Why people with diabetes are still at risk from COVID- 19

Some days, we seem to consider the COVID-19 pandemic history as we plunge into mask-less shopping, in-person meetings, and hugs from friends.

But the virus remains a high risk for many, particularly people with diabetes. The most common form is Type 2 diabetes, which is triggered by insulin resistance, often later in life. Type 1 diabetes is an autoimmune disorder and, while rarer, usually attacks children and teens, according to the U.S. Centers for Disease Control. The CDC estimates that among patients hospitalized with severe COVID-19 complications, 39.7 percent also had diabetes as an underlying medical condition. The percentage increased to 46.5 percent for patients ages 50 to 64. Other studies have shown that post-COVID patients are more likely to develop Type 2 diabetes.

“Even before COVID, people with diabetes were at higher risk of things like influenza, pneumonia and fungal infections,” said Sheila Maier, DO, an endocrinologist with the Endocrine Center of Hyannis. “We think that the risk is related to both having diabetes and how well the diabetes is controlled, but it is still an open question.”

In 2019, about 6.4 percent of adults in Barnstable County reported a diagnosis of diabetes, mostly Type 2, a rate slightly lower than the state average of 7.7 percent, according to data collected by the U.S. Centers for Disease Control. But the county rate has been inching up since 2015. And, Dr. Maier says doctors are seeing an increasing number of people under 35 with diabetes, putting them at greater risk for all kinds of infections.

“When people have an infection, the body releases proteins called cytokines, messengers that convey instructions to cells to create an immune response to a virus or bacteria,” she said. But the inflammation caused by diabetes complicates things and may make the immune system release too many cytokines that then damage vital organs, according to a report in The New York Times.

“People with diabetes have this low-grade inflammation,” Dr. Maier said. “When they get an infection, the immune system can’t respond as well, which may be what leads to more severe infections in people with diabetes.”

One way to reduce the risk is to be diligent about diet, exercise, monitoring blood sugar levels and taking diabetes medications. Patients with higher blood sugar levels and a higher score on the A1C test that measures blood sugar, are more vulnerable, she said. Dr. Maier also recommend age-appropriate vaccines, including influenza and COVID vaccines for her patients with diabetes.

“I think with the Omicron variant, people got a little bit down on the vaccines because you had so many people who had been vaccinated who then got sick. But the key point is that most got mildly sick. They didn’t get into the hospital or were severely ill.

“A vaccine is like a seatbelt,” she said. “You can’t go back and buckle your seatbelt later if it turns out you needed it.”

Anyone with diabetes who tests positive for COVID-19 should check with their doctor to see if they qualify for treatments such as Paxlovid or monoclonal antibodies, she said.

There is some progress being made in Type 2 diabetes treatment, Dr. Maier said. In May, the U.S. Food and Drug Administration approved a new class of medication called tirzepatide, a twice-weekly injection meant to be used in conjunction with dietary changes and weight loss. The FDA ruled the drug was “more effective” than other diabetes therapies to which it was compared in drug trials.

That said, diabetes remains a risk for millions of Americans, and still remains somewhat of a mystery, Dr. Maier said. For example, doctors don’t know why some people with high blood sugars develop vascular or kidney complications and some don’t.

“It’s really a multifaceted disease and it causes a lot of complications,” she said. “There is a lot we don’t know about the whys of diabetes and why it affects some people more than others.”