This link only leads to the abstract, I think, and the one article I found discussing this study had a broken link. But this seems to be yet another study that concludes that diabetes is among the major risk factors for severe illness and death from COVID-19 infection.
I am not sure if they distinguish between diabetes and the consequences of poor control. Which of the two is a risk factor?
For me there is also something else to worry about: it seems that COVID-19 has a lot of impact on different organs. I wonder what the long term consequences of an infection could be for a diabetic?
They distinguish between patients with good and poor control (in the paper defined as an HbA1c >= 58 mmol/mol, i.e. 7.5%). Diabetes is itself is a risk factor, but poorly controlled patients have a higher risk of death than patients with good control:
Increasing risks were seen with increasing obesity (BMI >40 fully adjusted HR 1.92, 95% CI 1.72-2.13), and most comorbidities were associated with higher risk of death, including diabetes (with a greater HR for those with recent HbA1c >= 58 mmol/mol)
Even with good control it still isn’t a comforting statistic. Diabetics get the shaft again.
It does suck. When reports that diabetes was among the risk factors first came out, I was really hopeful that it was only Type 2 diabetes. Then, when the NHS study came out showing that people with Type 1 were actually at higher risk than people with Type 2, I hoped that it was only people with poor control. But now more recent studies have drilled down into that, and shown that even those with good control are at higher risk. Still, as someone with two of the three biggest risk factors (diabetes and obesity, luckily I have age on my side), it’s good to know. It definitely impacts my risk assessment for things like going back to work or not.
I’ve read that evidence is indicating that COVID-19 is more of a vascular disease than a lung disease, so that may be why diabetes, obesity, and age seem to be the three biggest risk factors. All three of those things can have negative impacts on the cardiovascular system. I believe studies have shown that people with Type 1 diabetes are at substantially increased risk of cardiovascular disease even if they don’t have other typical risk factors, and that the risk level isn’t related to diabetes control the way other complications are.
This is true, it is an unfortunately sad statistic. In the future it will be interesting as there becomes a larger population of well controlled Type 1’s if the hazard ratio can be teased out at different sub 7 A1c’s. Now that closed loop systems are becoming mainstream, when the next generation of algorithms come on the market I expect a large number of diabetics will be able to maintain A1c in the 5’s and 6’s that previously were above 7 thus enabling more research of sub 7 diabetics.
The way I’ve been looking at it, based on a few of the papers that have come out, is age (63) + T1 = 50% chance of hospitalization if I am infected. For a 63 year old like me with decent A1c (6), I think those odds suck. I am looking for something like 0 to 5% odds of hospitalization before I reduce social distancing. And who knows what my BG control would be like a week or two into a hospital stay, further increasing the risk of severity?
I don’t think anyone has those odds with COVID-19. The baseline risk for everyone seems to be about a 20% risk of ending up in hospital, with those of us with underlying conditions having an even higher risk. That’s why everyone needs to do physical distancing and other public health measures, even if they themselves have no underlying health conditions. Those of us in higher risk categories need to be even more cautious and take additional steps to stay safe in addition to what everyone else is (or should be) doing…
Yep, only way to reduce the odds of hospitalization enough Is with a reliable vaccine or a reliable outpatient treatment of the virus.
I don’t think all diabetics are created equal. We aren’t created that way, instead we create ourselves.
You are in good shape, you are active, you get a lot of exercise, and have a good A1C.
You do not simply fit the checkbox of being a “diabetic”, without any other considerations. How many diabetics can skate like you can, and can manage BG during a game like you do? I can think of maybe one or two others. They played in the NHL.
Don’t ever make the mistake of thinking you are in any box along with a bunch of other statistics, just because you match 2 things like diabetes and age. Those 2 things are the least important factors.
Normally I would agree with your thinking but a few factors are giving me pause and causing me to look at the virus as high risk for me, despite my overall good health and good BG control. One is paranoia about what happens to my BG if I am laying on my back in a hospital bed. The second is more of a gut feeling that after a few days or weeks of high BG in a hospital and zero activity the risk of complications from the virus is bound to increase.
So anyway, I’m into the social distancing for the long haul. Not really a hardship in the big picture and satisfies my low risk approach. Definitely a lifestyle change though. I have not skated since early March and have gone all in on daily solo manual labor on house renovation and landscape projects. When the rinks open up I will probably stay away for a while until the community spread drops way down.
While I had it, my insulin requirements went way up. Do not let anyone manage your BG for you. Do it yourself.
I maintained activity. I cut back on mileage and intensity, but I knew exercise would be helpful.
Nothing wrong with that. Just see if you can find a way to maintain your activity.
Under Armour makes a very nice exercise mask. I ordered one. Once I receive it, I will write a review.
The question is whether you’ll be able to do that. You can only do that if the disease isn’t too severe and you’re in a regular hospital ward, but once you’re admitted to the ICU, someone else will have to do it for you. I think it’s in the ICU where good BG control matters most, but they won’t be able to achieve that.
Even in a regular ward, if you’re sick enough to need hospital admission, then you’re probably needing oxygen. You’re not going to be able to do even minimal exercise like walking around. You’re not going to have access to your normal food (and family or friends won’t be able to bring food in for you). You may be exhausted just trying to breathe. And you’ll be dealing with the insulin resistance from being sick. Even if you do have full control over your diabetes management, it could be very challenging to maintain your usual level of tight control under those circumstances.
I am not saying it will be perfect BG, or easy. Or that you can exercise in the hospital and eat whatever you want.
I am just saying that as long as you are conscious, you can do a better job than the hospital staff will do with their sliding scale of insulin dosing. They won’t know what the insulin resistance will be like. Anyone here could do a better job being proactive and managing it themselves. As long as someone is still awake and can test and take insulin or eat, it does not take a whole lot of energy to manage your BG while you are there.
Everyone should have a go-kit ready for a hospital stay that includes a way to test BG, a way to take insulin, and some carbs.
Every dose of insulin they give you, you can ask how much it is. They can’t keep that a secret. You will know what they are giving you (and how much you actually need).
Other easy things you can do. Anything on your food tray, whatever you do not eat, stash those things in your bag for lows that might happen later. The jelly pack, the little cup of juice, if they have sugar packets with coffee. Any of that, you stash it in your bag for a possible low later.
Have a wallet? Every floor has a vending machine. Take a walk if you are able.
As long as you are awake and not totally wiped out, none of this is impossible.
The alternative is just to give up and let them totally take care of the diabetes for you. See how that works out.
I don’t think anyone would suggest that. I just think that diabetes control if hospitalized is a legitimate concern. I also think trying to minimize the chances of ending up in hospital in the first place is a good idea. I think part of that is taking things like diabetes and age into consideration, based on what research is finding and what we know (and don’t know) so far, even if under normal circumstances these things are no big deal.
I’m reviving this topic because it highlights something that is puzzling me in Massachusetts.
Based on this topic and other things I’ve read, type 1 diabetics should be at high risk for Covid 19.
Yet in Massachusetts, Type 1 Diabetes is not included as a risk factor, although type 2 diabetes is.
Have there been new studies that suggest that T1 Diabetes is not as big a concern as once thought?
Based on the data the CDC has provided, Type 2 diabetics ARE AT AN INCREASED RATE of severe illness while Type 1 diabetics MIGHT BE AT AN INCREASED RISK.
I just find it a shame that SMOKERS (a choice) get privilege over Type 1 diabetics who didn’t choose their condition. Also, NOT ALL by any means, but I would wager that a good portion of the Type 2 diabetics ALSO meet two of the other criteria - obesity / severe obesity.
Data behind the numbers / risk categories.
I find it particularly galling that my son qualified to get a vaccine next month because he is a bus boy at a restaurant, and that were T1 the only condition he would have to wait two more months.
Thanks so much for this. I’m sad that the reason T 1 Diabetics don’t qualify is because of “limited evidence.”
It would have been so nice if it had been for ‘mixed evidence’; then maybe I would feel like we were maybe not high risk, but there’s no basis to say that. Just haven’t done enough studies yet.
Interestingly, the only difference between Type 2 and Type 1 is that Type 2 has a longitudinal study  which Type 1 is lacking. The other citations look to be for the same studies. Does anyone know if any of those studies reported different reactions between Type 2 and Type 1 diabetics, such that maybe Type 1 were at lower risk?
Still hoping …