Pandemics Collide: COVID-19 and Diabetes
Samantha Harmon, MS, RDN, LDN May 25, 2021

Emerging research shows COVID-19 may trigger diabetes in some individuals. Just over 1 in 10 Americans have diabetes,1 costing the United States $327 billion annually.2

These numbers are staggering and increasing year over year, making diabetes a pandemic.3 Sadly, another pandemic, COVID-19, is driving these numbers even higher. Read on to learn how these two pandemics are colliding.

COVID-19 Risk in People with Diabetes

Those with preexisting diabetes are at higher risk for severe complications from COVID-19 than the general population. This is to be expected, as infectious diseases are associated with worse outcomes in patients with diabetes.4

Research on 7,162 people in the United States with COVID-19 showed individuals with diabetes made up 6% of those not hospitalized, 24% of those hospitalized but not requiring ICU admission, and 32% of those admitted to the ICU.5 Another study showed diabetic patients were 65% more likely to die from COVID-19 than non-diabetic patients.6 In addition, getting COVID-19 increases the risk for diabetic complications like diabetic ketoacidosis (DKA).

Why are patients with diabetes more at risk for severe COVID-19 complications? Many believe it has to do with how diabetes affects the immune system.7 High blood sugar weakens the immune system, and over time, uncontrolled diabetes causes inflammation, which also affects the immune system.7 In fact, research shows that those with well-controlled blood sugar levels have higher rates of COVID-19 survival.8

COVID-19 Triggering Diabetes

New research on COVID-19 survivors is discovering they have an increased risk for developing diabetes. A study on the Department of Veterans Affairs national healthcare database found a 39% increased risk of being newly diagnosed with diabetes in the six months after having COVID-19.9

A systematic review on 3711 COVID-19 patients found 14.4% had newly diagnosed diabetes.10 With this being a new phenomenon, researchers and physicians are still speculating on why COVID-19 is triggering diabetes.

A leading theory is that the virus or the body’s response to the virus may damage the pancreas, which makes insulin.11,12 The lockdown may also be to blame because it caused a more sedentary lifestyle, and some people chose to avoid the doctor’s office.

Lastly, COVID-19 may merely unmask diabetes that went undiagnosed,12 as 7.3 million Americans live with undiagnosed diabetes.1

 

Managing COVID-19 and Diabetes

To help manage this crisis, everyone needs to continue to do what they can to reduce the risk of catching COVID-19.  That includes:

  • Getting vaccinated
  • Avoiding large gatherings
  • Wearing a mask
  • Maintaining a distance of 6 feet from others
  • Staying at home when possible

Those with diabetes or at risk for developing diabetes should also work to maintain their health despite social distancing for COVID-19. Strategies include:

  • Attend all medical appointments, making virtual appointments when possible
  • Exercise regularly at home
  • Maintain a healthy diet
  • Monitor blood sugar and maintain goal levels
  • Take medications prescribed

Anything we can do to maintain healthy lifestyles during this time will improve health outcomes and decrease the risk of severe complications from COVID-19 and diabetes.

 

References

  1. National Diabetes Statistics Report, 2020. Centers for Disease Control (CDC). https://www.cdc.gov/diabetes/data/statistics-report/index.html
  2. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. https://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007. Published March 21, 2018. Accessed May 7, 2021.
  3. Venkat Narayan KM. The Diabetes Pandemic: Looking for the Silver Lining. Clinical Diabetes. Apr 2005, 23 (2) 51-52.
  4. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012 Mar; 16 Suppl 1():S27-36.
  5. N. Chow, K. Fleming-Dutra, R. Gierke et al., Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019—United States, February 12–March 28, 2020, Morbidity and Mortality Weekly Report, vol. 69, no. 13, pp. 382–386, 2020.
  6. Palaiodimos L, Chamorro-Pareja N, Karamanis D, et al. Diabetes is associated with increased risk for in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis comprising 18,506 patients [published online ahead of print, 2020 Oct 29]. Hormones (Athens). 2020;1-10. doi:10.1007/s42000-020-00246-2
  7. Gerui Li, Ze Chen, Zhan Lv, Hang Li, Danqi Chang, Jinping Lu, "Diabetes Mellitus and COVID-19: Associations and Possible Mechanisms", International Journal of Endocrinology, vol. 2021, Article ID 7394378, 10 pages, 2021.
  8. L. Zhu, Z.-G. She, X. Cheng et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metabolism, vol. 31, no. 6, pp. 1068–1077, 2020.
  9. Al-Aly, Z., Xie, Y. & Bowe, B. High-dimensional characterization of post-acute sequalae of COVID-19. Nature (2021).
  10. T. Sathish, N. Kapoor, Y. Cao, R.J. Tapp, P. Zimmet. Proportion of newly diagnosed diabetes in COVID-19 patients: a systematic review and meta-analysis. Diabetes Obes Metabol (2020).
  11. Sathish T, Tapp RJ, Cooper ME, Zimmet P. Potential metabolic and inflammatory pathways between COVID-19 and new-onset diabetes. Diabetes Metab. 2021;47(2):101204. doi:10.1016/j.diabet.2020.10.002
  12. Accili, D. Can COVID-19 cause diabetes?. Nat Metab 3, 123–125 (2021).

About the Author

About the Author

Samantha is a registered dietitian nutritionist and Nutrition Programs Manager at Base10 Genetics. She created a nutrition genomics program that combines nutrigenomics, dietitian coaching, and behavior science.

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Nutrigenomics
Covid-19