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.