Covid/Coronavirus and diabetes - the numbers

DCUKMod · May 20, 2020

robertFE said:
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.

Hi there Robert - You have have an HbA1c any time you like, using something like these:
https://monitormyhealth.org.uk/diabetes/

Tests are done, by post, using blood harvested by finger prick. The lab is an NHS lab in Exeter:

https://monitormyhealth.org.uk/our-laboratory

In the past, I have used MonitorMyHealth, but for my thyroid issues. They are easy to deal with and efficient.

For complete disclosure, I am merely a satisfied user. I have no relationship with them, except for that.

bulkbiker · May 20, 2020

Jamie H said:
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.

Where I just read all of it and there's no mention of HbA1c or control in the whole piece?

marzak · May 20, 2020

bulkbiker said:
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.

My GP has been great but I haven't bothered them for April Hba1c that was due. If you put all the statistics together: BMI, level of fitness and hard aerobic exercise and blood glucose maintained at 'normal' population levels I imagine some of "us" are in better shape to overcome virus than general population. Note I use the word 'imagine'!! Not very scientific. My worry would be blood glucose control and insulin resistance going off plan if on a drip for food with no muscle activity. So best to keep away from risky crowds and keep out of covid19 statistics as best possible.

marzak · May 20, 2020

DCUKMod said:
Hi there Robert - You have have an HbA1c any time you like, using something like these:
https://monitormyhealth.org.uk/diabetes/

View attachment 41462

Tests are done, by post, using blood harvested by finger prick. The lab is an NHS lab in Exeter:

https://monitormyhealth.org.uk/our-laboratory

View attachment 41463

In the past, I have used MonitorMyHealth, but for my thyroid issues. They are easy to deal with and efficient.

For complete disclosure, I am merely a satisfied user. I have no relationship with them, except for that.

Someone always profits from health scares! They can use their lab space/time better for swab testing! Would it change your behaviour? My opinion is that you assume you are bit more vulnerable so behave in a way that reduces your risk of contracting disease. If you need to improve your lung fitness and can't do it through hard exercise I understand there are NHS breathing exercises on line you can follow to do that. Keep safe.

Jamie H · May 20, 2020

bulkbiker said:
Where I just read all of it and there's no mention of HbA1c or control in the whole piece?

In the second paper. Few quick screenshots for reference.

Reference to it in the text of the article aswell mate

HSSS · May 20, 2020

bulkbiker said:
Where I just read all of it and there's no mention of HbA1c or control in the whole piece?

Have you got the right paper. There are two. https://www.england.nhs.uk/wp-conte...D-19-and-Diabetes-Paper-2-Full-Manuscript.pdf talks about hb1ac and looks at increased deaths (in any setting) in diabetes

and this one deaths in hospitals https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf without hb1ac

Chrissie18 · May 20, 2020

Lupf said:
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.

You also need to identify/highlight than anyone with a BMI over 26 who is therefore clinically obese is much more likely to experience a poor outcome. The message should be if you are fat, eat less, move more. This message has been going out for years now, but is not being taken seriously. If you are a fat type 2 diabetic get your eating under control.

bulkbiker · May 20, 2020

HSSS said:
Have you got the right paper. There are two. https://www.england.nhs.uk/wp-conte...D-19-and-Diabetes-Paper-2-Full-Manuscript.pdf talks about hb1ac and looks at increased deaths (in any setting) in diabetes

and this one deaths in hospitals https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf without hb1ac

You're right I was looking at the non HbA1c one.. why on earth did they publish 2 papers and not just 1?

bulkbiker · May 20, 2020

Jamie H said:
In the second paper. Few quick screenshots for reference.

Reference to it in the text of the article aswell mate
View attachment 41465 View attachment 41466

Thanks for that .. seems I was looking at the "other" paper.. glad to be very low in HbA1c..

Jamie H · May 20, 2020

bulkbiker said:
Thanks for that .. seems I was looking at the "other" paper.. glad to be very low in HbA1c..

Yea think it's given some legitimacy to a lot of the measures many have suggested previously. Ie good control, matabolic health etc will help

HSSS · May 20, 2020

Chrissie18 said:
You also need to identify/highlight than anyone with a BMI over 26 who is therefore clinically obese is much more likely to experience a poor outcome. The message should be if you are fat, eat less, move more. This message has been going out for years now, but is not being taken seriously. If you are a fat type 2 diabetic get your eating under control.

Over 26 is overweight not obese (over 30 is).
“Move more“ whilst good for health is not a major faction weight loss, maybe 20% at most.
“Eat less” doesn’t work for many. Plenty don’t eat huge amounts but they eat the wrong foods. If type 2 the problem is carbs and lack of ability to process them. So eating a carb heavy diet as advocated by the current guidelines is the problem that needs addressing. Carbs also create cravings and have lesser ability to achieve satiety thus encouraging overeating too. A way of eating that is plentiful in other types of food, protein and healthy fats, need not be limited because our bodies are functional for them and reach satiety with those.

bulkbiker · May 20, 2020

This will be well worth a watch.

Lupf · May 20, 2020

HSSS said:
Sorry are you saying that if (random numbers) a particular female has a 5% risk of dying in hospital from covid then the same woman but with well controlled diabetes has a 10% chance of dying?

Chrissie18 said:
You also need to identify/highlight than anyone with a BMI over 26 who is therefore clinically obese is much more likely to experience a poor outcome. The message should be if you are fat, eat less, move more. This message has been going out for years now, but is not being taken seriously. If you are a fat type 2 diabetic get your eating under control.

Apologies, @Chrissie18 but this is close to fat shaming people.
Please read the book by Jason Fung: the Diabetes Code.
People don't want to get fat. Your advice: "Eat less, move more" has been proven to fail in innumerable cases. If we eat less of the wrong stuff, our metabolic rate will lower and after an initial loss we won't lose more weight. Plus you will feel hungry all the time which is not sustainable. It depends on what you eat. A calorie is not a calorie. Approaches which work are LCHF, i.e. replace carbs with fat, so you feel satiated and intermittent fasting (IF), which I call the oldest weight loss scheme and much tested in evolution when people had to survive in winters, ...
Of course, being active has many benefits and should be encouraged. However it also makes you hungry and is not very effective for losing weight.

Mike d · May 20, 2020

"Your advice: "Eat less, move more" has been proven to fail in innumerable cases".

And proven to work in many many others

Lupf · May 20, 2020

There are two papers submitted today by the group of Jonathan Valabhji. These can be downloaded from https://www.england.nhs.uk/publication/type-1-and-type-2-diabetes-and-covid-19-related-mortality-in-england/ Others have pointed to these papers already in this thread. Here are my initial thoughts after speed reading the papers.

One paper (24 pages) is a full population study. It shows odds or hazard ratios between males and females, different age groups compared to 60 to 69 year olds, with T1 and T2 diabetes compared to no diabetes and also for other conditions (see Figure 2). It also shows the mortality rate as a function of age (see Figure 1).
Their findings were reported today, e.g in the Guardian https://www.theguardian.com/society/2020/may/20/type-1-diabetics-type-2-coronavirus-nhs-study which focused on the difference between T1 and T2. What are the findings of the paper

1) the odds of dying for people with T1 was 3.5 times that of people without diabetes.
2) the odds of dying for people with T2 was 2.0 times that of people without diabetes.
3) for young people the overall risk is still very low. There were zero deaths with T1 reported under the age of 50. Since average age of T1s is 47 years, more than half of T1s have a very low risk of dying

This is the first study I have looked at which separates T1 and T2 (there could be other papers before) and it confirms that T1 is different from T2. The overall numbers are consistent with what was reported in other studies, like the one I mentioned at the start of this thread.

The second paper (22 pages) looks in more detail at people with diabetes. It gives mortality ratios within people with diabetes. For example for T2 (see p20, Figure 2) it shows the dependence on the latest Hb1Ac measurements
< 48 1.11
49- 53 1 (reference value)
54 -58 1. 05
59-74 1.23
75-85 1.37
> 86 1.62
Interesting to note is that very low Hb1Ac is slightly worse than 49 to 53.

The corresponding numbers for T1s have large uncertainties due to the smaller sample size, this is why there are horizontal bars through the data points (see p19, Figure 2), so it is difficult to make clear statements.

I also would like to point out this statement:
"Our observations show that risk of COVID-19 death is related to hyperglycaemia in people with either Type 1 or Type 2 diabetes risk and is proportional to the level of hyperglycaemia."

DCUKMod · May 20, 2020

marzak said:
Someone always profits from health scares! They can use their lab space/time better for swab testing! Would it change your behaviour? My opinion is that you assume you are bit more vulnerable so behave in a way that reduces your risk of contracting disease. If you need to improve your lung fitness and can't do it through hard exercise I understand there are NHS breathing exercises on line you can follow to do that. Keep safe.

Marzac, I have no interest in derailing this thread. I merely posted a solution to a member comment, stating they were unable to get an HbA1c done.

MonitorMyhealth has been running for quite some time now. I have utilised them, not because I am a worried well individual, but because I have been trying to better understand a complex issue with my health, and I am content to pay for that. I call that being a motivated person.

In terms of the lab being better used to process COVID swabs, I'm sure everyone would like every lab fully occupied with that objective, but I doubt all labs have enough of the relevant machines to do that, and then other equipment would be lying idle.

When I recently had an Endo appointment, I was struggling to get my bloods done, as my GP was being somewhat unhelpful. The Endo's response was that there are more issues out there than the headline grabbing COVID problem, and went off the sort out my bloods being done (via my GP).

Finally, as a matter f note, I have no utilised MMH since COVID has been in play.

@Lupf - my sincere apologies for a slight thread derailment. I will not be making any further derailing posts.

jane1950 · May 20, 2020

Lupf said:
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.

It is worrying, and although asked before, now this has come up in the news, what chance would a 70 year old have if the HBa1C isnt always a good level, last time I think it was about 12.8, I also have high blood pressure, although taking medication, sometimes it is still pretty high, as last week, one of the days it was 220/80, would I be able to survive or would I be one of the mortalities

Brunneria · May 20, 2020

jane1950 said:
It is worrying, and although asked before, now this has come up in the news, what chance would a 70 year old have if the HBa1C isnt always a good level, last time I think it was about 12.8, I also have high blood pressure, although taking medication, sometimes it is still pretty high, as last week, one of the days it was 220/80, would I be able to survive or would I be one of the mortalities

Hi Jane,

I am afraid that is not a question that anyone on this forum can answer.

We are all individual, and the figs that @Lupf has been talking about are averages based on a group of people. Each of us as an individual will have individual health issues which will affect our individual risk. As an example, your profile is incomplete and you do not say what type of diabetes you have, and whether you have any other co-morbidities. That affects the numbers, a great deal.

Please understand that no member of this forum is in a position to give you a personalised COVID risk assessment, and if you are sufficiently concerned, you should contact your doctor to discuss the risk with them, and whether you should be on the Shielding list (although at age 70 my understanding is that you are in the Extremely Vulnerable list and should be rigorously socially distancing already).

Jamie H · May 20, 2020

Lupf said:
There are two papers submitted today by the group of Jonathan Valabhji. These can be downloaded from https://www.england.nhs.uk/publication/type-1-and-type-2-diabetes-and-covid-19-related-mortality-in-england/ Others have pointed to these papers already in this thread. Here are my initial thoughts after speed reading the papers.

One paper (24 pages) is a full population study. It shows odds or hazard ratios between males and females, different age groups compared to 60 to 69 year olds, with T1 and T2 diabetes compared to no diabetes and also for other conditions (see Figure 2). It also shows the mortality rate as a function of age (see Figure 1).
Their findings were reported today, e.g in the Guardian https://www.theguardian.com/society/2020/may/20/type-1-diabetics-type-2-coronavirus-nhs-study which focused on the difference between T1 and T2. What are the findings of the paper

1) the odds of dying for people with T1 was 3.5 times that of people without diabetes.
2) the odds of dying for people with T2 was 2.0 times that of people without diabetes.
3) for young people the overall risk is still very low. There were zero deaths with T1 reported under the age of 50. Since average age of T1s is 47 years, more than half of T1s have a very low risk of dying

This is the first study I have looked at which separates T1 and T2 (there could be other papers before) and it confirms that T1 is different from T2. The overall numbers are consistent with what was reported in other studies, like the one I mentioned at the start of this thread.

The second paper (22 pages) looks in more detail at people with diabetes. It gives mortality ratios within people with diabetes. For example for T2 (see p20, Figure 2) it shows the dependence on the latest Hb1Ac measurements
< 48 1.11
49- 53 1 (reference value)
54 -58 1. 05
59-74 1.23
75-85 1.37
> 86 1.62
Interesting to note is that very low Hb1Ac is slightly worse than 49 to 53.

The corresponding numbers for T1s have large uncertainties due to the smaller sample size, this is why there are horizontal bars through the data points (see p19, Figure 2), so it is difficult to make clear statements.

I also would like to point out this statement:
"Our observations show that risk of COVID-19 death is related to hyperglycaemia in people with either Type 1 or Type 2 diabetes risk and is proportional to the level of hyperglycaemia."

Comment on deaths linked to hyperglycemia. Does this refer to control/hba1c or does this refer to hyperglycemia once admitted. I'm assuming the former as the latter isn't really referenced much throughout.

bobandpat · May 20, 2020

I don't understand the 'People with type 1 diabetes, which is usually diagnosed in childhood, tend to be younger than those with type 2.' statement in The Guardian. Surely there are lots of type 1 diabetics.....we do manage to live long lives!

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