Back in March, as the novel coronavirus began to spread across the United States and the world, we spoke to Fouad Kandeel, M.D., Ph.D., professor of the Department of Diabetes, Endocrinology & Metabolism at City of Hope, to discuss how COVID-19 might affect people with diabetes.
Much of what he shared then still holds true, including the basic reality that people with diabetes are at greater risk of contracting the virus.
"Both type 1 and type 2 diabetes patients can have difficulty in fighting infections, including viral infections, if their blood glucose is not well controlled," Kandeel, the Arthur D. Riggs Distinguished Chair in Diabetes & Metabolism Research, explained.
"And typically, type 2 patients tend to be older. And older patients tend to have a worse disease course when they contract a viral infection. The incidence of type 2 diabetes gets higher with age; by the age of 70, 40% of the population has type 2 diabetes. Type 2 patients who are older have additional risk related solely to their age and other pre-existing conditions such as cardiovascular disease," he added.
New Information Comes to Light
But in the ensuing eight months of the pandemic, new information has come to light, Kandeel said, via the Centers for Disease Control and various scientific studies being done across the globe. Perhaps the most disturbing fact is a finding Kandeel calls "a significant concern."
"It seems that COVID can kick in a mechanism for establishing diabetes in people who do not have diabetes," he said.
"The CDC says that the data on this is not well established or clear," he added. But in June 2020, an international group of diabetes experts announced the launch of CoviDIAB, a global registry of COVID-19-related diabetes. The registry’s aim is to investigate the development and extent of “new-onset diabetes due to coronavirus infection.” It plans to expand to include patients with preexisting diabetes who present with “severe acute metabolic disturbance.”
Scientists speculate that the SARS-CoV-2 virus may cause multiple alterations of glucose metabolism that could intensify the symptoms of preexisting diabetes (such as diabetic ketoacidosis) or lead to new disease in previously non-diabetic individuals. According to a study published in the New England Journal of Medicine in August, “Greater incidences of fasting glycemia and acute-onset diabetes have been reported among patients with SARS coronavirus pneumonia than among those with non-SARS pneumonia.” It is unknown at this time whether these alterations in glucose metabolism persist after the COVID-19 infection has resolved.
In addition, Kandeel says that it has become clear in the last six months that contracting the coronavirus is even more dangerous than doctors first believed for people with either type 1 or type 2 diabetes.
"The CDC is acknowledging the fact that the disability caused by COVID-19 disease in those with diabetes is much more significant than in nondiabetic individuals. And the mortality from COVID-19 in diabetics is probably three to four times higher than in nondiabetic people," he said.
"The nondiabetic population's mortality rate [from coronavirus] is 2-3%. And the diabetic population’s is 7-8%. So obviously, the most important thing for patients with diabetes is to keep themselves out of trouble," Kandeel said.
Staying Healthy This Winter and Beyond
As Kandeel advised back in March and reiterates now, for diabetics the key to keeping "out of trouble" is two-pronged. First, he emphasizes, it is important to keep inflammation in the body down to a minimum.
"Diabetes, really, is an inflammatory disease. Whether it's type 1 or type 2, there is lots of inflammation in the body. So that makes diabetic individuals very vulnerable — if they get hit with another infection, the environment in their bodies is the right environment for this virus to take off," Kandeel said.
"It's really important for the diabetic to understand that if they are in an inflammatory state before COVID, and then you add COVID to that, you're adding fuel to the fire."
He outlines the keys to staying healthy in the time of COVID-19, which he says everyone needs to continue to follow, as the scientific reality is that "this is a disease that's likely to be with us probably for at least another year, that's likely to keep controlling our life for another year.
"It's really very important to follow the guidelines, because we have no effective treatment at the present time,” he said. “And we have no way of actually preventing the disease from spreading, except for social distancing, wearing masks, and cleaning and washing our hands after everything we do and making sure that we remain in a protected environment."
His specific advice for people with diabetes hasn't changed from March, and bears repeating.
"The key to all of this is certainly protection, and better control of diet, better control of lifestyle, better control of blood sugar," Kandeel said. "Eating well, maintaining a high level of physical activity as much as possible, taking your medication, controlling your blood glucose and blood pressure. This is the best way to go forward and not to let your guard down throughout much of 2021.”
And in this time of pandemic shortages coming and going, Kandeel suggests that all diabetes patients do one more thing to stay healthy and safe.
"The general recommendation is that everybody should have about a month's supply of their medication on hand, whether it's insulin or an oral agent or something like that. So that should any shortage happen in one of the supply chains, the patient is safe and protected until another source of supply has been identified and established."