Is everyone with diabetes at high risk from COVID-19, or does it depend on your individual circumstances?‍

Research is starting to show that people with diabetes are more at risk from COVID-19. But SARS-CoV-2, the novel coronavirus that causes COVID-19, can affect people very differently. Some have no symptoms at all, while others can develop life-threatening complications. 

We spoke to our expert, Dr Paul Franks from Lund University Diabetes Centre in Sweden, to find out more about how COVID-19 affects people with diabetes, and what people with diabetes can do to protect themselves during the pandemic.‍

What are the risks for people with diabetes from COVID-19?‍

‍Early reports suggest that people with diabetes are at increased risk from severe complications of COVID-19.

“Data from China says that about 20% of the hospital admissions for COVID-19 were people with diabetes, which is considerably higher than the background proportion, meaning that people admitted to hospital tended to be more likely to have diabetes than we would expect,” explains Paul. ‍

Studies from China also report that around 7% of patients with COVID-19 and diabetes died from the disease, compared with 2% of the general population, suggesting that people with diabetes suffer worse outcomes from COVID-19 than the general population. ‍

Are people with Type 1 and Type 2 diabetes affected differently by coronavirus?‍

There are two main types of diabetes: Type 1, which affects fewer than one in 10 people with diabetes, and Type 2, which accounts for 90% of cases. Both conditions lead to problems with controlling the levels of sugar in the body, but they have different underlying causes.

“It's probably not the case that everybody with diabetes is at the same level of risk. There will be some people with diabetes who are at relatively low risk of adverse outcomes from COVID-19 and others who are very high risk,” says Paul.  ‍

Reports from Stockholm over the last month suggest that Type 2 diabetes is more common in patients developing severe COVID-19. And data from New York also suggests that people who were hospitalised with COVID-19 were more likely to have Type 2 diabetes. 

The correlation could also be due to other factors such as age, weight, high blood pressure and ethnicity, which affect the risk of developing Type 2 diabetes as well as the chances of becoming severely ill from COVID-19. 

For example, people who are very overweight are much more likely to develop Type 2 diabetes than those who maintain a healthy weight. And those who are obese are more likely to suffer severe symptoms of COVID-19 and end up in hospital, particularly younger people under the age of 60.‍

More research is needed to understand how all these risk factors interact together. ‍

Are people with diabetes more likely to catch COVID-19?‍

Even in highly-contained environments infected with coronavirus, like the Diamond Cruise ship and infected Navy ships, some people on board never developed the disease. But right now we don't fully understand why some people catch the virus while others don't, or why some people can be infected but never show any symptoms at all (known as asymptomatic infection).

“Many people have caught coronavirus and don't know it because they're asymptomatic, so it can be difficult to study how many people really catch the disease,” says Paul.

“Right now it’s not clear whether people with diabetes are more likely to catch COVID-19 in the first place. But the evidence suggests that people with diabetes are more likely to be symptomatic.”

If you’d like more in-depth information, Paul and his colleagues have recently published an overview of what we know so far about COVID-19 and diabetes in the scientific journal Diabetes Care. ‍

How people with diabetes can protect themselves during the pandemic‍

The NHS, health authorities, and charities have developed guidelines for people with diabetes during the pandemic. Guidance may vary depending on your individual circumstances, so it is essential to discuss your situation with your care team. But in general, if you have diabetes you can protect yourself by: 

• Maintaining good control of your blood glucose levels - studies suggest that properly-controlled blood sugar levels might improve the chances of surviving COVID-19 and avoiding invasive treatments like ventilation.
• Reducing the risk of catching coronavirus by following social distancing advice and staying at home as much as possible
• Maintaining good levels of hygiene and frequent hand washing
• Eating healthily and taking regular physical activity
• Getting influenza and pneumonia vaccinations when they are offered to you, to reduce the risk of catching a second infection on top of coronavirus
• Checking in with your healthcare team to discuss your treatment plan and the risks and benefits of any medications you are taking
  

What to do if you have diabetes and get COVID-19‍

Being sick can make it difficult to control your blood sugar levels, making your diabetes harder to manage and increasing your risk of developing complications.  As a result, if you catch coronavirus, it's crucial to talk to your diabetes care team for advice. 

Follow the ‘sick day rules’ to help you manage your condition if you fall ill with COVID-19 - they are different depending on whether you have Type 1 or Type 2 diabetes.‍

How your data can help us understand diabetes and COVID-19‍

Information about COVID-19 is changing almost daily as we continue to learn about the virus and how it interacts with other conditions like diabetes. But we still need a lot more research into how the type, duration and treatment of diabetes affects COVID-19 outcomes. ‍

Our COVID Symptom Study app is collecting data about how COVID-19 is affecting people with diabetes in the UK, US, and Sweden. You can see the data we have collected so far on our website. 

We’re researching how COVID-19 interacts with diabetes and other health conditions so that we can help to improve health advice and redirect resources to where they are needed most, to help save lives.‍

Diabetes and COVID-19 - what do we know so far?‍

• People with diabetes are more likely to suffer severe effects from COVID-19, particularly if they are very overweight and/or have high blood pressure
  
• COVID-19 is so new that we don’t have much information about how it affects people with different types of diabetes
• Some people with diabetes may be at higher risk than others, depending on the type of diabetes they have, the medication they take and many other factors
• Our COVID Symptom Study app is collecting information about how COVID-19 affects people with diabetes, helping us to learn more about how both diseases interact and identify who is at high risk
  

Find out more:

• COVID-19 in People With Diabetes: Urgently Needed Lessons From Early Reports - Diabetes Care
• Diabetes Is a Risk Factor for the Progression and Prognosis of COVID-19 – Diabetes Metabolism Research & Reviews
• Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention - JAMA
• Diabetes in COVID-19: Prevalence, Pathophysiology, Prognosis and Practical Considerations – Diabetes & Metabolic Syndrome
• COVID-19 and Diabetes: Knowledge in Progress – Diabetes Research and Clinical Practice
• COVID-19 and diabetes – EASD e-Learning resources for healthcare professionals treating people with diabetes
• We know you have questions. We have answers – American Diabetes Association
• Coronavirus: I have diabetes, am I at a greater risk? – Diabetes.co.uk
• Updates: Coronavirus and diabetes – Diabetes UK
• Diabetes UK issues latest guidance on coronavirus – Diabetes Times