As the coronavirus (COVID-19) epidemic spreads throughout the United States, the Centers for Disease Control and Prevention (CDC) has recommended that people with diabetes should stock up on supplies and prepare themselves for a prolonged stay at home.
Clearly, the CDC believes that now is the time for Americans at higher risk of corona-related complications get ready for the outbreak.
On a March 9 conference call Dr. Nancy Messonier, the Director of the National Center for Immunization and Respiratory Diseases, emphasized that the CDC’s new recommendations “will require you and your family to take action.”
“People with serious underlying health conditions also are more likely to develop more serious outcomes, including death. The people who are at greatest risk are those who are older and also have serious long-term health conditions like diabetes, heart disease or lung disease.”
“Make sure you have supplies on hand, like routine medications for blood pressure and diabetes, and over the counter medicines and supplies to treat fever and other symptoms. Have enough household items and groceries so that you will be prepared to stay home for some period of time.”
It’s not necessarily time to shut yourself indoors quite yet. The outbreak has yet to reach most of the United States, and large cities such as Los Angeles and Chicago have only recently reported their first cases of community transmission. Dr. Messonier clarified that the reason to stock up now is so that you can stay close to home later, when even a trip to the grocery store might pose an undue risk.
In the meantime, the broad advice – avoid crowds, wash hands, avoid nonessential travel – remains the best possible preventive measure, and applies even more to people at enhanced levels of risk. If (or when?) the outbreak reaches your community, then it may be time to stay at home as much as possible.
The Nature of Risk
We know that many in the diabetes community are nervous about COVID-19 and don’t feel as if they have a good handle on the risks involved. Unfortunately, we have been unable to identify a truly authoritative analysis of the risks to people with either Type 1 or Type 2 diabetes.
It’s been known from the early days of the epidemic that people with diabetes who are infected with COVID-19 are much more likely to develop severe complications, including death. But it is not yet possible to isolate the unique and independent risk of diabetes from the statistics we have. A high percentage of the victims with Type 2 diabetes would invariably have been older adults, and many would also have suffered from comorbidities such as high blood pressure and heart disease, otherwise predisposing them for bad outcomes. One journalist did ask Dr. Messonier if she could give more detailed advice to younger Americans with diabetes, and she apologized that she was unable to.
JDRF has asserted that those with Type 1 diabetes are not necessarily at higher risk of contracting illness: “According to several physicians whose expertise includes T1D, people with T1D are not more susceptible to coming down with COVID-19.”
There is, however, some evidence that poorly controlled blood sugar can negatively impact the immune system, putting patients at a higher risk of infections. Diabetes Daily concluded that “maintaining optimal blood glucose control is an important preventative strategy,” and Dr. Messonier also stated that “certainly for those with diabetes and high blood pressure, managing your diabetes and your high blood pressure clearly is a priority.”
And as Dr. Messonier emphasized in her talk, there are two separate issues to weigh: “Risk can be looked at in two ways: there’s the risk of being exposed and getting sick from this virus, and there’s a risk of getting verysick or dying from illness.”
It can be very difficult for people with diabetes to control their blood sugar during a serious illness, especially if symptoms make it difficult to eat or take medicine. Type 1 diabetes in particular can make any illness more complex and dangerous, given the danger of diabetic ketoacidosis (DKA).
All of these variables make it very difficult to determine the true nature of the risk from coronavirus for people with diabetes.
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