You may have seen headlines such as “Quarter of COVID-19 deaths in English hospitals were of diabetics” or “COVID-19: people with type 1 diabetes more likely to die than those with type 2 – study”.  Terrifying, right? In this article we aim to provide you with an update on what latest research is telling us about the novel SARS-CoV-2 coronavirus (COVID-19) and diabetes.

We are all aware by now that the spread of COVID-19 has reached pandemic proportions. Globally there is a real threat for older people and those with pre-existing conditions, such as diabetes.

What the research shows

Although one early study from China indicated that “patients with diabetes are at high risk for COVID-19 infection” an Australian team of researchers state that “this did not reach statistical significance”. Having diabetes does not put you at higher risk of being infected with the coronavirus. However, what is becoming clear from research so far is that people with diabetes who are infected with COVID-19 do tend to get sicker and are at higher risk of dying. This is particularly true if glucose levels are high. Experts think that the increased risk of poorer outcomes is because diabetes puts strain on the heart and other organs.

Statistics

More research is needed to understand why diabetes increases the risk of death from COVID-19. But one thing we have learned so far is that people with type 2 diabetes are twice as likely to die from COVID-19 and people with type 1 diabetes are 3.5 times more likely to die if they catch COVID-19, compared to people who do not have diabetes. Age, however, is the biggest determining risk factor for death among people with either form of diabetes who get COVID-19. According to new findings collated by the NHS in England, people under 40 have a very low risk compared with those over 40, and especially compared with older people. Importantly, it also shows that higher blood glucose levels and obesity further increase the risk in both types of diabetes.

Recommendations

Researchers from Sydney University and Royal North Shore Hospital highlight in a recent publication that:

• It is critical to have ongoing medical care to make sure blood glucose levels are in the optimum range throughout the pandemic
• Telehealth is recommended in most cases due to the need for social distancing
• Seek face-to-face care for complications such as heart attacks or foot ulcers
• Use of technology, such as continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) as well as uploading data from insulin pumps and blood glucose monitors by the user prior to the consultation, can be of great benefit
• Having the flu vaccine is advisable. Although it will not protect against COVID-19, it will protect against influenza
• Both people with type 1 and type 2 diabetes need to have a clear sick day plan
• People with type 1 diabetes should have ketone monitoring strips available. Know when to check for ketones and be aware of the need of additional insulin doses during illness
• Those who use hybrid closed loop pumps (such as the Medtronic 670G) may need to exit auto-mode to enable more rapid correction of hyperglycaemia with manual correction boluses and a temporary basal rate
• Individuals treated with an SGLT-2 inhibitor (such as Forxiga, Jardiance, XigDuo or Jardiamet) should also check ketones when unwell. You may need to stop the SGLT-2 medication during periods of illness (talk to your doctor)

What you have told us

Our diabetes advocacy team ran a poll recently to better understand what people living with diabetes are experiencing during the COVID-19 crisis. Over 1,600 people responded to the survey and while for many COVID-19 hadn’t impacted their diabetes management for others getting adequate exercise, anxiety caused by isolation and access to health professionals were of concern. A table of the responses is shown below.

Help is available

If you’re finding things tough at the moment, you’re not alone. There are so many things we can’t control right now, so it’s important to focus on the things we can. Read our advice on staying well during this period. Or if you need some extra support or someone to talk to call our Helpline on 1300 342 238. You can ask to speak to a credentialled diabetes educator, dietitian or exercise physiologist, or to book an appointment with our psychologist. Remember you’re not alone. We’re here for you.