Perspectives on Diabetes Care

COVID-19: Risky Business for People With Diabetes?

Mar 12, 2020, 17:10 PM

by Melissa Young, PharmD, RPh, BC-ADM, CDE

As diabetes care and education specialists, we were working our way through the 2019-2020 influenza season focused on motivating people with diabetes to get the flu vaccine, when in December 2019, reports of a new coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), outbreak in Wuhan, Hubei Province, China, began to appear in the media. To date, the resulting disease, COVID-19, is responsible for over 124,000 infectious cases and 4,600 deaths spanning 118 countries/territories.¹   

Chronic hyperglycemia can negatively affect immune function and increase risk of morbidity and mortality due to infection and associated complications.² During the Influenza A (H1N1)p pandemic, the presence of diabetes tripled the risk of hospitalization from Influenza A (H1N1)p infection and quadrupled the risk of ICU admission once hospitalized. Fasting PG and diabetes are independent risk factors for complications and death from SARS.  Seasonal flu poses a severe risk to people with diabetes as discussed in a previous blog and the vaccine can provide many benefits, including secondary cardiovascular risk reduction, especially in those with high-risk CVD.  

What is the risk for people with diabetes who have contracted COVID-19? Among 26 fatality cases in Wuhan, China, major comorbid diseases were hypertension (53.8%), diabetes (42.3%), CHD (19.2%) and cerebral infarction (15.4%).³ As with seasonal influenza, new abstract data associated COVID-19 with potentiating myocardial damage and identified underlying CHD as a risk factor for critical complications.⁴ 

Among the confirmed COVID-19 cases in China as of Feb 11, 2020, the case fatality proportion was reported at 2.3%. However, the measure included a large portion of hospitalized patients.^5,6 Among persons with no underlying medical conditions, the case fatality was 0.9%, but severely increased with the presence of comorbid diseases, including CVD (10.5%); diabetes (7.3%); chronic respiratory disease, hypertension and cancer, each at 6%. Among those 60 years and older, the case fatality proportions were 14.8% (80+ years); 8% (70 to 79 years) and 3.6% (60 to 69 years). Compared to patients not admitted to the ICU, critically ill patients were older (median age 66 years vs. 51 years) and suffered from underlying medical conditions (72% vs. 37%).⁷

Data will be further validated as time progresses. As of now, it indicates that individuals living with diabetes should be prepared to protect themselves from COVID-19 as they are at high risk for severe complications, especially with the presence of additional comorbid conditions and increasing age. As diabetes care and education specialists we should remind our clients about sick day management rules and to prepare sick day kits. For more tips, visit DiabetesEducator.org/COVID19.  

References:

1. World Health Organization Novel Coronavirus (COVID-19) Situation Webpage. https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd. Updated March 12, 2020. Accessed March 12, 2020.
2. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16 Suppl 1(Suppl1):S27–S36. doi:10.4103/2230-8210.94253
3. Deng S-Q, Peng H-J. Characteristics of and Public Health Responses to the Coronavirus Disease 2019 Outbreak in China. Journal of Clinical Medicine. 2020; 9(2):575.
4. Chen C, Chen C, et al. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. https://www.ncbi.nlm.nih.gov/pubmed/32141280#. Abstract. 2020 Mar 6;48(0):E008. [Epub ahead of print] 
5. Novel Coronavirus Pneumonia Emergency Response Epidemiology Teamexternal iconexternal icon. [The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–151. DOI:10.3760/cma.j.issn.0254-6450.2020.02.003.
6. Center for Disease Control and Prevention. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html#foot09. Webpage. Last updated. March 7, 2020. Accessed March 12, 2020.
7. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. Published online February 07, 2020. doi:10.1001/jama.2020.1585

About the Author:

Dr. Melissa Young is a clinical pharmacist with 20-years of experience in diabetes education and management. She is a certified diabetes care and education specialist and has earned a board certification in advanced diabetes management. She specializes in the treatment of adults with complex diabetes and metabolic disorders while providing chronic disease management services for veterans. Dr. Young holds a teaching affiliation with the University of Utah and leads a national committee for the American Association of Diabetes Educators. Her current interests include opioid safety, disease prevention, and matters related to healthcare policy.

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ADCES Perspectives on Diabetes Care

The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.

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HEALTHCARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit DiabetesEducator.org/Find.