Updated 30 September 2020

Covid-19 and diabetes: What the evidence says

The latest evidence shows the devastating impact of Covid-19 on people who have diabetes.

  • People living with diabetes appear to be at an increased risk of severe Covid-19 infection.
  • In a recent review, a professor presented details about the link between the two conditions.
  • According to the professor, the situation can lead to a 'dual epidemic' if it is uncontrolled.

Diabetes has been reported to be a risk factor for severe Covid-19, the disease caused by SARS-CoV-2. This is because high blood sugar levels can weaken the immune system, making it harder for diabetic people to fight off infections such as Covid-19.

During a Covid-19 special session at the online Annual Meeting of the European Association for the Study of Diabetes (EASD), a new review of the evidence on the devastating impact of Covid-19 on people who have diabetes was presented by Professor Juliana Chan from the Chinese University of Hong Kong and Prince of Wales Hospital, Sha Tin, Hong Kong, China, according to EurekAlert.

"Major risk factors for mortality include advanced age and chronic conditions, notably obesity, diabetes, hypertension, heart and kidney disease as well as social deprivation, minority ethnic groups and those with poor access to care," said Chan, explaining that these common coexisting conditions highlight the complexity of Covid-19.

Type 2 diabetes: higher risk of death

A recent report (from The Lancet Diabetes & Endocrinology), based on a UK population-based survey of more than 60 million people registered with the primary care system, showed that 0.4% had type 1 diabetes, and 4.6% had type 2 diabetes.

However, the report further highlighted that among the more than 24 000 Covid-19-related deaths, 30% occurred in diabetics.

After the researchers of the paper adjusted for several risk factors, including social deprivation, ethnicity and other chronic conditions, they found that people who had type 1 diabetes had an almost threefold (2.86) risk of death. In those who had type 2 diabetes, they found an almost two times (1.8) higher risk of death due to Covid-19, compared to those who did not have diabetes.

Search term

Chan also explained that the search term "Covid-19 and diabetes" yielded more than 1 800 publications in PubMed, a free full-text archive of biomedical and life sciences journal literature at the US National Institutes of Health's National Library of Medicine.

"Many of these reports indicated close relationships between high blood glucose levels and poor outcomes, including mechanical ventilation, admissions to the intensive care unit and death in patients with Covid-19," explained Chan.

Diabetes and Covid-19: what exactly is the link?

This Health24 infographic explains that our bodies break down carbohydrates into glucose, a fuel - and its effectiveness depends on adequate oxygen supply as well as insulin action. Our bodies need insulin to transport glucose into the cells.

Diabetes occurs as a result of insulin insufficiency or resistance, and people with poorly controlled diabetes experience low-grade inflammation, poor circulation and body defences.

When acute stress occurs, such as in the case of Covid-19, the authors explain that these interlinking systems can end up destabilised, resulting in uncontrolled blood glucose and multi-organ failure.

In a consensus statement published in The Lancet Diabetes & Endocrinology, international experts have therefore called for optimisation of outpatient and inpatient care, including the appropriate use of insulin (to control blood glucose), and use of organ-protective drugs to improve the outcomes of these high-risk patients.

A dual epidemic, if not controlled

"SARS-CoV-2 may damage pancreatic beta-cells, the only insulin-secreting cells. As such, Covid-19 may precipitate diabetes in people with risk factors such as those with obesity, low socioeconomic status and psychosocial stress," said Chan.

Chan further commented that if they remain uncontrolled, diabetes and Covid-19 will become "silent epidemics with devastating consequences".

"These global epidemics have strong environmental, behavioural and system determinants. The Covid-19-diabetes story highlights the huge burden of diabetes which affects [more than] 460 million people worldwide, mainly coming from developing countries with unprepared healthcare systems," she said.

"In this interconnecting world, there is an urgent need to improve our ecosystem, promote health literacy and reform our health and social systems to protect the health and humanity of people with vulnerable conditions such as diabetes," Chan said.

READ | Loneliness, the surprising factor that can influence the onset of type 2 diabetes


Ask the Expert

Diabetes expert

Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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