1. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  2. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2020 »
    Dismiss Notice
  3. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
  4. Guest, stay home, stay safe, save the NHS. Stay up to date with information about keeping yourself and people around you safe here and GOV.UK: Coronavirus (COVID-19). Think you have symptoms? NHS 111 service is available here.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Covid/Coronavirus and diabetes - the numbers

Discussion in 'Diabetes Discussions' started by Lupf, May 15, 2020.

  1. Lupf

    Lupf Type 2 · Well-Known Member

    Messages:
    81
    Likes Received:
    37
    Trophy Points:
    38
    Many people with diabetes have reacted to yesterday's news that 25% of people who died from Covid-19 in UK hospitals also had diabetes. This is both understandable and scary, but it is not really unexpected.

    Let me try to explain. I am T2, a scientist and I have been following what the epidemiologists and statisticians are learning about Covid. For example we are being told the daily death tolls. According to this 34,000 people have died in the UK from Covid by today 15 May. However, this number includes the deaths in hospitals, but not all deaths in care homes and at home. This number can be calculated by comparing the total number of deaths in the UK with the long-term average and sadly by 1 May there have already been 50,000 excess deaths in the UK [​IMG]. These deaths are mostly due to Covid.

    A few days ago I found a paper by the group of Ben Goldacre, https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1. It studies the in-hospital deaths by potential risk factors. For diabetes they find the following. For the group with "controlled Diabetes", defined as HbA1c<58 mmol/mol) the risk of death was between 1.40 and 1.60 times that of non-diabetics.
    For the group with "uncontrolled diabetes" defined as HbA1c>=58 mmol/mol the risk of death was between 2.18 and 2.56 times that of non-diabetics. For the group with no recent Hb1Ac measure the risk was between 1.63 and 2.16 that of non-diabetics.
    In summary, depending on the severity of our diabetes the risk of death is a factor 1.5 to 2.5 higher than for non-diabetics.

    In the UK almost 4 million people or 6% of the population are diagnosed with diabetes. While diabetes is increasing in younger people, we know that the rate is higher for elderly people and is probably at least twice that high (12%) in the over 65 age group. We now need to multiply this number with the 1.5 to 2.5 and can estimate that between 18% and 30% of people who died from Covid also had diabetes. This is in agreement with yesterdays announcement of 25%.

    If you have other questions on the science of Covid, please feel free to ask on this thread and I'll try to answer these.

    update 20 May: In this thread in post #96 I discuss the latest paper by the group of Jonathan Valabhji, see the direct link Covid/Coronavirus and diabetes - the numbers
     
    • Like Like x 6
    • Informative Informative x 5
    • Agree Agree x 2
    • Winner Winner x 1
    #1 Lupf, May 15, 2020 at 10:43 PM
    Last edited: May 20, 2020
  2. bulkbiker

    bulkbiker Type 2 · Oracle

    Messages:
    16,404
    Likes Received:
    11,323
    Trophy Points:
    298
    What about those with an HbA1c lower than the general population? I'm guessing zero data... but if you have seen anything?
     
    • Like Like x 2
    • Agree Agree x 1
  3. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

    Messages:
    2,208
    Likes Received:
    1,244
    Trophy Points:
    178
    This makes sense when the age group is applied. Context is everything.
     
    • Like Like x 4
    • Agree Agree x 1
    • Useful Useful x 1
  4. Bill_St

    Bill_St Type 1 · Well-Known Member

    Messages:
    164
    Likes Received:
    62
    Trophy Points:
    68
    • Like Like x 2
    • Agree Agree x 2
    • Informative Informative x 1
    • Hug Hug x 1
  5. copilost

    copilost Type 2 · Well-Known Member

    Messages:
    353
    Likes Received:
    230
    Trophy Points:
    103
    Worth pointing out that the HbA1c data comes from Primary care (i.e. local clinic not in hospital admission data). So this is an indication of diabetic control prior to hospital admission and most likely prior to infection with covid-19.
     
    • Agree Agree x 2
    • Informative Informative x 2
    #5 copilost, May 16, 2020 at 8:37 AM
    Last edited: May 16, 2020
  6. urbanracer

    urbanracer Type 1 · Moderator
    Staff Member

    Messages:
    4,564
    Likes Received:
    3,394
    Trophy Points:
    198
    It's a fascinating subject and in view of the research paper that @Mike d linked to in the Covid thread which discusses the prevalence of increased insulin resistance in the BAME community I have taken a quick look at the immune system and glucose requirements.

    It would seem that the immune system is 'glucose hungry' and I presume that we may need glucose for energy to fight the invaders. But if you can't use insulin efficiently then where does that leave you?

    Similarly, if one's a1c is very low, would a person have enough glucose to mount an efficient immune response? With our old friends the mice, glucose was “required for survival in models of viral inflammation, it was lethal in models of bacterial inflammation."

    Some bedtime reading.

    https://www.google.com/amp/s/amp.theatlantic.com/amp/article/498965/

    https://www.scientificamerican.com/...e-response-in-the-flu-and-possibly-covid-191/
     
    • Informative Informative x 3
    • Creative Creative x 1
  7. kev-w

    kev-w Type 1 · Well-Known Member

    Messages:
    1,903
    Likes Received:
    3,154
    Trophy Points:
    178
    • Agree Agree x 1
  8. Lupf

    Lupf Type 2 · Well-Known Member

    Messages:
    81
    Likes Received:
    37
    Trophy Points:
    38
    Update:
    @Brunneria posted the age distribution of diabetes at https://www.diabetes.co.uk/forum/th...ity-with-diabetes.171962/page-91#post-2262093. thanks.
    Form this you can see that about a quarter or 1 million of diabetics are in each of the 60 to 69 and 70 to 79 age brackets.
    From the population pyramid https://www.ons.gov.uk/peoplepopula...les/ukpopulationpyramidinteractive/2020-01-08
    I find that 11% or over 7 million people in the UK are in the 60 to 69 age bracket. One in seven or 14% of these have diabetes.
    Similarly almost 18% of the 66.4 million or close to 12 million people are over 65 and about 2 million that is one in six or 17% have diabetes.

    Using these numbers and the elevated Covid risk factor for diabetics and elderly it is even less surprising that one quarter of people who have died also had diabetes.
     
  9. Lupf

    Lupf Type 2 · Well-Known Member

    Messages:
    81
    Likes Received:
    37
    Trophy Points:
    38
    I have not seen anything on lower Hb1Ac, so can't comment.

    Important I am only explaining results and numbers, and each of us is an individual,
    so please talk to your GP about your personal case.
    For example. these studies mainly apply to T2. This is since about 9 out of 10 of us are T2.
    However if you are T1, please be careful on how to interpret these results.

    In the paper by the Ben Goldacre group you can find the elevated risk factors for many diseases and conditions. It confirms that age is the main factor, compared to the 50 to 60 age brackets, the risks for the 60 to 69 year olds is a factor of 2 higher. For the 70 to 79 year old the risk is a factor of 5 higher and for the over 80 year old it is more than a factor of 10 higher.

    Relevant for diabetics is obesity. For a BMI > 30 the risk is 20% to 40% higher,
    for a BMI over 35 it is 40% to 70% higher
    and for a BMI > 40 the death risk increases by a factor to 2.6
     
    • Like Like x 1
  10. bulkbiker

    bulkbiker Type 2 · Oracle

    Messages:
    16,404
    Likes Received:
    11,323
    Trophy Points:
    298
    My GP has less of a clue than the man in the street concerning these things I'm afraid..

    I just wondered if anyone had seen anything.

    Personally I'm very pleased with my low HbA1c and am pretty confident that it would be a major plus in fighting off any virus that hits.
     
    • Like Like x 2
    • Agree Agree x 2
  11. Honeyend

    Honeyend · Well-Known Member

    Messages:
    151
    Likes Received:
    109
    Trophy Points:
    63
    Talks about diabetes and covid
     
    • Like Like x 2
  12. jjraak

    jjraak Type 2 · Well-Known Member

    Messages:
    4,053
    Likes Received:
    8,590
    Trophy Points:
    198

    Thank you @Lupf.

    Most interesting.

    Persinally think the better control does have a positive impact.
    So worth aiming for, as most on here do.

    So Cheers for the post.:)
     
    • Like Like x 1
  13. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

    Messages:
    2,414
    Likes Received:
    1,517
    Trophy Points:
    198
    I am a type 1 and assume I have elevated risk because my hba1c is teetering around 58 and hyperglecemia is a risk factor independent of age, hyperinsulinemia and age. Luckily I am under 50, female and otherwise healthy so other than taking vitamin D I am not taking more stringent measures to avoid getting this.
    Btw your original post seemed to infer that diabetes is a marker of other CoVid risks e.g. age and obesity however I think more research will be needed to break down the causal mechanisms for each individual risk factor e.g. having high blood sugars is known to reduce the efficacy of our immune systems as does having excess insulin.
    So if you are a well controlled diabetic this reduces one risk factor but if your good sugar levels are achieved by having excess insulin then I imagine you would still be more at risk.
    Of Mice and glucose needed for immune response, surely our saviour in times of glucose need is the liver i.e. gluconeogenesis therefore there's no such thing as too low unless you have a rare metabolic condition?
     
    • Like Like x 1
    • Agree Agree x 1
  14. jrussell88

    jrussell88 Type 1 · Well-Known Member

    Messages:
    78
    Likes Received:
    42
    Trophy Points:
    58
    Well done. But surely the statisticians who have access to NHS data should be disaggregating the numbers by now?

    Figures out of China were published on 24 January, and similar to this.

    Can we not do better?
     
  15. Lupf

    Lupf Type 2 · Well-Known Member

    Messages:
    81
    Likes Received:
    37
    Trophy Points:
    38
    Thanks for this comment. That was not intended, all I wanted to point out is that obesity, which affects many diabetics, has a higher risk. These are correlations, not markers. A proper evaluation of multiple risks needs to take these correlations into account. As far as I understand the causal mechanisms for age factors are not yet known.
     
    • Like Like x 1
  16. DavidGrahamJones

    DavidGrahamJones Type 2 · Well-Known Member

    Messages:
    3,244
    Likes Received:
    2,093
    Trophy Points:
    178
    Does it say they only have diabetes or do they have other medical issues. I'm thinking aloud and not trying to make any real point. I'm assuming some people with diabetes are surviving Covid. Some might hardly have noticed anything other than a bad cold/flu type thing, others might have spent some time in hospital and others are sadly passing away. There must be something else going on with their health?
     
  17. urbanracer

    urbanracer Type 1 · Moderator
    Staff Member

    Messages:
    4,564
    Likes Received:
    3,394
    Trophy Points:
    198
    From what I have seen reported, it seems like many diabetics are dying from DKA due to C-19 causing massively elevated glucose levels.

    And from reports in yesterday's press that doctors are being advised to monitor glucose levels closely, I am left "guessing" that they haven't been routinely doing it up to this point?
     
    • Like Like x 2
    • Informative Informative x 1
  18. copilost

    copilost Type 2 · Well-Known Member

    Messages:
    353
    Likes Received:
    230
    Trophy Points:
    103
    The paper reports adjusted hazard. That means if you compare two people who are same age, sex, BMI, etc etc for everything on the list in the table then the hazard reported for diabetes is the additional hazard regardless of all the other factors. Someone who looks exactly like you (for the listed factors) and doesn't have diabetes has less risk. Of course it may not be diabetes! The list doesn't include vitamin D status and it could be that diabetes is a proxy indicator for vitamin D status and that is the real risk (unlikely but it's an example of the uncertainty in these types of analysis). Also the analysis doesn't cover interactions i.e. what is the risk if you are both diabetic and have hypertension for example? You can't simply add the two figures together as this will probably overestimate the risk as it's likely they will share some of the risk. People will start to calculate these combined risks but you need a large sample size to get a useful result.
     
    • Like Like x 1
    • Agree Agree x 1
  19. Jamie H

    Jamie H · Well-Known Member

    Messages:
    126
    Likes Received:
    89
    Trophy Points:
    28
    If you are referring to the NHS figures released on Friday, then it doesn't report adjusted hazard and its been quoted several times that people may have other comorbidities... This is what diabetes uk and partha kar are investigating so it can be broken down more... One area is also other existing comorbidities.
     
    • Agree Agree x 1
  20. Jamie H

    Jamie H · Well-Known Member

    Messages:
    126
    Likes Received:
    89
    Trophy Points:
    28
    If you're referring to the NHS figures released on Friday there has been no hazard adjustment. That is what has caused the uproar and panic. Nothing about age, sex, BMI, control etc. All the areas required to perform hazard adjustment. They are just raw figures.
     
    • Agree Agree x 1
    • Hug Hug x 1
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook