Covid/Coronavirus and diabetes - the numbers

[Nikki1111]

What about those with an HbA1c lower than the general population? I'm guessing zero data... but if you have seen anything?

Thank you for your post, very informative. Can I ask you, my mmol for the last 3 months has been controlled with medication, exercise and healthy eating. The readings are between 4 - 7 mmol before and after eating, silly question but is that ok?

 

[Cofty]

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

So have we any data on T1. I'm T1, and currently lack any context on this 25%. Thank you

 

[bulkbiker]

Thank you for your post, very informative. Can I ask you, my mmol for the last 3 months has been controlled with medication, exercise and healthy eating. The readings are between 4 - 7 mmol before and after eating, silly question but is that ok?

Sounds ok to me.. probably at the same level as the general population.

 

[Lupf]

Thank you for your post, very informative. Can I ask you, my mmol for the last 3 months has been controlled with medication, exercise and healthy eating. The readings are between 4 - 7 mmol before and after eating, silly question but is that ok?

In my understanding this in the category of well controlled diabetes, where they give a 50% increase in risk of dying from Covid when compared to a healthy female of the same age. However this is an average, your numbers look very good, so your increased risk could be lower. Recall the biggest risk factor is age, so once you are infected the absolute risk mainly depends on that.

 

[bulkbiker]

In my understanding this in the category of well controlled diabetes, where they give a 50% increase risk. However this is an average, your numbers look very good, so your increased risk could be lower. Recall the biggest risk factor is age, so it mainly depends on that.

50% risk of what?
Catching it , expiring from it or what?
Relative or absolute ?

 

[Lupf]

50% risk of what?
Catching it , expiring from it or what?
Relative or absolute ?

Thanks for pointing out that I am sloppy with my answers
when quoting numbers I always refer to the hazard ratios of in-hospital Covid-19 deaths,
which is discussed in the paper I refer to in the top of this thread, see Table 2 of https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.
I have updated the answer to @Nikki1111 and defined this.

 

[Erin]

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

. 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.

I am sceptical about these statistics because they tend to focus on specific variables, not taking into account other possible interactions, such as other medications, or diseases. From my recent exprience, (which was a bit of a nightmare, and required trips to the ER) I attributed many diabetic symptoms to "iatrogenic" factors. But when these factors were corrected the "diabetic" symptoms, (though still there) diminished and even a high blood sugar did not make me feel so sick.

The media, both government and helpful websites keep repeating that vulnerable classes for contracting this virus are primarily diabetics. But a diabetic may have other disorders, either due to age, condition, or medications. To get the whole picture, I think that more than one disorder should be studied in these statistics.

Erin

 

[robertFE]

I am currently, like most people, unable to obtain a current HbA1C, though my eA1C is 6.4%, simply where does that place me... am I well controlled or badly, since I was advised by my GP to self isolate, which at the time I felt was slightly extreme, but after reading the above, and hearing the BBC news state diabetics are at risk (but not listed by this government as vulnerable), just inquisitive to know where I fit.

 

[kev-w]

https://twitter.com/parthaskar/status/1261938907865907201

48 hours or so and they'll' be able to publish the data as pertaining to 'diabetes'.

Reading Dr Kar's twitter feed I see mention the data relating to all diabetes and covid deaths is released tomorrow....

Hazard ratios are going to be a thing https://twitter.com/parthaskar/status/1262778270048825344/photo/1

 

[urbanracer]

I am currently, like most people, unable to obtain a current HbA1C, though my eA1C is 6.4%, simply where does that place me... am I well controlled or badly, since I was advised by my GP to self isolate, which at the time I felt was slightly extreme, but after reading the above, and hearing the BBC news state diabetics are at risk (but not listed by this government as vulnerable), just inquisitive to know where I fit.

In the UK, a diagnosis of diabetes is made with an a1c of 6.5% and above. So you're doing well, just creeping under the wire there fella.

 

[MTS1980]

The Brits will overcome ... but I'm Australian

Good day mate well I tried to bowl like glen macgrath but cudnt a pure world class and a champion bowler one of my fav Australian !

 

[kev-w]

https://twitter.com/parthaskar/status/1262884059858034688/photo/1

 

[tim2000s]

The data on diabetes type and risk:

https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf

Worth digging through. As with the general population, increased risk is associated with deprivation, cardiovascular disease and age, alongside diabetes.

 

[Rose22]

So have we any data on T1. I'm T1, and currently lack any context on this 25%. Thank you

I read this morning that type 1 are 3.5 times more likely have complications with COVID. Type 2 twice as likely! Then it’s even higher if poorly controlled.
I have zero appointments scheduled, no contact from nurses or consultant, yet it would seem higher risk group! I feel totally left to my own devices, I’m only newly diagnosed really 3 months on insulin.

 

[Robinredbreast]

I read this morning that type 1 are 3.5 times more likely have complications with COVID. Type 2 twice as likely! Then it’s even higher if poorly controlled.
I have zero appointments scheduled, no contact from nurses or consultant, yet it would seem higher risk group! I feel totally left to my own devices, I’m only newly diagnosed really 3 months on insulin.

Hi, t's not nice, especially when newly diagnosed, like yourself, get's left on the back burner. Do you have the DSN's number so you can make a call, or the surgery's/hospital number and actually speak to someone ?
Good luck and take care x

 

[bulkbiker]

The data on diabetes type and risk:

https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf

Worth digging through. As with the general population, increased risk is associated with deprivation, cardiovascular disease and age, alongside diabetes.

But without any mention of most recent HbA1c levels it shows nothing of much value to anyone ..

 

[Jamie H]

But without any mention of most recent HbA1c levels it shows nothing of much value to anyone ..

It does mention it. It's in one of the papers and talks about hazard ratios and hba1c. Control is also mentioned as being important in the findings/conclusion.

 

[Estragon]

When I hear “support” for diabetics my antenna starts vibrating. Could this mean that any of us of BMI/HT higher than X and age greater than Y and a Diabetic Profile ( T1 T2 , controlled/uncontrolled) Z would get COVID19 Hospital Care?

Oh, BTW, I was hospitalised with COVID19 for a week. I pulled through with a HbA1c of 52 and controlled with BG morning of anything from 6.7 to 7.6. I’m hoping for the best. However, IMHO, Diabetes has become another political vector. I know Diabetes has been for far too long, what I call the Cinderella Disease. It wasn’t until I’d reached an HbA1c of 89 and a fasting BG of 18 that I was GIVEN the Pricks n Strips.

I’m a diabetic. I survived COVID19 in only a week. Am I a Diabetic that can go on being part of the “at risk” Diabetic Group? As I said, my antenna are fully switched on.

 

[Dusty911]

New article in the guardian today with diabetes data analysed.
Here
https://www.theguardian.com/society/2020/may/20/type-1-diabetics-type-2-coronavirus-nhs-study
I would just say even at 3.5 % for type 1 remember that s 96.5% survival if you take 1% as the average mortality rate.

 

[tim2000s]

New article in the guardian today with diabetes data analysed.
Here
https://www.theguardian.com/society/2020/may/20/type-1-diabetics-type-2-coronavirus-nhs-study
I would just say even at 4% for type 1 remember that s 96% survival.

Again, even this number is misleading. In the under 50s, the numbers were considered too low, so suppressed, meaning that counted* deaths in type 1 cases were exclusively in the over-50s.

Or in other words, if you have type 1 and are under 50 without comorbidities, it looks as though there is little difference to the general population. It is, once again, those over 50 where the risks start to rise.