COVID-19 and diabetes

By Professor Jeremy Krebs

3 April 2020

The Ministry of Health and multiple media sources state that people with diabetes are at greater risk of COVID-19 than the general population. This has generated concern and uncertainty amongst patients with diabetes, their families, employers and indeed health professionals. I will summarise below what is currently reported in the literature as of 28 March 2020, recognising that this is a rapidly evolving situation and more will become apparent over the coming months. I have not covered the general information about coronavirus public health messages that apply to everyone with or without diabetes. 

Risk of infection vs risk of severity of disease and mortality

Individuals with diabetes are at greater risk of other viral infections such as influenza. However, there is currently not enough data to conclude whether individuals with diabetes are more likely to contract coronavirus than the general population. What is known and important is that if people with diabetes get coronavirus, they are more at risk of severe disease and mortality. In China, people with diabetes had much higher rates of serious complications and death than people without diabetes if they contracted coronavirus.  In general, the more health conditions someone has the higher their chance of getting serious complications from coronavirus.  In February, the Chinese Centre for Disease Control and Prevention reported increased mortality in people with diabetes (7.3 percent vs 2.3 percent overall) in a series of 72, 314 cases1). In a more recent report from 24 March, Louisiana in the States, 41 percent of those who died from coronavirus had diabetes as a co-morbidity, the highest rates reported so far.  Furthermore, 34 percent had chronic kidney disease, 28 percent obesity and 23 percent cardiac disease – all common additional risks with Type 2 diabetes in particular.  Prevention against contracting coronavirus is very important for people with diabetes.

Type 1 vs Type 2 Diabetes

It is still unknown whether there is a difference in risk between patients with Type 1 or Type 2 diabetes. However, age, additional comorbidities, and management of diabetes all play important roles when assessing complication risks.  An important message for patients is that if they effectively manage their diabetes, the risk of getting severely sick from coronavirus is about the same as the general population.  Therefore, in the current pandemic it is even more important for people with either Type 1 or 2 diabetes to focus on achieving tight glycaemic control.  

It is important that people with Type 1 diabetes frequently measure their glucose and check for ketones if they are unwell and their glucose is greater than 15 mmol/L. They should have a “sick day plan” and follow this. It has been reported that more people with Type 1 diabetes are being hospitalised with ketoacidosis during the pandemic than actually having coronavirus. 

ACE Inhibitors and Angiotensin receptor blockers (ARBs)

Many people with diabetes are taking ACE inhibitors or ARBs for treatment of hypertension and/or microalbuminuria. There is evidence that coronavirus has a strong affinity for the ACE receptor.  This has raised concerns that people taking ACE-inhibitors or ARBs may be more at risk of infection and severity of illness because of an upregulation in these receptors.  However, this remains theoretical at this time and it is NOT recommended to stop either of these agents, unless there is another compelling reason to do so. 

Influenza vaccine

It is strongly recommended for all people with diabetes to get the flu vaccination as soon as possible to reduce the risk of co-infection. 

Patient information

Useful sites for patients include:

References

  1. Wu Z MM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020.
  2.  Gupta R, Ghosh A, Singh A, Misra A.  Clinical considerations for patients with diabetes in times of COVID-19.  Diabetes and Metabolic Syndrome: Clinical Research and Reviews 2020;(14) 211-212.