UK Study Under Review Finds People With Type 1 Diabetes More at Risk to Die of COVID-19 Than People With Type 2 Diabetes

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.” 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:

  1. Do your best to keep your blood sugar in target range
  2. Eat as healthily as you can – vegetables, whole, not processed foods, some fruit, dairy if you can tolerate it, beans, seeds, nuts, healthy fats
  3. 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.

Source: diabetesdaily.com

The Impact of COVID-19 on African Americans

This content originally appeared on Beyond Type 1. Republished with permission.

By T’ara Smith

Think the coronavirus is the “great equalizer”? Think again. New data on the deaths from coronavirus shows the pandemic is impacting communities of color, specifically African-Americans, at disproportionate rates. African-Americans and other minorities are more likely to have underlying conditions such as diabetes, hypertension, heart disease, and asthma, which contribute to the mortality rate of COVID-19. These underlying conditions stem from health inequalities that range from food accessibility to barriers to healthcare.

African American

Image source: Beyond Type 1

Compared to non-Hispanic whites, Black/African-Americans are 60 percent more likely to have diabetes according to the Office of Minority Health. However, this doesn’t mean minorities are more susceptible to being infected by COVID-19, but that when they are infected they are more likely to die from it.

“It’s not that they’re getting infected more often. It’s that when they do get infected, their underlying medical conditions wind them up in the ICU and ultimately give them a higher death rate. We really do need to address the health disparities that exist in the U.S,” said Dr. Anthony Fauci, National Institute of Allergy and Infectious Disease (NIAID) director and leading expert on the coronavirus pandemic, at a White House briefing on Tuesday.

Recent data reported from cities and states magnifies how dire the pandemic situation has become for African-Americans. In Michigan, African-Americans made up 35 percent of COVID-19 cases and 41 percent of deaths — African-Americans consist of 14 percent of Michigan’s population. Specifically, Detroit, a city with predominantly Black residents, is a hot spot for coronavirus cases. In Chicago, 72 percent of COVID-19-related deaths were Black, who only make up 29 percent of the city’s population. Louisiana has shown a trend nearly identical to Chicago’s.

Evidence shows African-Americans are also having more difficulty getting tested for coronavirus. In early April, Syracuse University reported that while COVID-19 testing is far too low in the United States in general, the testing rates are lower in states with higher percent black populations and poverty rates.

Coronavirus Further Exposes Long-Existing Health and Economic Disparities

The prevalence of chronic health conditions in minorities such as diabetes can be attributed to long-existing barriers to quality of life essentials such as food, health care, and sustainable income. Food deserts, or areas where there is no access to food or quality healthy food, are more abundant in minority neighborhoods. African-Americans are more likely to be uninsured, rely on government insurance, and are less likely to have private insurance compared to their white counterparts, according to the Office of Minority Health. They’re also more likely to have a lower median income. Recent data also shows the wave of millions of job losses is disproportionately affecting minorities.

“It’s jarring to me to hear that African-Americans are disproportionately affected by COVID-19,” said Mila Clarke Buckley, Beyond Type 2 Leadership Council member and owner of the Houston-based Hangry Woman website, who has been living with type 2 diabetes since 2016. “We do have to recognize the systemic factors that play a role in this. Even though I have privilege and resources, I don’t feel safe. It has highlighted the importance to me of practicing social distancing, and staying in as much as possible. I don’t want to be in a position where I can’t get the care I need if I were to get the virus.”

Current CDC recommendations to decrease the risks of contracting coronavirus are to stay home and practice social distancing. However, not everyone has the privilege to abide by those guidelines. A report by the Economic Policy Institute based on federal labor data shows Black and Hispanic workers are less likely to be able to work from home.

“Taking public transportation to get to jobs as essential workers because they can’t afford to not work, living in food deserts and having to travel to get groceries, and other issues that have been reported on,” said Dr. Fauci at a press conference.

Constance Brown-Riggs, MsEd, RD, DCES, CDN, discussed another layer to the public health crisis’ impact on minorities: the lack of trust in the healthcare system itself.

African American

Image source: Beyond Type 1

“There are many factors that contribute to health disparities in people of color. One factor is the mistrust of the medical community. Additionally, numerous studies show that health care provider bias also contributes to health care disparities,” said Brown-Riggs. A New York Times article published in January summarized the generations of institutional racism and discrimination towards African-Americans.

“One of the most troubling explanations for mistrust is the Tuskegee experiment, in which poor black men were unknowingly infected with syphilis and allowed to live with the deadly infection so doctors could track the life history of the disease. Black Americans who know of the study report a greater mistrust of medicine and research,” said Brown-Riggs.

Global patient diabetes advocate of Black Diabetic Info and Beyond Type 2 Leadership Council member, Phyllisa Deroze, also echoes a similar sentiment about bias within the healthcare system.

“I’m not surprised that African-Americans are impacted more,” said Deroze, who lives with LADA diabetes. “I have long since said that the coronavirus might not discriminate, but the American Healthcare system has a long history of being biased. Just look at the maternal mortality rate – black women are 3-4 times more likely to die than white women [in childbirth].”

African-Americans and other minorities have also reported experiencing racial discrimination at medical appointments. Among professionals who work with minorities with diabetes, Brown-Riggs says the lack of diversity plays is a factor as well.

Studies show that most health care providers have an implicit bias in terms of positive attitudes toward whites and negative attitudes toward people of color,” says Brown-Riggs. “This bias is particularly worrisome when the majority of people with type 2 diabetes are African American or Hispanic American and the majority of diabetes care and education specialists and nutrition professionals are white.”

Pressing Forward Despite Systemic Barriers

African American

Image source: Beyond Type 1

Still, African-Americans and other minorities with diabetes are taking the steps to lower their risks of getting the novel coronavirus. Paul Ellis, a person with type 2 diabetes living in Cerritos, California, says despite the issues within the healthcare system, he’s going to do what’s necessary to decrease his chances of contracting it. “I try not to let [the health disparities] get to me,” said Ellis. “I’m determined to manage the disease the best I can and have made a lot of progress since I was diagnosed. I lost a lot of weight, and between that, exercise, diet, and meds, I am doing pretty well. I even did a virtual 5k for the first time a couple of weekends ago and even though I was as slow as molasses, I did it to show myself I won’t be beaten.”

Likewise, Deroze is not taking any chances with COVID-19 and says she’s taking the guidelines seriously. However, the stress and anxiety from the COVID-19 have impacted her glucose levels.

“I’m staying indoors and am only leaving the house for an hour walk in the morning,” said Deroze. “After going to the grocery store a week ago, I decided I didn’t want to be around many people. I started to see an increase [in my blood sugar] the second week of quarantine. The lack of my usual exercise routine and the abundance of food in the house contributes to that. I know this is partly due to environmental stress, but this is a lot to deal with at once.” 

Fortunately, the push for telehealth may yield its benefits for those who need to seek care without leaving their homes. Brown-Riggs suggests inquiring about telehealth with healthcare professionals.

“During this COVID-19 pandemic, it’s extremely important for African Americans and other minorities with diabetes to stay in contact with their diabetes treatment team. Under the recently enacted Coronavirus Preparedness and Response Supplemental Appropriations Act, physicians, nurse practitioner (NPs), physician assistants (PAs), nurse-midwives, clinical nurse specialists (CNSs), and registered dietitians (RDs) or nutrition professionals (RDNs) are permitted to provide telehealth services,” said Brown-Riggs.

She also emphasizes that it’s important to continue with regular self-care behaviors such as eating healthy, being active, and getting regular sleep. For people who are food insecure, check out local food assistance programs and banks. Brown-Riggs warns against scams and misinformation from people looking to capitalize on those most vulnerable to COVID-19.

There are other steps being taken to address this issue from an institutional level. Chicago Mayor Lori Lightfoot said in a news conference that an urgent public-health education and outreach campaign will be launched in minority neighborhoods worst-impacted by the coronavirus.

In early April, California released partial race-based data that did not show a disproportionate impact of COVID-19 on racial minorities — but the bottom line is that we need more data. “Based upon the 37% of the data that’s in, we are not seeing [race and ethnic disparities],” said California Governor Gavin Newsom. “But I caution you, the data is limited. Nothing is more frustrating than the disparities that manifest in relationship to public health. Those issues preceded this crisis and they persist in this crisis.”

The coronavirus crisis is a global pandemic, but its impact will follow the same patterns of health inequality built into systems, institutions, and culture. It’s important to remember that minority communities are already facing disproportionate impacts of COVID-19, with additional barriers to the resources and care needed to mitigate damage caused by the virus.

Source: diabetesdaily.com

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