• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

diabetes and other co-morbidities with COVID-19

M

Max68

Well-Known Member
Messages
753


I have added this link above to the wonderful Dr John Campbell who does some very insightful videos on You Tube on another thread but also think it should be included on this "shielding thread". I found this video in particular to be of some concern. There are links below the video which show the studies and the tables can be accessed via PDF on the studies pages, far too much Info to post here.

In a nutshell on this particular study in the UK it concentrated on a study on a fair amount of people admitted to hospital with Covid 19. Interestingly what is called in the study "Uncomplicated diabetes" which I assume is no obvious complications seemed to fare worse than "Complicated diabetes" which I find quite baffling. It also concerningly had "uncomplicated diabetes" second in the table behind heart disease and ahead of cancer as far as I can see which begs the question why ALL persons with diabetes are not on the Governments shielding list but according to these tables other conditions below diabetes are?! Until we know more at least!
 
I’m not sure all cancers are shielded , just certain types/treatments. However in answer to your question my first assumption it is because the numbers involved with diabetes is so scarily high a massive section of the population would then need shielding with all the difficulties that entails. Alternatively, and less conspiratorial, it might be about how much the comorbidity raises the risks by rather than how common it is.
 
@HSSS I must confess that is my thought that if you shielded diabetes and high blood pressure you would be shielding millions of people. However it seems a strange thing for a government to pick and choose just because of numbers involved. Very much hangs us all out to dry a tad when it comes to the legal aspects of work etc.
 
Max68 said:
Interestingly what is called in the study "Uncomplicated diabetes" which I assume is no obvious complications seemed to fare worse than "Complicated diabetes" which I find quite baffling
Click to expand...
The presenter hinted as the reason for this when he considered pregnant women. He noted that although 6% of admissions of women of child-bearing age were pregnant, that is the normal percentage of women in that age group who are pregnant. From that, we conclude that pregnancy does not increase risk of admission for Covid-19.

For uncomplicated versus complicated diabetes, we would need to compare the percentage of those admitted in each of those groups to the percentages in the general population. Everyone starts their diabetic journey with no complications and it generally takes years for them to appear. Death-rate increases with age so some of those people with complications will die and be replaced in the 'diabetic population' by newly-diagnosed people with diabetes who have no complications. The population of people with diabetes who have uncomplicated diabetes is therefore larger than the population of people who have complicated diabetes.

Even if the presence of complications had no effect on admission rate, you would still expect a bigger percentage of people with uncomplicated diabetes to be admitted for Covid-19 just because there are more of them. To unpick the effect of complications, you need to know the prevalence of complications in the population of people with diabetes and see if the proportion is higher amongst hospital admissions for Covid-19. For example,if only one-third of people with diabetes have complicated diabetes, you would expect twice as many people with uncomplicated diabetes to be admitted as people with complicated diabetes.
 
I have just registered on this forum after reading through quite a number of times... find it extremely informative, interesting and at times reassuring.

In relation to this particular topic there appears to be quite a lot of conflicting reports around the risk associated with diabetes... it would therefore be extremely useful if this was further broken down by age, BMI, hba1c etc. Also my interpretation of this study is that it is a yes/no response to each comorbidity.... therefore I am not sure "uncomplicated diabetes" necessarily means that there was no other co-morbidity present... eg what % were obese, what % also had COPD etc. I fully appreciate there are many on this forum in that position and I only say this as each of us will want to know as full a picture as possible in order to make informed decisions about how move to the "new normal".

Of course we all know there is no such thing as good or bad diabetes it's how well it is managed, and also it may come down to what other conditions are present, as well as other contributing factors such as age. ... until studies are further broken down diabetics are left a bit in the dark in terms of what exactly the increase in risk is.

Best guess in reading other studies may be that those with diabetes that are younger , have good control and no other co morbidites may not be at much of an increased risk of more severe infection and outcome than the general population. However that still leaves a significant percentage of diabetics in the dark about their own specific risk. (including the example above as this is just a best guess).. this will be vital in not only the government's response to scaling back lockdown measures but also ensuring individuals have the full picture to weigh up their own associated risk when trying to get back to some level or normality.

I
 
Fully agreed with both the above posts. There seems to be so much ambiguity it's difficult to make an informed decision. For instance as per my thread, work are leaning on me and threatening me with SSP if I don't return to work. All they see is this ambiguity just as I do, and probably what my GP sees as well. They don't seem to accept that whilst I "don't know" why take the risk, but they take the "don't know" as a neutral. Until we find out more it's very difficult.
 
what about if you have brittle diabetes, and some blood pressure readings of 180/80
 
Interesting and very informative read, thanks for sharing. I wonder if the same is true for T1D? Also not sure if this refers to typical/avg BG levels or management of these levels during the period in hospital.... Or both?
 
Jamie H said:
management of these levels during the period in hospital....
Click to expand...

Unfortunately I've had 3 stays in hospital in the last 6 years, plus 2 day surgeries where I was expected to eat their food. Luckily 2 occasions were in a private hospital where I had 2 knee replacements on my wife's health insurance, I managed to get them done before she retired. Although there wasn't a great choice, I managed low carb choices as opposed to what they called 'diabetic friendly' and my BG was OK

Then there was a burst appendix/peritonitis and a prostate procedure and a liver procedure. The day procedures I had to go without otherwise my BG would have gone up a lot. The 7 day stay for the appendix was not so easy and I was surprised how the nurses thought a BG reading of 10 was good.

I hate to think what happens when you have no control over what nutrition you are given.
 
Yea that can be a challenge and I've experienced that when I was in for surgery on my leg. Luckily I was able to monitor my own BG levels and had access to my own food a lot of the time.

I would imagine it refers to both.. Ie how well you BG levels are controlled prior to admission and then how well they can continue to be managed during any stay. I would imagine the effects of a consistently high hba1c wouldn't be completely mitigated by well controlled BG levels during a hospital stay... And would expect the opposite to also be true. Though we are all fully aware how tricky it is to keep BG levels under complete control during illness.

As a type 1 it would be interesting to know if the findings of this report also apply.. I would imagine so but would expect more variables in terms of age and other comorbidities..perhaps making findings more profound on terms of keeping BG levels under good control.
 
HSSS said:
https://www.cell.com/cell-metabolism/fulltext/S1550-4131(20)30238-2#.XqxOw3EasVI.twitter

This has been posted on a couple of threads and seems to be the first paper breaking down the diabetes categories and associated risks. Well worth a read.
Click to expand...

One issue is that they measured BG variability after people were admitted with COVID-19, hence the poor BG may be due to people being sicker with COVID-19

So is this more a statement of how a person responds to hospital food, eg their level of inslin resistance?
 

and those unconscious on ventilators are tube fed - big dollops of glucose included, no doubt.
 
"Fourth, given the retrospective nature of the study, it was not possible for us to determine if active management of BG levels to a more normal range could ameliorate COVID-19 severity or adverse outcomes."

So still unsure of management before admission and how it relates to risk of becoming severely ill in the first place.. Other than the basic assumption that poor management increases risk. Interesting nearly all had other comorbidities... Something that would perhaps be more variable in the type 1 community.. Though this study does not examine how that's effected severity.


This looks to be more about management during treatment/admission. No indication if the patient had poor control before admission or the poor control was caused by the illness. You'd imagine a bit of both..
 
The report itself does acknowledge the limitations of not knowing levels prior to admission.

Therefore, the effect of BG control may be different among patients with COVID-19 and pre-existing T2D in the outpatient setting or in ethnically or geographically diverse populations. Second, we were not able to retrieve the pre-hospital status of T2D from the current cohort due to the urgent circumstance of the COVID-19 pandemic. The status of pre-hospital T2D could be significantly associated with numerous clinical parameters, which are known independent risk factors for the poor outcomes of COVID-19, including cardiovascular abnormalities and immunological dysfunction.​

I can’t imagine those with good control in hospital managed that unless it was also good outside though.

Some of those with poor control in hospital may well have been the result of the disease/hospital ill nutrition
 
Probably to some extent. But good control at home (even if disease or hospital food raises it later) will likely mean less insulin resistance, less complications and more “room for manoeuvre” than previously poor control.

As stated above it’s not likely that those with good hospitalised control were great at home, although the reverse can’t be said I agree
 
Last edited:
Tend to agree. It's likely those with bad control outside of a hospital setting are not going to suddenly have optimal control when ill... Or indeed reverse any complications as a result. There will of course be patients where bad BG control is caused by the virus.. However previously good control may well have ensured a limit to other complications and a ultimately a better chance of fighting the virus.
 

For me, the take-away message from all of this is that now is a good and important time for us all to me exercising as good control as we can manage.

Of course for for those approaching this from a very sub-optimal place, that might seem daunting, but whatever the starting point, giving it our best efforts could well pay dividends, should we be unfortunate and encounter the virus.
 
Referring to: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(20)30238-2#.XqxOw3EasVI.twitter

The study does indicate better outcomes for T2s with well-controlled BGs. I spotted a couple of things......

'Among the cohort with COVID-19 and T2D, there were 282 individuals with well-controlled BG (136 males, 48.2%) and 528 individuals with poorly controlled BG (298 males, 56.4%). The median BG level was much lower in the well-controlled BG group than the poorly controlled BG group (6.4 mmol/L [5.2–7.5] versus 10.9 mmol/L [7.6–14.3]), and the levels of HbA1C in these two groups were 7.3% (6.6%–8.2%) and 8.1% (7.2%–10.1%), respectively.'
Doesn't this seem to indicate that the study regarded 'well controlled' T2s to have higher readings than many of us deem satisfactory? Unless I've read it wrong.

However, it goes on to state that, '.....an overly rigid glucose control may increase the risk of severe hypoglycemia, which can also lead to an increased mortality.'
Not sure I understand this. Is this because any treatment / nourishment may induce hypoglycemia?
 
I agree I thought their good control was fairly unambitious.

My assumption regarding hypoglycaemia was the same old one that excellent hb1ac’s are assumed to have come about via lots of hypos rather than tight control for those on glucose lowering medications as many out there (unlike us enlightened few), especially as they age, are on such meds for the progressive disease they have
 
Last edited:
You must log in or register to reply here.
Menu
Log in
Register
Cookies are required to use this site. You must accept them to continue using the site. Learn More.…