High-Risk: Diabetes in the time of Coronavirus

Piatt: There's really not enough data right now to show that people with diabetes are more likely to get COVID-19 than the general population. But the problem that people with diabetes face is a problem of worse outcomes if they do contract the virus.

Speaker 1: According to the American Diabetes Association, more than 34 million Americans have diabetes. That's one out of every 10 people. Chances are you probably know someone with diabetes and managing their condition puts them at higher risk should they contract coronavirus. But what does high risks exactly mean? And what can we do to keep this large population of Americans safe throughout this pandemic?

Hello and welcome to Population Healthy, a podcast from The University of Michigan School of Public Health. This episode is part of a series of special editions of our podcast, focusing on the ongoing coronavirus pandemic. Gretchen Piatt, is an associate professor and the associate chair for education within the Department of Learning Health Sciences at the University of Michigan Medical School, as well as an associate professor of Health Behavior and Health Education in the School of Public Health. As a chronic disease epidemiologist, she specializes in healthcare issues around diabetes. We spoke with her about why people with diabetes are deemed a high-risk population during the COVID-19 pandemic and the unique risks these people are facing.

Piatt: The data coming out of China shows us that people with diabetes had much higher rates of serious complications and death than people without diabetes when they did contract the virus. So in general, the more health conditions or illnesses that you have, the higher the chance of getting serious complications from COVID-19.

People with diabetes, unfortunately, usually don't just have diabetes - they very much have a slew of other chronic illnesses. So it's very typical for someone with diabetes to have heart disease in addition to the diabetes, they may have high blood pressure, they may have asthma. It's very likely that they have multiple chronic illnesses. 

If you have multiple chronic illnesses, your body doesn't fight infection the way a healthy body would normally fight infection, so it's just not as strong. So therefore, if someone with diabetes and one or two other chronic illnesses contract COVID their body isn't going to be as strong to fight the ramifications of COVID.

The number one most important thing for people with diabetes to keep in mind is that they absolutely need to monitor their blood sugars and try the best they can to keep their blood sugar under control. The risk of getting really, really sick from coronavirus is likely to be lower if your diabetes is well managed. If your blood sugars are constantly fluctuating, that inevitably makes your risk for diabetes complications go up. Any viral disease, but particularly coronavirus in this case, also increases inflammation in people with diabetes. So that's internal swelling within the body, and this is also caused by above target blood sugar levels. So more inflammation, more fluctuation of blood sugar levels, more severe complications, all lead to worse outcomes, from COVID-19.

Another thing that I wanted to point out is actually people with diabetes who have been laid off from their jobs, I think that this could pose a really difficult issue for them because of lack of healthcare coverage. So in the event that someone would lose their job and say I wasn't eligible for unemployment or maybe they're unemployment is running out, their healthcare coverage would come into question. And then that becomes a big issue with continuing to get those meds and continuing to get those supplies like testing strips.

My recommendation to them would be, if you have been laid off and you're worried about your healthcare coverage, one option is to apply for Medicaid if that's something that's feasible, But also to just try your best at the beginning to stock up on your medications and syringes if you need them, while you still may have insurance.

Speaker 1: Many people with diabetes put a lot of work into managing their disease every day. There's a delicate balance between reliance on certain systems to deliver care and on their own choices. As the world is up-ended, that balance may be threatened.

Piatt: Right now, manufacturers are reporting that COVID-19 is not really impacting manufacturing and distribution capabilities of things like insulin and other supplies. So that's a good thing. Access to insulin and to their meds is not in danger as long as they could get to the pharmacy or the pharmacies could deliver it to the house. In terms of grocery stores and being able to get out and get what you need.

Preparing healthy food - that could become a bit of an issue. I think it's the same for the general population as it is for people with diabetes. Just people are tending to maybe go to the store once a week or every two weeks and stock up on a bunch of things to cook. And a lot of times those things that they're stocking up on maybe aren't necessarily the healthiest. People may be eating more carbs than usual, more fat than usual. So it's something for people with diabetes to keep an eye on because their blood sugars are very, very dependent on the types of foods that they eat.

I would probably recommend some sort of routine, like they would have if we weren't all isolated at home. Trying to make thoughtful choices about the meals, about the snacks. As difficult as it is, try not when you're at home to have a piece of candy or left over piece of pizza or something like that. So that would be my suggestion for the people who are feeling like they just want to give themselves a break with the regimen.

We're tending to see this a lot in the research that I do - my research is focused on African-Americans with diabetes and Detroit and Flint and Toledo and Ypsilanti - and in our calls with them since this has all happened with the pandemic, people really seem to be feeling pretty good and pretty healthy and I'm so grateful for that. Maybe people being at home, it's giving them the time to make a decent meal, rather than running from this place to that place to this place and stopping and getting fast food along the way for lunch. It's sort of grounding them a little bit in healthier choices around meals.

Speaker 1: While all of us adjust to life in isolation, the burdens of managing a chronic disease like diabetes can compound the stress that many of us already feel.

Piatt: Mental health in people with diabetes is a very, very important topic to talk about, and we know from the literature and from research that people with diabetes experience significant levels of diabetes-related to distress. It varies a lot in terms of the different things that people with diabetes experience and the mental health issues that people with diabetes experience. During this time of COVID-19, that's even exacerbated more. Not only is there this worry about managing the diabetes, there's this worry about being more at risk for COVID-19 because you have diabetes.

We also know from the literature that a support network that’s strong really helps people with diabetes to manage it more effectively. And in the time of COVID-19 and stay at home orders, then social distancing, that support network really becomes limited unfortunately. At least I would say face-to-face support. If people can use things like video conference call software like Zoom or even if people wanna FaceTime each other, it's so so important because a lot of times our closest and most important support people are those outside of the home.

Speaker 1: So if you or a loved one have diabetes, what do you need to do to be safe? And what should you do if you think someone with diabetes has contracted the coronavirus?

Piatt: The number one thing to do first is to call your doctor and let them know what your symptoms are. Even if it's just the scratchy throat, or maybe you think that it's allergies, just call the doctor and let them confirm whether or not you should be seen. Use them as the gauge to taking it one step further and going to the hospital or going to the testing site, or whatever. So first and foremost, call your doctor.

My biggest device for caregivers, especially if the caregiver is a family member or someone living in the household, would be to treat the person with diabetes like you have COVID or that you're a significant risk to them I should say. That means doing all of the things that the federal agencies and state agencies recommend - making sure you wash your hands before feeding them or help giving them an insulin shot etcetera, or caring for them. If it's possible, a lot of people with diabetes would benefit from a sort of a protected space in their house just so that everything that’s in that space is disinfected, it's clean, it's cleaned regularly.

My advice for people in a household where a person of the household might contract COVID-19 would definitely be to give them their own room and keep the door closed, for sure. This is particularly important for people over the age of 65 with diabetes because that's sort of like a double-edged sword. Not only are they more at risk because of the complications and fluctuating blood sugars and all of those things that come with diabetes, we know that people over the age of 65 are particularly at risk for contracting COVID.

I think we're going to see this coming out more and more in the news and in the research literature, is that unfortunately this pandemic has demonstrated a lot of disparities in the health care system in terms of racial and ethnic minority groups that seem to be contracting the illness. It's not that certain racial and ethnic groups contracted it at higher rates than others, but it seems to be that in areas that are sometimes under-served people don't tend to fare as well.

It's an area that I believe is going to receive more attention as time goes by and it just demonstrates that once this is all said and done we need to pay a lot of attention to these types of disparities within health systems.

Speaker 1: This has been a special edition of Population Healthy, a podcast from the University of Michigan School of Public Health. During the ongoing coronavirus pandemic, we’ll work to bring you analysis from our community of experts to help you understand what this public health crisis means for you. To stay up-to-date in between special edition episodes, be sure to check out our website publichealth.umich.edu, subscribe to our Population Healthy newsletter at publichealth.umich.edu/news/newsletter and follow us on Twitter, Instagram, and Facebook @umichsph.