What Is the COVID-19 Risk for People with Diabetes?

As scientists learn more about COVID-19, it has become clear that the virus impacts people in different ways and that symptoms can range in severity. This is especially true for those with existing medical conditions or whose immune systems have a harder time fighting disease.

Janaki Vakharia, MD, clinical fellow in the Endocrinology Division at Massachusetts General Hospital, discusses the impact of COVID-19 on people with diabetes, and offers tips on how to manage diabetes during this time.

The Misconception of Diabetes and COVID-19 Risk

Some people with diabetes, a disease that affects the body’s ability to produce or use the hormone insulin to reduce glucose (sugar) in the blood, may be concerned about being at higher risk of getting COVID-19. However, Dr. Vakharia points out that this is a misconception.

“We do not believe that people with diabetes are more likely to get COVID-19 than the general population,” says Dr. Vakharia. “They are, however, at risk for more severe outcomes, based on what we have been learning so far from research studies. We know from our experiences with other viral illnesses that patients with diabetes also tend to have more severe reactions to those illnesses.”

The Connection Between Diabetes and COVID-19

Though the exact cause of severe outcomes in patients with diabetes and COVID-19 is unknown, research over the years has suggested that people who have diabetes may have impaired immune systems, which would affect their ability to heal from an illness or disease quickly. Additionally, diabetes, especially if uncontrolled for a long period of time, may cause inflammation, which also affects the immune system.

“Inflammation happens when there is a level of injury to a cell. For example, let’s say you cut yourself while cooking and that area gets inflamed. The purpose of that inflammation is to bring different molecules and proteins to that site to improve its healing. But it doesn't always work that way on a microvascular level with chronic disease. And so, inflammation, over time, can actually be more damaging than helpful,” says Dr. Vakharia.

“There are markers in blood that can measure inflammation. Clinically, we've been seeing patients who have more severe COVID-19 to have higher markers of inflammation. These markers also seem to be higher in patients who have poorly controlled diabetes.”

Diabetes and COVID-19: Who is Most at Risk?

While diabetes type does not affect a person’s response to the coronavirus, how well-managed their diabetes is, or whether or not they have co-morbidities such as obesity or hypertension, has an impact.

“The body recognizes and responds to hyperglycemia (when there is too much glucose in the blood) regardless of the cause. We do know that patients who have type 1 diabetes compared to type 2 diabetes tend to get complications from diabetes later on, whereas someone with type 2 diabetes may have complications already at diagnosis or within the first few years of diagnosis.

"Studies have reported that patients with well-controlled diabetes who have been hospitalized for COVID-19 have a higher rate of survival. Better controlled diabetes is also associated with lower markers of inflammation, which may explain this better rate,” says Dr. Vakharia.

“Additionally, the trends we are seeing within the diabetes population for those most at risk for severe COVID-19 outcomes are elderly patients, though we are increasingly seeing younger patients coming in, and men. Hispanic and Black patients seem to be disproportionately affected, which could be related to social determinants of health or differences in job type (essential workers), extended-family home structure (making it more difficult to physically distance) or reliance on public transportation.”

What to Do if You Have Diabetes and COVID-19

If you are a patient with diabetes and have COVID-19, you may be able to manage your care at home, especially if you are able to remain physically distant from other people in your household.

“Patients who have mild disease or who are relatively asymptomatic from COVID-19 can be managed at home, even if they have diabetes. It is important for these patients to monitor their symptoms and blood sugar levels closely. Patients should call their provider immediately if they are not able to control their blood sugars or if their symptoms worsen and they experience nausea, vomiting or trouble breathing. This could mean that the infection is worsening,” says Dr. Vakharia.

However, COVID-19 may make it difficult to manage diabetes. According to Dr. Vakharia, patients with diabetes admitted to the hospital have had higher insulin requirements and higher rates of diabetes complications, such as diabetic ketoacidosis (sometimes known as DKA), which occurs when the body breaks down fat too quickly and, as a result, creates ketones and causes the blood to become acidic.

Dr. Vakharia recommends that patients who are insulin-dependent or take a class of diabetes medication called SLGT-2 inhibitors should have ketone testing kits at home in order to monitor their ketone levels when they are sick. Additionally, patients should review their medications with their doctor to see if any should be placed on hold or if dosages should be changed during this time.

If hospitalization is required, Dr. Vakharia suggests that patients consider bringing their own supplies to help reduce the exposure of the patient and clinical staff from repeated entry into the room. This includes:

• Glucometer or continuous glucose monitor (with supplies)
• Extra supplies for your insulin pump
• Insulin pens/needles
• Cell phone chargers to ensure call access to family, friends and providers

Managing Your Diabetes During COVID-19

Dr. Vakharia emphasizes the need to follow the Centers for Disease Control and Prevention’s recommendations to reduce the risk of catching COVID-19:

• Avoid large gatherings
• Practice hand hygiene
• Maintain a distance of more than six feet from others and wear a mask when this is not possible

It is also very important that patients manage their diabetes by:

• Keeping blood sugars at goal and prevent fluctuations in blood sugars
• Improving diet
• Exercising at home
• Ensuring that other co-morbidities, such as hypertension or heart disease, are being treated appropriately

Additionally, patients should also make sure that they are maintaining any medical appointments they have, especially if they can have these appointments virtually.

“In the Endocrinology Division, we have been able to connect with some of our patients virtually, by either phone or video, and it has been successful. Patients like it. They have their glucometers and medications available. We are able to discuss all of the same things and provide the same education as if they were in the office,” says Dr. Vakharia. “It can actually make the appointment much more productive and less stressful for the patient.”