The disproportionate toll that COVID-19 took on people with diabetes continues today

From theconversation.com

By Jamie Hartmann-Boyce

At the start of the pandemic, many people living with diabetes were wondering what COVID-19 meant for them. Diabetes was already known to put people at higher risks from other infectious diseases, including flu. Would it be the same with COVID-19? At the time, all scientists could do was make educated guesses.

In 2024, things look very different. A great deal more research is available, as well as effective vaccines, and life has in many ways returned to something like normal.

COVID-19 hasn’t disappeared, however, and for the more than 400 million people living with diabetes worldwide, very real risks and impacts from the pandemic remain.

I specialize in drawing on and combining existing evidence to inform health policy across a range of areas. I’ve been studying COVID-19 and diabetes since the start of the pandemic and have experienced first-hand some of the many ways in which COVID-19 has affected people with diabetes. I’ve lived with Type 1 diabetes for the past 30 years. And at the start of the pandemic, I had a lot of questions about what COVID-19 meant for me. 

Diabetes types defined

Diabetes is characterized by having higher than normal blood sugars. Different types of diabetes create this condition in varying ways.

Type 1 diabetes occurs when your body attacks the cells that produce insulin.

Insulin is the hormone that converts sugar into energy – without it, sugar remains in the blood, and the body is deprived of the energy it needs. Type 1 diabetes can be treated only by injecting insulin and is irreversible. If left untreated, Type 1 diabetes is fatal. There is no cure. No one knows for sure why some people get Type 1 diabetes and others don’t.

By contrast, in Type 2 diabetes – by far the most common type – your body is still producing insulin but is less able to use it. People are more likely to get Type 2 diabetes if they are living with obesity. But people who aren’t obese can also get Type 2 diabetes, and many people living with obesity never get diabetes.

Type 2 diabetes often runs in families. It can be treated in a range of ways. This includes weight loss for people living with obesity, changes to diet and exercise, and medications. In some cases, Type 2 diabetes can be reversed.

Type 1 diabetes is most likely to start in childhood or adolescence, and Type 2 diabetes is most likely to start later in life. However, older people can develop Type 1 diabetes, and children can develop Type 2.

There are other types of diabetes, too. Gestational diabetes develops in pregnancy and goes away after giving birth. As with Type 2 diabetes, the body is still making insulin but is less able to use it.

In general, diabetes is on the rise, with most of this being driven by Type 2. By 2050, it’s estimated that 1.3 billion people will be living with diabetes worldwide.

Diabetes can damage many parts of your body, including your eyes, heart, blood vessels, nervous system, feet and kidneys. Blood sugar management and regular checkups can help reduce these risks.

Diabetes and COVID-19

In a 2023 study, my colleagues and I reviewed a wide body of literature to examine the extent to which people with diabetes were at increased risk from COVID-19, and whether some people with diabetes were at greater risk than others.

Overall, we found that people with diabetes were about twice as likely to get seriously sick with COVID-19 than people without diabetes. Evidence also consistently showed that people with diabetes were more likely to die from COVID-19 than people without diabetes.

Some people with diabetes appeared to be at greater risk than others. The higher people’s blood sugar levels were before or during COVID-19 infection, the worse their outcomes were likely to be. In addition, risks generally seemed higher for people with Type 1 diabetes and people who used insulin.

There are several potential explanations. We know that having higher blood sugar levels makes it harder for people’s bodies to fight infections. On average, blood sugar levels are higher in people with Type 1 than Type 2 diabetes. Infection can make blood sugar levels harder to manage.

People with Type 1 diabetes also tend to have lived with diabetes longer than people with Type 2 diabetes, and that might mean their bodies are less able to fight COVID-19 because of diabetes complications – for example, damage to their heart and kidneys.

Pandemic disruptions

The pandemic triggered wide-scale disruptions for people living with diabetes. Many found it harder to make appointments with their health care providers. Some found it harder to access their medications. For many people, diet and physical activity were disrupted, too.

We did a wide-ranging, systematic review of 139 studies in more than a million people to examine the impact of pandemic disruptions on people with diabetes. Evidence showed that people were more likely to die from diabetes during the pandemic than before it and were more likely to lose sight because of diabetes during the pandemic than before. People with diabetes need regular eye checkups to help protect their sight; these checkups often didn’t happen during the pandemic, and people’s vision suffered as a result.

We also found that young people with diabetes fared particularly badly. Children and adolescents with Type 1 diabetes were more likely to be admitted to the hospital with a life-threatening condition called diabetic ketoacidosis, which is when your blood turns toxic because you don’t have enough insulin in your body.

Admissions to paediatric intensive care units for diabetes were higher during the pandemic than prior. It might be that people delayed seeking care, or were unable to access care, because of pandemic disruptions. That could mean that by the time young people with diabetes made it to a hospital, they were already really, really sick.

Looking forward

There is still plenty of reason for optimism, though. COVID-19 vaccines have markedly decreased the chances of dying or getting really sick from COVID-19, and in many countries, people living with diabetes have been prioritized for vaccines.

There are also developments in diabetes care. Improved diabetes management, whether it be through technologies such as insulin pumps or continuous glucose monitors, behaviour changes or medications, can help reduce risk from COVID-19 and other infections.

Weight loss drugs may also play a role in diabetes prevention, but it’s still too early to say for sure.

Time will tell what the long-lasting impacts of the pandemic will be. Diabetes complications can often develop many years down the line, so researchers like me may see more people suffering complications from diabetes five to 10 years from now as a result of challenges with diabetes management during the pandemic.

Regular monitoring, particularly of the groups most affected by the pandemic, is likely to help. Caught early, many diabetes complications can be successfully treated.

My team found that among people living with diabetes, women, young people and people from racial and ethnic minority groups were most likely to suffer ill effects from the pandemic. These are groups who may be more likely to struggle to access care, with insulin prices and access remaining a particularly critical issue.

Efforts to make insulin and health care more accessible can help improve diabetes outcomes before, during and after pandemics.

https://theconversation.com/the-disproportionate-toll-that-covid-19-took-on-people-with-diabetes-continues-today-227314

Risk of diabetes rises 58% after COVID, even amid omicron, study finds

From arstechnica.com

This is the latest study finding COVID infections can spur the development of diabetes

A person's odds of getting a new diabetes diagnosis were 58 percent higher in the months following a COVID-19 infection compared with prior to infection, even amid the era of omicron, researchers reported Wednesday in the journal JAMA Network Open.

The study is just the latest to link the development of diabetes to COVID-19, which pandemic data suggests increases the risk of a range of cardiometabolic conditions, including blood clots, myocarditis, stroke, and diabetes. A study published early last year in Nature Medicine tapped into the medical records of more than 11 million veterans and found that people who had recovered from COVID-19 had a 63 percent higher risk of developing any of 20 cardiovascular diseases, including a 55 percent higher risk of heart attack, stroke, and death.

The data on diabetes is equally worrying. In a systemic meta-analysis published in Scientific Reports last November, researchers compiled data from eight cohort studies involving more than 47 million people and found that COVID-19 infection was linked to a 66 percent increased risk of developing diabetes.

"Given the extraordinary number of COVID-19 survivors globally, the modest increase in diabetes risk could correspond to a drastic rise in the number of people diagnosed with the disease worldwide," the authors—researchers at Penn State College—wrote.

In a commentary written last year in the journal The Lancet Diabetes & Endocrinology, diabetes researchers at Emory noted that the long-term implications of the association are "profound." Dramatic rises in diabetes cases could end up "wreaking havoc on already over-stretched and under-resourced clinical and public health systems globally, with devastating tolls in terms of deaths and suffering."

It's still unclear how COVID-19 is sparking such dramatic cardiometabolic conditions in survivors, but researchers have speculated that immune responses play a role. For instance, in the case of diabetes, researchers have hypothesized that inflammation from COVID-19 is contributing to insulin resistance.

Persistent risk

In the new study this week, researchers extended the data to look at cardiometabolic links to COVID-19 through June 2022, a period that includes the omicron coronavirus variant wave. Omicron was widely seen as being "milder" than previous variants, raising the question of whether it poses less risk of spurring concerning long-term consequences, such as cardiovascular disease and diabetes. The answer, according to the study, is no.

The authors of the new study—researchers at Cedars Sinai Medical Centre Los Angeles—looked at data from a cohort of over 23,000 patients and calculated their odds of being diagnosed with diabetes in the 90 days prior to a COVID-19 infection to the 90 days after an infection. To account for fewer doctor visits at points during the pandemic, the researchers adjusted the data based on the diagnoses rates of non-COVID-linked conditions, namely urinary tract infections and acid reflux.

In the adjusted modelling, the odds of being newly diagnosed with diabetes in the post-infection window were 58 percent higher compared with the odds prior to infection. And in further analyses, the risk remained when looking at odds prior to the omicron era and afterward. Age and sex also did not seem to sway the risk.

Unvaccinated people did appear to have higher odds of developing diabetes in the post-COVID window than vaccinated people, but the link was not statistically significant due to wide confidence intervals of the odds estimates. Studies overall have been mixed on how vaccination status impacts the risk of long-term COVID-19-associated conditions—such as diabetes—given differences in definitions of long COVID and in the time since vaccination. Some studies have found no difference in risk, while others have found that vaccination reduces the risk of long-term conditions by as much as 41 percent.

Overall, the researchers of the new diabetes study concluded that their data found a link between higher risks of diabetes and COVID-19 infection, consistent with the previous data, and that "this risk persisted as the omicron variant became predominant, and the association remained even after accounting for temporal confounders."

https://arstechnica.com/science/2023/02/risk-of-diabetes-rises-58-after-covid-even-amid-omicron-study-finds/

Diabetes and Your Emotions

From diabetes.org.uk

Diabetes doesn't just affect you physically, it can affect you emotionally too.

Whether you've just been diagnosed or you've lived with diabetes for a long time, you may need support for all the emotions you're feeling. This could be stress, feeling low and depressed, or burnt out. The people around you can feel all of this too. Whatever you're feeling, you are not alone. Here's some information you might find helpful – you might like to share it with your family and friends too.

Coronavirus and your emotional health

We know that things feel a little scary and uncertain at the moment because of the coronavirus pandemic. Your experience of living with diabetes and the stresses it brings may make you more prepared to cope with this situation than most people. But we're here for you if you are struggling too.

Focus on things you can control

If you're finding yourself worrying, it might help to try to focus on the things that you can control in your life. Here are some tips:

• know your sick day rules
• go to appointments if your healthcare team ask you to
• check out your work policies around sickness and time off
• keep important numbers handy
• know the symptoms of coronavirus and what to do if you begin to feel ill
• make sure you have supplies and repeat prescriptions up to date
• look after your body – try to make healthy food choices, be active, get enough sleep and wash your hands more often
• check out our recipe finder for new ideas
• make sure to look after your mind if you're staying at home – keep in touch with friends and family if you can
• say no to things if you need to, and ask for help if you feel you need it
• get your news from reliable sources, but it’s also okay to take a break from the news if it feels too much.

Things you can’t control

Focusing your mind on things out of your control won't change things. This can lead to worry, so gently try to redirect your attention.

You might be feeling nervous, because your condition may make you more vulnerable to becoming unwell if you catch coronavirus. Or you might be worrying about who around you could catch the virus. But you don’t have control over these things, so try to be supportive and understanding for the people who do get coronavirus. And remember that it is not your fault if you catch the virus too. Be kind and compassionate to yourself. 

If you need to self-isolate, you may have to miss work, school or appointments. This is okay and the best thing to do to look after yourself and others.

You might also be worrying about some diabetes appointments being cancelled or finding it difficult to get hold of your healthcare team. There might be alternative options, like phone or video appointments, so look into these. Most appointments aren't urgent, but if your diabetes team really need to see you they will get in touch with an appointment. It’s important that you try to go to these.

Not being able to get what you want from the shops can be stressful. You can't control the availability of supplies. Try to be patient and try not to panic buy. If you are having difficulty getting food supplies, we are doing our best to support you. Find out what we're doing.

It’s not easy to stop feelings of anxiety and worry, and these are completely normal responses given the current circumstance. You can't control your feelings, but you can control what you do with them. Talking about how you’re feeling might help. And the mental health charity Mind have put together some useful information about taking care of your mental health during this time too.

Talking about how you feel

Talking about diabetes and how it's making you feel isn’t always easy. It can be hard to get started, or find someone you think you can open up to. Maybe you don't feel like you need to talk about anything or you don't want to burden anyone. But offloading some of what you're feeling has so many benefits, both for you and for those close to you. 

Read our advice on talking about your diabetes. We've got tips to help you start those conversations with your family and friends, your boss at work, and really importantly your healthcare professional team.

Stress and diabetes

Everyone can feel stressed from time to time. But having diabetes to manage as well as everything else in life can feel very overwhelming. Stress can affect your blood sugar levels, so it's important you know how to recognise when you're stressed and how to deal with it. We can help you cope with stress when you have diabetes.

Coping with being diagnosed

Being diagnosed with diabetes can come as a shock. First reactions may be disbelief, feeling overwhelmed, even anger. Usually these feelings ease after a while and diabetes becomes part of life. But sometimes these feelings don’t go away easily. If you feel this way, you're not alone. 

There are lots of people out there to support you – your family, your friends, your healthcare professional team, and we're here for you too. We can help you get to grips with diabetes and help you find other people going through the same things as you. Take a look at our guide to being diagnosed to help you start adjusting to life with diabetes.

Depression and diabetes

Diabetes can be difficult to live with day to day and get you down, this is completely normal. But if these feelings won't go away, you might have depression. Having depression and diabetes is more common than you might think – people with diabetes are twice as likely to develop depression than people who don't have diabetes. We can help you know the signs of depression and how to manage it.

Diabetes distress

Diabetes can be really tough to live with. Sometimes people feel distressed, which can include feeling frustrated, guilty, sad or worried. It's understandable if you feel this way from time to time – you’re not alone. There are lots of things you can do to help you cope with feeling diabetes distress.

Fear of hypos

Hypoglycaemia or a hypo is when your blood glucose level (blood sugar) goes too low. Not everyone with diabetes can get hypos, but some often worry or get anxious about having them. If these feelings don't go away or start to take over your daily life, then it's important you talk to someone about it. Find out how to work through your hypo anxiety.

Emotions and food

Diabetes can put more of a focus on food and diet. Having to pay close to attention to what you eat and learn new ways to cook can be stressful. Some people find they eat more when they're stressed or eat less because they're feeling low. Eating different foods can have an impact on your mood too – find out more about the link between your feelings and food.

Sometimes, it can mean more of a focus on weight and body image too. This can lead to an unhealthy relationship with food, something called disordered eating, or possibly an eating disorder. Diabulimia is a serious eating disorder that people with Type 1 diabetes can develop. We've got more information on diabulimia and what can help if you're struggling with it.

https://www.diabetes.org.uk/guide-to-diabetes/emotions 

People who’ve had COVID appear more likely to develop diabetes – here’s why that might be

From theconversation.com 

By Jamie Hartmann-Boyce 

Many people who have had COVID-19 have gone on to develop diabetes. But diabetes is relatively common, and COVID is too, so that doesn’t necessarily mean one leads to the other.

The question is whether people who have had COVID are more likely to develop diabetes than those who haven’t. And if so, is it COVID that’s causing diabetes, or is there something else that links the two?

                                                        DisobeyArt/Shutterstock

Recent studies suggest there is an association between having COVID and going on to be diagnosed with diabetes. US data, based on records of more than 500,000 people aged under 18 who had COVID, found these young people were more likely to receive a new diabetes diagnosis following their infection, compared to those who didn’t have COVID and those who’d had other respiratory infections prior to the pandemic. The study didn’t specify which types of diabetes people developed.

Another US study in an older age group found the same patterns in their analysis of over four million patients. In this case, most of the diabetes cases were type 2.

A German study based on medical records of more than eight million patients again found people who had COVID were more likely to subsequently be diagnosed with type 2 diabetes.

Remind me, what is diabetes?

There are various different kinds of diabetes. What they all have in common is that they affect the body’s ability to produce or respond to the hormone insulin. Insulin controls the amount of sugar in our blood, so if we don’t produce enough of it, or it’s not working properly, our blood sugar goes up.

The most common type of diabetes by far is type 2 diabetes. It often comes on in adulthood and is characterised by insulin resistance. In other words, people with type 2 diabetes are still producing insulin, but the insulin isn’t working properly. Treatments vary and include medication, changes to diet, and increased physical activity.

The next most common is type 1. Type 1 diabetes often, but not always, comes on in childhood or adolescence. I was diagnosed at the age of ten. In type 1 diabetes, the body stops producing insulin altogether. People with type 1 diabetes need to take injections or infusions of insulin for the rest of their lives.

So how could COVID cause diabetes?

There are many plausible theories about how COVID might cause diabetes, but none have been proven. One possibility is that inflammation caused by the virus could bring about insulin resistance, which is a feature of type 2 diabetes.

Another possibility relates to ACE2, a protein found on the surface of cells, which SARS-CoV-2 (the virus that causes COVID-19) attaches to. Some studies have shown that the coronavirus can enter and infect insulin-producing cells via ACE2, which might cause the cells to die or change how they work. This could mean people are not able to produce enough insulin, leading to diabetes.

                Diabetes affects the body’s ability to produce or respond to the hormone insulin.     Pikselstock/Shutterstock

In type 1 diabetes, the immune system attacks insulin-producing cells, but we don’t know why. One theory is that the immune system is triggered by something else – say, a virus – and then accidentally also attacks insulin-producing cells. It could be that COVID is causing some people’s immune systems to do just this.

Not so fast

Just because it appears people who have had COVID are more likely to develop diabetes, and there are plausible theories to explain this, it still doesn’t necessarily mean COVID causes diabetes.

It could be that COVID is causing temporary rises in blood sugar, that then resolve over time. A US study of 594 people newly diagnosed with diabetes while hospitalised with COVID found that blood sugar levels often returned to normal after discharge from hospital, without treatment.

We also know that dexamethasone – a steroid used to treat people with severe COVID – causes temporary rises in blood sugar.

Some scientists have questioned whether COVID is causing a new type of diabetes altogether, or whether people are being mistakenly classified as having diabetes after COVID. 

Further, a lot of diabetes tends to go undetected, especially type 2. It could be that people who are diagnosed with diabetes after having COVID actually had diabetes before getting COVID, but that the diabetes wasn’t picked up until they were being treated for COVID.

Rising levels of diabetes could also reflect an impact of pandemic restrictions, or changed behaviour as a result of infection or fear of infection, including delayed medical care and changes in diet and physical activity levels.

The four Ts

Type 2 diabetes tends to develop slowly over time, and even type 1 diabetes can take months to years to show up. So it’s likely to be some time before anyone can say definitively if COVID is leading to an increase in diabetes.

Regardless, it’s really important that people be aware of the signs and symptoms of this condition. Diabetes UK tells us to look out for the four Ts: toilet (going to the toilet a lot or wetting the bed), being thirsty, tired, and thinner. These are typical symptoms of type 1 diabetes. For type 2, a lot of people don’t get symptoms, or don’t notice them. However, the four Ts still apply, with blurred vision and general itching or thrush also listed as symptoms. 

If you suspect you or a family member may have diabetes, don’t delay seeking medical attention. A quick finger prick test by a healthcare provider can determine immediately if your blood sugar is high, and whether further investigations might be needed.

https://theconversation.com/people-whove-had-covid-appear-more-likely-to-develop-diabetes-heres-why-that-might-be-180211