Coronavirus and COVID-19 have had an unprecedented effect on the world, and the global community has come together to help protect those more at risk of the virus through self-isolation.

One of the key concerns for people with diabetes during this time is whether they are classed as more at risk of the virus or not. Diabetes has links with autoimmune deficiency, with type 1 diabetes specifically being an autoimmune condition.

Is diabetes an ‘at-risk’ category?

Initially, the Government guidelines in the UK listed diabetes as one of the ‘at-risk’ categories, but later updates and revisions to this list saw diabetes disappear. This left the question of whether those with any type of diabetes were or were not at risk.

Dr Dipesh Patel, a consultant in diabetes and endocrinology who has been working on the frontline in the hospitals during the COVID-19 crisis, guested on the Science Weekly podcast for The Guardian. He set out to try and explain the confusion behind the listing and de-listing of diabetes as an ‘at-risk’ category.

He said, “I am, I guess, slightly surprised that it’s not on the list of vulnerable conditions. However, we simply don’t have the data to support this in younger patients… the majority of patients with type 2 diabetes are both older, but also have other associated medical conditions that make them even more vulnerable. Until we have data to support that, it is difficult to advise upon.”

Why is data limited?

The speed of the spread of coronavirus has meant that peer-reviewed scientific data from the UK is still scarce.

Dr Patel said that Chinese data reports that “prevalence of diabetes reportedly has been around 10% but the important thing to note is that it appears that patients with diabetes seem more susceptible to developing a more severe type of illness” and “it’s reported that the risk of death is increased in people with diabetes.”

Until data is collated from the UK, it is difficult to make claims with any certainty.

What can Dr Patel tell us?

However, as he works closely with patients, Dr Patel can still give some insight from his experience. He said that any given week could see “anywhere between 15% to 25% of patients having diabetes mellitus. At the moment, although we don’t have any official data within the hospital or the UK my feeling is that we’re seeing more patients than that due to the current COVID-19 pandemic.”

He said that type 2 diabetes cases of COVID-19 are more prevalent than type 1 diabetes, although this is likely because type 2 diabetes itself is far more common than type 1 in the UK. Furthermore, he says “it is felt that a lot of patients who have type 1 diabetes are much younger and maybe they also have a greater level of physiological reserve by the sole fact that they are younger.”

“Patients with type 2 are older and are more likely to have other comorbidities such as hypertension or heart disease. We know that these also seem to be vulnerability factors in patients presenting with COVID related illness.”

Dr Patel said that those with diabetes are more vulnerable to certain severe respiratory infections, one of the reasons we offer older people with diabetes an influenza vaccination every year.

“We suspect that there is altered or reduced effectiveness of the immune system in people with diabetes mellitus and this is more seen in people with higher blood glucose levels.

“We are also beginning to think that actually abdominal fat which is increased in many patients with type 2 diabetes seems to be a potential for more excess inflammation. That excess inflammation is seen more commonly in people suffering from severe illness.”

When questioned about the higher rates of COVID-19 hospitalisation cases of people with raised BMI, Dr Patel said that “that’s what we’re seeing. Not only here but also I’ve seen some pre-published data from New York showing the rates of hospitalisation being much higher in people who have obesity, but also in people who have more severe grades of obesity.

“So, we now know that this is also a signal in terms of vulnerability to both hospitalisation and a more severe disease. That might be linked directly to inflammation. We know that people who have excess amounts of abdominal fat already have a low level of inflammation more so than people with normal levels of abdominal fat.”

Dr Patel indicates that those who develop COVID-19 illness are more likely to suffer a worse form of the disease if they have diabetes, its associated illnesses, or poor metabolic health and obesity.

What does Dr Patel advise for people with diabetes during this time? “I think it is important not to worry excessively. It is difficult to put into practice. It is important to check blood glucose levels regularly and it is best to do the things we would normally advise our patients to do. Get plenty of sleep, eat a well-balanced diet, drink plenty of water.”

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