Effects of COVID-19 On Diabetes Patients

A dangerous combination: Diabetes and COVID-19 call for extra vigilance

A woman getting her diabetes levels checked by a healthcare professional


A dangerous combination: Diabetes and COVID-19 call for extra vigilance

While there is still much to learn about COVID-19, doctors and researchers say data is showing COVID-19 and diabetes can be a dangerous, or even deadly, combination. This makes it especially important for those with diabetes to be vigilant when it comes to following COVID-19 precautions, say two BJC experts.

While having diabetes doesn’t seem to raise the risk of becoming infected, it does put people at a higher risk of developing complications if they do contract COVID-19, according to Robert Saltman, MD, and Suppraja Reddy, MD. Dr. Saltman is an internal medicine physician specializing in endocrinology at Barnes-Jewish West County Hospital. Dr. Reddy is a BJC Medical Group endocrinologist at Christian Hospital.

“Data is showing us that COVID-19 patients with diabetes are unequivocally at high risk for complications and, in the most severe instances, death,” says Dr. Saltman.

Although researchers haven’t pinpointed the exact reasons, they do have some theories.

People with diabetes are more likely to have comorbidities — or additional medical conditions — like obesity, heart disease, chronic kidney disease, lung disease and advanced age that have definitely been found to increase the risk of serious complications from COVID-19, Dr. Saltman says.

Becoming infected with any virus can be dangerous for people with diabetes, especially those who don’t manage their condition well, says Dr. Reddy. Poor diabetes management often results in fluctuating blood sugars, which can lead to or worsen comorbidities, making patients more vulnerable. Dr. Saltman adds that retrospective studies confirm that poor control of diabetes before being admitted to the hospital for COVID-19 is associated with a high risk of in-hospital death.

Dr. Reddy continues, “Viral infections can also increase inflammation, or internal swelling, in people with diabetes. This is also caused by above-target blood sugars, and both could contribute to more severe complications.”

The disease itself also presents its own risks for COVID-19 patients. People with diabetes are at an increased risk for chronic inflammation and blood clots, both identified as risk factors for COVID-19 complications, Dr. Saltman says.

COVID-19 also can worsen some complications of diabetes. COVID-19-infected patients are at higher risk of diabetic ketoacidosis — a dangerous build-up of acids called “ketones” in the blood. In addition, steroids used to treat COVID-19 can push blood sugar levels dangerously high.

There’s not enough data yet to tell if having type 1 diabetes, sometimes called “juvenile diabetes,” or type 2 diabetes makes a difference in how a particular person responds to becoming infected with COVID-19, Dr. Saltman and Dr. Reddy agree.

“But, it’s important to remember that people with either type of diabetes can vary in their age, complications and how well they have been managing their diabetes,” says Dr. Reddy. “People who already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have.”

What is clear is that people with diabetes can lower their risks from COVID-19 by strictly adhering to the CDC guidelines on wearing masks, social distancing and handwashing, as well as controlling their blood sugar levels and getting exercise.

Dr. Saltman’s diabetic patients seem to be taking this warning to heart, he says. Of the patients in his practice who have had COVID-19, none were diabetes patients.

“Perhaps,” he says, “they are simply being more careful.”

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