Global expert on flourishing with diabetes and international inspirational speaker. Living with type 1 diabetes 48 years.
By Riva Greenberg
There’s a large UK study (2 million people) under peer review that’s gaining traction on social media. Why? Because it defies our - already overtaxed mental states - of what’s possible.
“Covid-19: people with type 1 diabetes more likely to die than those with type 2.” (https://www.theguardian.com/society/2020/may/20/type-1-diabetics-type-2-coronavirus-nhs-study?fbclid=IwAR3CA7ppQuf9r1lzVgb37tiym-mbQd-Z2RyZcmuci0NmGJp4BGBq2z09nME). This is how The Guardian, among other publications, headlined it.
NHS (United Kingdom National Health Service) research reports that people with type 1 diabetes are at 3.5x higher risk for death if they get COVID-19 than people without diabetes. In contrast, people with type 2 diabetes are twice as likely to die as people without diabetes.
Surprised? I was. And even though the research is currently being reviewed, and nothing’s yet been proven, the data has a strong statistical basis.
If you’re curious what all this means, I can share with you information I’m privileged to have access to. I am part of a team of global diabetes experts - MDs, researchers, scientists, heads of the university, and hospital departments. The group was formed a few months ago under the leadership of Professor Itamar Raz, diabetologist and former head of Israel’s national diabetes health policies and Guang Ning, Head of Shanghai Clinical Center for Endocrine and Metabolic Disease.
The team is digesting a barrage of information, sharing their expertise and experiences and brainstorming prevention and treatment guidelines that they can safely, and quickly, recommend to health professionals and the public.
Unnerved by The Guardian article, I reached out to the group immediately. Philip Home, Emeritus Professor at Newcastle University, UK responded within an hour. It was 10:30 PM in the UK.
Here’s what I can tell you with the proviso, as Home emphasizes, that currently this research presents an interpretation of the data, which is dependent on a rapidly changing situation in the UK. This means its application to other people, in other circumstances, is not easy - medicine is as much art as it is science. And, it’s hard to know whether there have been any population and/or calculation errors. For instance, some people with type 2 diabetes on insulin may have been incorrectly counted as type 1s.
Below (in italics) is a summary from my email exchange with Professor Home.
Those Not Necessarily at Higher Risk
This comment is currently a hypothesis, but we do think people who have no evidence of vascular damage, no retinopathy, no albuminuria (including microalbuminuria) and no cardiovascular disease, are likely not at greater risk to be hospitalized or die if they get COVID-19 than people without diabetes.
Further, if one’s blood sugar is also well managed, A1c under 7.5%, they are probably at no greater risk of getting COVID-19 in the first place than someone without diabetes.
Those at Higher Risk for Poorer Outcomes
People who have type 1 diabetes who show evidence of vascular damage, should they get COVID-19, would be at higher risk of severe outcomes including hospitalization and death. The risk for vascular damage is higher the longer you’ve had diabetes, particularly if glucose levels have been high.
Further, if you have poor glucose management you may be at greater risk to contract the virus.
People can check with their health professionals whether their markers that indicate vascular damage are in range, that includes CRP, HDL cholesterol, triglycerides, and liver enzymes (ALT). They can also check if they have any albumin leakage through the kidney. Also, they can check with their eye professional whether they have any retinal damage.
Understanding that this is a vascular issue and that vascular damage increases risk for comorbidities such as cardiovascular disease, I better understand why it’s possible someone with longer duration type 1 diabetes, who gets COVID-19, may be at higher risk for worse outcomes than someone with type 2 diabetes.
What else can you do now to protect yourself should you get COVID-19?
First, don’t panic. As Home says the data is not yet in. Second, use this time to build your nutritional and metabolic health. In other words, follow the common recommendations:
Do your best to keep your blood sugar in target range
Eat as healthily as you can - vegetables, whole, not processed foods, some fruit, dairy if you can tolerate it, beans, seeds, nuts, healthy fats
Be active, even if you’re in lockdown
Like everyone, diabetes or no diabetes, wear a mask when out in public, stay six feet away from others and wash, wash, wash your hands. My personal prescription includes using those clean hands to then pour a glass of antioxidant-rich red wine.
Note - I wish to gratefully acknowledge Professor Home who responded to my query immediately, answered my questions, lowered my stress level and helped me interpret the medical data.