Precise Coronavirus Risk to People with Type 1 Diabetes Still Uncertain

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It has been widely reported that COVID-19, the novel coronavirus, is more dangerous to people with “diabetes.” Early data showed that people with diabetes infected with COVID-19 were more likely to experience severe illness, complications and death, a fact that has only been confirmed by more recent reports.

But “diabetes” is a vague term, covering both Types 1 and 2, in addition to several less frequent variants. The causes of diabetes are diverse and complex, and people with diabetes will vary considerably, both demographically and metabolically. The added risk that diabetes confers to an elderly Type 2 patient and to an adolescent Type 1 patient cannot be assumed to be exactly the same.

Is coronavirus just as dangerous to people with Type 1 diabetes as it is to people with Type 2 diabetes?

Those of us that have been waiting for more details from scientists on the particular risks of Type 1 diabetes have so far waited in vain. As yet neither the CDC nor any other official body we can find has given any word on the relative risks of Type 1 or Type 2 diabetes, or to the risk of children and younger adults with either condition, or to any other conceivable sub-category.

Setting aside the fact that our epidemiologists and infectious disease experts are already tremendously overworked, it’s very possible that the data simply doesn’t exist yet to make such distinctions. At writing, there have been about 175,000 confirmed cases of coronavirus infection. If we assume that about 0.5% have Type 1 diabetes, we would expect that fewer than 1,000 people with Type 1 diabetes have tested positive worldwide, a fairly small sample in the grand scheme of things, and one that is spread across the globe, the data collected unevenly and in many different languages.

Some anecdotal reports have trickled in. UK resident and T1D Andrew O’Dwyer contracted COVID-19 while on a skiing holiday in Italy, and is now on the mend. He reported that his illness was “no different [than] normal flu-type symptoms.” It’s good to hear that one man is recovering without serious incident, but it doesn’t tell us much about the prognosis of the average person with Type 1 diabetes.

There’s just not much to go on yet. With infection and death rates varying significantly from one community to another, and testing frequency subject to the vagaries of local politics and economics and logistics, it is probable that nobody will be able to assess the true risks of COVID-19 for quite some time. By the time we do have validated and accepted estimates, the virus may have spread to most corners of the globe.

This unfortunate uncertainty has led to much speculation in the diabetes online community. To what extent is the high COVID-19 mortality rate among people with diabetes due to overlap with other complicating factors, such as old age, obesity or high blood pressure? How much does glucose control matter? Are people with diabetes more likely to contract the disease in the first place?

The American Diabetes Association released its own guidance recently specifically on the topic:

“In general, we don’t know of any reason to think COVID-19 will pose a difference in risk between type 1 and type 2 diabetes. More important is that people with either type of diabetes vary in their age, complications and how well they have been managing their diabetes. People who already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have.”

The most anyone can really say, then, is that the healthier you are, the less risk you face from the new coronavirus. Young age, good glucose control, and a lack of complications are likely to bode well for the prognosis of anyone who develops COVID-19. Those in the opposite situation should consider themselves especially at risk of severe illness, and should take any local recommendations to self-isolate especially seriously. But it is impossible to try and numerically estimate the risks and hazards associated with these different health conditions.

In the meantime, official sources are asking all people with Type 1 diabetes to err on the side of caution.

We find this to be irrefutable advice. If you have Type 1 diabetes, the common flu can be a real danger even at the best of times, considering the danger of DKA and the unpredictable effects that any illness can have on insulin sensitivity. And with very real fears that hospitals will soon become badly overcrowded, it may become impossible to rely on any normal standard of medical care. Diabetes Daily has tips on obtaining extra diabetes supplies.

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