Should all diabetics be labeled 'high risk' for COVID-19? Maybe not, but it's complicated

From eu.azcentral.com
By Joanna Allhands Arizona Republic

Should diabetics be in the “high risk” group for COVID-19?
The Centres for Disease Control and Prevention says that people over 65, plus those with underlying conditions, such as heart disease, asthma or diabetes, are “at high risk for severe illness from COVID-19.” Reopening guidelines strongly suggest that those in these high-risk groups continue to stay home.

But is that necessarily the case for all diabetics?
It’s tough to say. The research is all over the place.

There's a lot we don't know

That’s understandable. There are still so many things we don’t know about how the novel coronavirus spreads and affects the body – especially the bodies of those with chronic conditions like diabetes, notes Johanna DiStefano, who heads the diabetes and fibrotic disease program at TGen.
COVID-19 hasn’t been around long enough to conduct the massive, peer-reviewed studies we’ll need to help answer these questions. Much of what exists so far relies on relatively small patient samples or focuses on patients in certain settings – such as only those who have been hospitalized.

Not all studies sufficiently exclude other underlying conditions. And few make differentiations between type 1 and the much more common type 2 diabetes, even though they are quite different diseases.

So, why do we think that diabetes elevates the risk of a severe COVID-19 reaction?

Part of it is based on what we already know about diabetes, and about how similar coronaviruses, such as SARS and MERS, have previously impacted diabetics. It stands to reason that if diabetes is a chronic inflammatory condition, and inflammation tends to exacerbate COVID-19, that diabetics would be at risk for more severe illness.

There are dire headlines

There are plenty of dire headlines to this effect. A widely debated British study concluded that type 1 diabetics – whose bodies don’t produce insulin – were more likely to die from COVID-19 than type 2 diabetics, whose bodies make insulin but don’t process it correctly.

While the study noted that age was a larger risk factor for death than either type of diabetes, it renewed calls in that country to force diabetics to self-isolate at home.

Another widely reported French study found that 1 in 10 diabetics with COVID-19 died within a week of being hospitalized. Age and obesity were among the factors that seemed to worsen outcomes.

The study followed whether patients had type 1 or type 2 diabetes but didn’t make conclusions based on these differences because a small sample of type 1 diabetics were hospitalized.

Controlling blood sugar levels is crucial in preventing diabetic retinopathy, because elevated blood sugar levels can damage the blood supply to the retina. Getty Images

But not all diabetics are the same

That leads to a key point.
It’s widely accepted that while diabetics are not more susceptible to COVID-19, they are at higher risk of more serious outcomes once they contract the disease. But the risk for all diabetics may not be the same.
It could vary widely depending on:

• Their age.
• Whether patients are type 1 or type 2, though the differences remain unclear.
• How well they are managing their blood sugar levels.
• Whether they have other underlying conditions, such as heart disease or obesity.

Again, we don’t know this for sure. The research is still catching up. But there are enough studies to suggest these factors could play a part in a diabetic’s reaction to the virus that causes COVID-19.

Think of it this way:
All diabetics likely face a higher risk of severe illness than their non-diabetic peers. But a younger diabetic whose diabetes is well managed and who has no other underlying conditions likely faces a lower risk than an older diabetic with a high A1C level who also has heart disease.

Should I change my routine?

So, what does that mean for the 34.2 million Americans with diabetes (not to mention the millions more who live with a diabetic)?

“It's about minimizing unnecessary contact and exposure,” said Aliria Muñoz Rascón, a clinical associate professor and assistant director of Arizona State University’s Global Health Collaboratory.
At minimum, that means following the CDC guidelines to not touch your face, frequently wash your hands and disinfect surfaces. Get some exercise and frequently monitor your blood sugar and ketones, even more so when you’re ill.

Getting a good night’s sleep and managing stress also are important, because they can impact glucose levels. So are continuing your medications and regularly visiting with your doctor – particularly if you have other underlying conditions. Putting off this care can impact your health and, potentially, put you at higher risk for a severe COVID-19 reaction.

That said, should all diabetics continue to shelter at home, as the White House and CDC reopening guidelines suggest? Or is there some wiggle room for those who are younger, with well managed diabetes and no underlying conditions to return to the office, go to the grocery store or eat at a restaurant?

Possibly. But because of the potential health impacts, these decisions are best made with your doctor.

https://eu.azcentral.com/story/opinion/op-ed/joannaallhands/2020/06/14/should-all-diabetics-labeled-high-risk-coronavirus-maybe-not-complicated/5329558002/