sugar well-controlled and follow the guidelines strictly. It is a worry, but I think I’d be worried even without the diabetes until they know more about this virus. So I’m practising strict social distancing and hygiene.


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## Robin (Apr 16, 2020)

sambda said:


> I am now totally confused.  They've just had a medical expert on Breakfast (16/4/20) and she said that diabetes sufferers will/should have received a letter from their GP and that they are in the vulnerable category.  I have had no letter, and the government's online vulnerability sign-up won't take diabetes.  What is going on?  Can somebody advise.  The front page of this site says that should a diabetes patient get Coronavirus they have a 1-in-14 risk of dying!  Those are not stats I want to play with.
> 
> I am type 2, managed with metformin/empagliflozin combination, and simvastatin.  Last HbA1C was 46 mmol/mol with no special diet. No other medical problems, but also on Venlafaxine. What should I be doing?


I’ve just watched it back, and no, she didn’t say that Diabetics would be getting a letter. It wasn’t the clearest conversation, but it went something like this.
Question from viewer. Why do some people get Covid worse than others.
Answer. We know that some people with health conditions get it worse, such as people with Asthma, COPD, Diabetes, Heart conditions (ie, the people who were asked to practise extra social distancing). 
That is why we’ve asked some people to be shielded and are writing to them.

So the list of conditions she gave wasn’t the shielding list, but she ran on without a break.


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## Inka (Apr 16, 2020)

Thanks @Robin i can see why that conversation was less than clear then. I wish people would differentiate more clearly as it can cause anxiety and confusion, not just for people with diabetes but their family too. 

Also, just reading your summary and not having watched the clip, I didn’t think she answered the question anyway. I took the question to be asking about why 20% of people get a more serious form of the disease whereas many get only a mild version. Those 20% are _not_ just the vulnerable. I’d like to hear more about that and whether it’s a genetic reason, etc.


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## Robin (Apr 16, 2020)

Inka said:


> Thanks @Robin i can see why that conversation was less than clear then. I wish people would differentiate more clearly as it can cause anxiety and confusion, not just for people with diabetes but their family too.
> 
> Also, just reading your summary and not having watched the clip, I didn’t think she answered the question anyway. I took the question to be asking about why 20% of people get a more serious form of the disease whereas many get only a mild version. Those 20% are _not_ just the vulnerable. I’d like to hear more about that and whether it’s a genetic reason, etc.


Yes exactly, she didn’t answer the question. The take away message was that you were in the clear if you don't have a preexisting condition, (and as far as we know, Boris didn’t fit into any of those categories.)
I think it’s not known why, at the moment, I read an article the other day that said Biobank, (the large ongoing health project that I did a health screening for about10 years ago),is making its data available to geneticists to see if there’s any reason why some people are more badly affected.


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## sambda (Apr 16, 2020)

Thanks for the replies.  That doctor gave a very liable-to-be-misunderstood answer!


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## Docb (Apr 16, 2020)

sambda said:


> Thanks for the replies.  That doctor gave a very liable-to-be-misunderstood answer!


Thats the problem with 24hr news trying forever to find a new angle and the fact that there is no end to people wanting their five minutes of fame.


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## grovesy (Apr 16, 2020)

Docb said:


> Thats the problem with 24hr news trying forever to find a new angle and the fact that there is no end to people wanting their five minutes of fame.


I get feed up with 24 hour news repeating g the same clips over the 24 hour period.


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## Eddy Edson (Apr 16, 2020)

grovesy said:


> I get feed up with 24 hour news repeating g the same clips over the 24 hour period.



Television ... ugh.


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## everydayupsanddowns (Apr 16, 2020)

Robin said:


> I’ve just watched it back, and no, she didn’t say that Diabetics would be getting a letter. It wasn’t the clearest conversation, but it went something like this.
> Question from viewer. Why do some people get Covid worse than others.
> Answer. We know that some people with health conditions get it worse, such as people with Asthma, COPD, Diabetes, Heart conditions (ie, the people who were asked to practise extra social distancing).
> That is why we’ve asked some people to be shielded and are writing to them.
> ...



Thanks for your detective work @Robin

So frustrating that these messages are still being given in a confused and confusing manner. There’s enough stress and anxiety already without needing any more fuel liberally sprinkled on everyone's glowing ‘worry embers’.


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