Diabetes and COVID-19: a particularly at-risk group and some tips
While the risk of being infected with coronavirus is the same for everyone, the consequences for people with diabetes could be much more severe
The British Diabetes Association (Diabetes UK) one of the most highly regarded institutions in the world’s diabetes field, sustains that anyone with diabetes, whether type 1, type 2 or gestational, is at risk of developing a serious disease if they catch the infection, although in the end the way in which each patient may be affected will vary from person to person… so how does anyone else? Well, no, like anyone who doesn’t have diabetes, no.
Everything points to the fact that the group of people with diabetes seems to be particularly sensitive, not so much because of the probability of being affected by the coronavirus infection, but probably because of suffering greater complications once infected. And even for having a significantly higher probability of death in relation to the general population without diabetes. Or at least that seems to be the case from the epidemiological data of a disease with which we have only been living for 4 months.
Still a theory, but it could be feasible
A very recent publication in The Lancet on the most common comorbidities of people who have died in China from COVID-19 echoes three studies conducted to date:
- The first, in a group of 52 patients admitted to intensive care units, 22% of them had diabetes.
- The second, out of a total of 1099 patients with confirmed disease, of which 173 had more severe symptoms, 16.2% had diabetes mellitus.
- The third, of 140 patients admitted to hospital with COVID-19, 12% had diabetes.
In fact, these three studies have shown that patients with the most frequent comorbidities associated with the most severe cases and deaths from COVID-19, i.e. patients with diabetes or hypertension, are frequently treated with drug therapy (for their diabetes or hypertension) based on the use of angiotensin converting enzyme (ACE) inhibitors. It is a known fact that this type of drug, ACE, promotes an increase in the expression of a family of enzymes that are precisely those proteins used by the SARS-CoV-2 virus to bind to target cells. Therefore, it has been proposed – and I emphasize this expression of “it has been proposed” – that the use of pharmacological strategies based on ACE for the treatment of diabetes or other foods could negatively affect these patients who, for this reason, could be victims of severe consequences derived from infection by this or other pathogenic coronaviruses in humans.
In addition to the theoretical problems, other more real ones
The fact is that patients with diabetes face two particularly complicated scenarios when faced with COVID-19. Both refer to the increasing difficulty in controlling blood glucose, the first only in the case of people with diabetes who have been infected, and the second, which will affect all patients, derives from the situation of universal confinement to which the entire population is subject.
In the case of infection by COVID-19 -or by any origin- one of the responses to situations of metabolic stress consists of an increased release of glucose into the bloodstream. The added problem in cases of diabetes is that, as is easily predicted, this increase in blood glucose will not be managed in the same way as in non-diabetic patients, and will lead to a sustained increase in blood glucose values. The British Diabetes Association explains in this link how to manage diabetes when you are sick in any circumstance.
In relation to the confinement situation, we cannot forget that in most cases this will mean a reduction in the possibilities of being active. Let us not forget that physical activity is one of the most powerful tools with which to face both the risk of suffering from diabetes, and the same once it has been diagnosed.
Staying active without leaving home, which is a new situation (as it is for most of the diabetic population or not) is a challenge. However, we have consulted with Jorge Garcia Bastida, a physical trainer, who has offered us some alternatives for more basic levels: