# Coronavirus: Diabetic people offered support



## Northerner (May 20, 2020)

People with diabetes are being offered help and support as a study reveals some people with the condition may be at higher risk if they catch coronavirus.

Although the threat of coronavirus is still low for most diabetic people, diabetes was linked to a third of virus deaths in England from 1 March to 11 May, NHS England research shows.

High blood sugar levels and obesity add to the risk.

But age is a bigger risk factor.

People with type 1 or 2 diabetes are strongly advised to follow the government's coronavirus advice.

Diabetics are not included in the list of people at highest risk who should shield at home, although some may be advised to shield if they are at significant risk due to a combination of health factors.

There is a helpline and online advice which people with diabetes can use to help manage their condition during the coronavirus outbreak.









						Coronavirus: Diabetic people offered support
					

A study reveals, for some, having diabetes is linked to an increased risk of dying with coronavirus.



					www.bbc.co.uk
				




Remind me - how many weeks into this are we?


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## Docb (May 20, 2020)

Anybody know where the base data can be found?  I'd like to find out where the ageing, well-controlled, not overweight type 2 fits into the scheme of things.


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## grovesy (May 20, 2020)

Docb said:


> Anybody know where the base data can be found?  I'd like to find out where the ageing, well-controlled, not overweight type 2 fits into the scheme of things.


Partha Kar said on twitter yesterday there review of the data should be out today.


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## Robin (May 20, 2020)

Docb said:


> Anybody know where the base data can be found?  I'd like to find out where the ageing, well-controlled, not overweight type 2 fits into the scheme of things.


There’s one study here, Paper 2.


			https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf
		

Edit: There is Paper 1 here. Haven’t had time to read them all yet.


			https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf


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## Docb (May 20, 2020)

Thanks Robin, I'll read properly later although I noted that a conclusion referred to hyperglycemia and not to diabetes which I found interesting.


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## AJLang (May 20, 2020)

I feel it has some very unexpected information such as Type 1 as an independent variable being a higher risk factor than Type 2  and tight control of Type 1 being a higher hazard risk than not so good control. I would thoroughly recommend looking at the info about it from Parthia Kar on his twitter page or his FB Page..


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## Eddy Edson (May 20, 2020)

AJLang said:


> I feel it has some very unexpected information such as Type 1 as an independent variable being a higher risk factor than Type 2  and tight control of Type 1 being a higher hazard risk than not so good control. I would thoroughly recommend looking at the info about it from Parthia Kar on his twitter page or his FB Page..



Kar's discussion thread: https://threadreaderapp.com/thread/1262884059858034688.html


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## Docb (May 20, 2020)

Fair enough but there is an awful lot of lumping together going on.

For example, can you separate out the risk for thin, well controlled, T2 diabetics from the data set? 

At least T1 & T2 are separated which is something the general media don't do.


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## AJLang (May 20, 2020)

In the paper there are the risk figures for all “normal” Type 1 and Type 2 e.g. 3.5 for Type 1s. Then there are additional hazardous risk factors which can be both plus and minus from the normal/standard number. These hazard risk factors are shown in the appendices at the end of the main paper. Does this help with your question?


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## AJLang (May 20, 2020)

This link takes you to the papers




__





						NHS England » Type 1 and Type 2 diabetes and COVID-19 related mortality in England
					






					www.england.nhs.uk


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## Bruce Stephens (May 20, 2020)

Docb said:


> For example, can you separate out the risk for thin, well controlled, T2 diabetics from the data set?



As far as I can tell being normal weight and well controlled is associated with lower risk. (They say there's a U shaped curve for weight so being too thin or too fat are worse.)

They also mention that being a current smoker is associated with a lower risk. (Though I imagine if you look at deaths from all causes being a smoker is still a very bad was to preserve health.)


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## Docb (May 20, 2020)

AJLang said:


> In the paper there are the risk figures for all “normal” Type 1 and Type 2 e.g. 3.5 for Type 1s. Then there are additional hazardous risk factors which can be both plus and minus from the normal/standard number. These hazard risk factors are shown in the appendices at the end of the main paper. Does this help with your question?



Yes, just need to get my somewhat slow and ageing brain round how they have manipulated the numbers.  Thanks for the links.


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## Lucy Honeychurch (May 20, 2020)

Odd how really tight control with low hb1ac is a risk factor and a low bmi...I see the active smokers rates are low again


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## Docb (May 20, 2020)

My first look at the raw data suggests that the conclusion that you cannot separate out the effects of age, BMI and diabetes control is unclear from the data set is entirely justified simply because no attempt has been made to sort these things out in the data collection. The data is either grouped by age, by BMI or by HbA1c so interactions cannot be distinguished.

If you look at the raw data very simply (always my starting point in data analysis) what you find is that if you look at deaths in the population of those with a T2 diagnosis, then the only thing which has even the semblance of correlation is age.  More older T2 diabetics are dying than younger ones.


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## Lucy Honeychurch (May 20, 2020)

...that's for type 1's...I downloaded the pdfs from Partha Kar Facebook and the data is more indepth.


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## Docb (May 20, 2020)

No Lucy.  It was for T2's and taken directly from the original paper.  I was only interested in answering the question about my own circumstances!


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## trophywench (May 20, 2020)

The thing about smokers I should think, is that because all our breathing tubes are at the least generously coated in tar if not completely blocked, the virus possibly (?) has less chance of entering ?

Comparatively though - not actually a good thing.


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## Jane50 (May 20, 2020)

Northerner said:


> People with diabetes are being offered help and support as a study reveals some people with the condition may be at higher risk if they catch coronavirus.
> 
> Although the threat of coronavirus is still low for most diabetic people, diabetes was linked to a third of virus deaths in England from 1 March to 11 May, NHS England research shows.
> 
> ...


with the new results on diabetes patients, is there any more risk to a type 1 diabetic who is 70 years old, with high blood pressure


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## Docb (May 20, 2020)

Jane50 said:


> with the new results on diabetes patients, is there any more risk to a type 1 diabetic who is 70 years old, with high blood pressure



There are data in the second paper but make of it what you will.  Making sense of it is not as straightforward as some would have you believe and I still have not worked out what the authors have done to come to the conclusions they have.  I'll take responsibility for any conclusions I reach as regards myself because its my own stupid fault if I get it wrong and suffer but won't chance it for anybody else!


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## trophywench (May 21, 2020)

Hi @Jane50 - you and me both!  It still depends on any number of other factor you haven't mentioned though - eg the natural colour of your skin/ethnicity, your day to day and therefore long term control of your BG, being too fat or too thin to name just 3.


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## Jane50 (May 21, 2020)

trophywench said:


> Hi @Jane50 - you and me both!  It still depends on any number of other factor you haven't mentioned though - eg the natural colour of your skin/ethnicity, your day to day and therefore long term control of your BG, being too fat or too thin to name just 3.


Blood glucose is ok sometimes, but do tend to get higher levels over 4 or 5 tests a day, think it is because it is difficult to get the insulin in without it going into a lump, I am white british, and am obese (over 30 bmi), just cant seem to get this down. blood pressure is normal sometimes, but other times it is far too high so have to get plenty of exercise


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## Docb (May 21, 2020)

Well, I have now read the second of the two papers.  I think I know what has been done.  They have done an enormous data collection for the period from 1st Jan to 1st May.  They have found out how many people there are with a diagnosis of diabetes, what their age is, what their BMI is, their latest HbA1c and a couple of other factors.  They have done this using input from GP records using NHS number to identify individuals.  They have then looked at death stats for the same period looking for death certificates where COVID is referred to as a contributor to the death.  The NHS number provides the link to the diabetes data.

They have then entered the data into a statistical package which looks at all the data and looks for the effect of each of the factors as separate entities.  It does this by calculating a hazard ratio for each factor ( HbA1c, BMI ethnicity, etc) which says something about the additional risk of being in a particular category.  This hazard ratio increases with age, HbA1c, and generally with BMI although are higher for anorexic levels of BMI.  

So far so good.  The next thing I have to work out is what the hazard ratio means and what the risks are being compared to. I would expect the comparisons to be to people without a diabetes diagnosis but on a first read, I cannot see how that can have been done.  Also, the raw data shows an expected increase in death rate with age but not for HbA1c or BMI, that only comes out in the statistical analysis. I need to get comfortable with that and the conclusions you can draw.

Might run out of steam on this one.


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## Eddy Edson (May 21, 2020)

Docb said:


> Well, I have now read the second of the two papers.  I think I know what has been done.  They have done an enormous data collection for the period from 1st Jan to 1st May.  They have found out how many people there are with a diagnosis of diabetes, what their age is, what their BMI is, their latest HbA1c and a couple of other factors.  They have done this using input from GP records using NHS number to identify individuals.  They have then looked at death stats for the same period looking for death certificates where COVID is referred to as a contributor to the death.  The NHS number provides the link to the diabetes data.
> 
> They have then entered the data into a statistical package which looks at all the data and looks for the effect of each of the factors as separate entities.  It does this by calculating a hazard ratio for each factor ( HbA1c, BMI ethnicity, etc) which says something about the additional risk of being in a particular category.  This hazard ratio increases with age, HbA1c, and generally with BMI although are higher for anorexic levels of BMI.
> 
> ...



The HR's are relative to a chosen level within each risk factor category, all referenced to the diabetic cohort. So hazard relative to being diabetic and female for sex, to diabetic and age 50-59 for age, to diabetic and BMI 25-30 for BMI etc, as independent factors. It's the standard multivariate analysis.

What I might be interested in is: What is my risk of dying if I catch COVID-19, as a 59 yr old T2D with BMI=20, HbA1c=34 etc etc. The paper won't tell you that and no 2-dimensional paper could, presumably. But maybe an interactive app could.


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## everydayupsanddowns (May 21, 2020)

AJLang said:


> This link takes you to the papers
> 
> 
> 
> ...



My understanding is that the majority of the risk for T1s was in the older group (70+). The 3.5x is a composite, not universal. Risk to T1s in their 40s is very low, and no deaths in T1 population younger than 20.


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## SB2015 (May 21, 2020)

everydayupsanddowns said:


> My understanding is that the majority of the risk for T1s was in the older group (70+). The 3.5x is a composite, not universal. Risk to T1s in their 40s is very low, and no deaths in T1 population younger than 20.


Well that gives me a few years in which they can hopefully find a vaccine!!


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## Bruce Stephens (May 21, 2020)

Eddy Edson said:


> So hazard relative to being diabetic and female for sex, to diabetic and age 50-59 for age, to diabetic and BMI 25-30 for BMI etc, as independent factors.



The reference age is 60-69 (so that has odds ratio 1.0).


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## Bruce Stephens (May 21, 2020)

everydayupsanddowns said:


> My understanding is that the majority of the risk for T1s was in the older group (70+).




__ https://twitter.com/i/web/status/1262997620865327104


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## Docb (May 21, 2020)

Eddy Edson said:


> The HR's are relative to a chosen level within each risk factor category, all referenced to the diabetic cohort. So hazard relative to being diabetic and female for sex, to diabetic and age 50-59 for age, to diabetic and BMI 25-30 for BMI etc, as independent factors. It's the standard multivariate analysis.
> 
> What I might be interested in is: What is my risk of dying if I catch COVID-19, as a 59 yr old T2D with BMI=20, HbA1c=34 etc etc. The paper won't tell you that and no 2-dimensional paper could, presumably. But maybe an interactive app could.



Thanks Eddy, just about beginning to work that out and you have clarified it for me.  I was sort of getting to the position that the analysis was saying something about relative risk within the categories but would be of little use in calculating specific risk under a given set of circumstances.  As such the noise that is being made in the press about diabetes and covid needs to be listened to with your ear defenders on.


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## Eddy Edson (May 21, 2020)

Bruce Stephens said:


> The reference age is 60-69 (so that has odds ratio 1.0).



Oops - was doing it from memory.


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## everydayupsanddowns (May 21, 2020)

Bruce Stephens said:


> __ https://twitter.com/i/web/status/1262997620865327104



Thanks Bruce. Average age of 72. Not sure what the median or mode would be, but I think there were many T1 deaths in their 80s. Which is of course, incredibly sad (my Mum and Dad both turned 80 this year and are fit as fleas), but I think 80 is a pretty good innings with T1D, especially given the insulins etc available in 1940 when insulin was still a relatively newfangled therapy.


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## trophywench (May 21, 2020)

everydayupsanddowns said:


> … especially given the insulins etc available in 1940 when insulin was still a relatively newfangled therapy.



We haven't even achieved our first century yet!  Bloomin good job so many folk worldwide were carnivores, eh?


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## mikeyB (May 21, 2020)

Aye, TW, we Creonistas would be right up shit creek without pigs too.

(That’s a deliberate graphic use of the coarse word)


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## trophywench (May 22, 2020)

To save having to use that particular word when she absolutely felt she needed to, a girl at work always used a mixed metaphor instead, which made us all chuckle appreciatively anyway.  Hence, I offer it now - Up a gum tree without a paddle!


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## everydayupsanddowns (May 22, 2020)

Jane50 said:


> Blood glucose is ok sometimes, but do tend to get higher levels over 4 or 5 tests a day, think it is because it is difficult to get the insulin in without it going into a lump, I am white british, and am obese (over 30 bmi), just cant seem to get this down. blood pressure is normal sometimes, but other times it is far too high so have to get plenty of exercise



I think you need to speak to your GP @Jane50 - there certainly seem to be several boxes ticked in your case that could infer additional risk if you got the virus badly. I think you need to be as careful as you possibly can be with social distancing, and ask your GP their advice. It may be that they advise self-isolation and could give you a letter for additional support (online shopping slots etc)


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