Patients with Type 2 diabetes are twice as likely to die from coronavirus – and being obese increases the risk even further, research reveals today.
A third of deaths from the virus have occurred among individuals with diabetes, which is linked to excess weight and a lack of exercise.
The study by the NHS and Imperial College London also found that those with Type 1 diabetes –which is not linked to obesity – were three and a half times more likely to die.
The findings provide further evidence that certain groups of patients are at much higher risk of suffering fatal complications.
A third of deaths from coronavirus have occurred among individuals with diabetes, which is linked to excess weight and a lack of exercise. Stock: Glucometer used to manage the condition
But they also suggest that lifestyle strongly influences someone’s susceptibility to the virus.
Lead researcher Professor Jonathan Valabhji, the NHS’s national clinical director for diabetes and obesity, analysed the deaths of 23,804 patients in England from coronavirus between March 1 and May 11.
Professor Valabhji, also a consultant diabetologist at Imperial College Hospitals, found that 31.4 per cent had Type 2 diabetes and 1.5 per cent had Type 1.
WHY DOES DIABETES RAISE THE RISK OF COVID-19?
Diabetes puts people at a higher risk of developing severe COVID-19 because it makes the immune system weaker, scientists say.
The illness, which affects more than four million people in the UK, is caused by abnormal levels of sugar in the blood. For most people this takes the form of Type 2 diabetes, in which there is too much sugar in the blood.
This, researchers, say, thickens the blood and reduces its ability to carry substances around the body at speed.
Dr Hajira Dambha-Miller, a GP and specialist in diabetes, said a patient’s blood becomes ‘like treacle’ as a result of high sugar levels.
‘Physically, it’s harder for the immune system to get to the virus,’ she said. ‘The virus bugs do a lot of damage before the immune system even realises it’s there.’
Therefore, when someone is infected with the coronavirus, it may take longer for their body to respond and fight it off, and the response may be less effective when it does begin.
Their illness doesn’t make a diabetic person any more likely to catch the virus itself – that is indiscriminate – just less likely to be able to recover quickly.
Dr Dambha-Miller added: ‘When the body does kick in, it won’t work as it should do. The immune cells are damaged because they’ve been saturated in sugar for years and don’t work the way they should.’
The American Diabetes Association says it’s not clear if COVID-19 will pose a difference in risk between type 1 and type 2 diabetes.
But the risk of getting very sick from COVID-19 is likely to be lower if diabetes is well-managed no matter whether it is type 1 or type 2.
The Association explains that people who have diabetes often have other health problems, such as obesity, heart disease or high blood pressure, which in turn contribute more to their risk of dying with COVID-19.
The ADA said: ‘Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because your body’s ability to fight off an infection is compromised.
‘Viral infections can also increase inflammation, or internal swelling, in people with diabetes. This is also caused by above-target blood sugars, and both could contribute to more severe complications.’
People of black African or Caribbean, or south Asian, backgrounds are more likely to develop diabetes and have also been found to be at more risk of dying if they catch the coronavirus.
The study also found that patients with Type 2 diabetes doubled their risk again if they were severely obese, with a body mass index (BMI) above 40.
They were twice as likely to die than those patients with the condition who were in the overweight or normal category. Patients with Type 2 diabetes who also had high blood glucose levels because their condition was poorly controlled increased their risk of death by another 60 per cent.
Professor Valabhji said: ‘This research shows the extent of the risk of coronavirus for people with diabetes and the different risks for those with Type 1 and Type 2 diabetes. Importantly, it also shows that higher blood glucose levels and obesity further increase the risk in both types of diabetes.
‘This can be worrying news but we would like to reassure people that the NHS is here for anyone with concerns about diabetes – and has put extra measures in place to help people and keep them safe, including online sites to support people to care for themselves, digital consultations, and a dedicated new helpline for advice and support for people treated with insulin.’
The Government is carrying out a major review into whether obesity, ethnicity and gender increase their chances of dying or becoming severely ill with the virus.
The findings, which are due within the next few weeks, could influence whether these groups are given tailored advice regarding social distancing and working in non-frontline NHS roles.
At least 3.9 million Britons have diabetes and the number has doubled in the past 20 years in line with rising levels of obesity.
Up to 90 per cent have Type 2 which usually develops after the age of 40 but is being increasingly seen in children and teenagers.
Bridget Turner, director of policy at Diabetes UK, said: ‘This new data sheds much-needed light on which groups of people with diabetes are more likely to experience poor outcomes if they catch coronavirus.
It also shows that the risk of death for people with diabetes is higher than for people without the condition – with the risk for people with Type 1 being higher than for those with Type 2 – and that a history of higher blood sugar levels as well as obesity seem to be contributing factors.
‘It’s very important to remember that the risk of dying from coronavirus – for people with and without diabetes – remains very low, and that as cases of coronavirus decline, the risk to everyone of catching the disease will reduce in turn.’
Can the heart predict who will die of coronavirus? Hospitalized patients with enlarged right heart chambers are nearly FOUR TIMES more likely to be killed by the infection, study finds
It’s become clear that coronavirus attacks the heart as well as the lungs, and one of its harmful effects on a cardiac chamber may predict who dies of the infection, a new study suggests.
Researchers at Mt Sinai University Icahn School of Medicine in New York followed the conditions of 110 hospitalized coronavirus patients and their prior medical records.
EIGHT MILLION BRITS WITH HEALTH CONDITIONS ‘SHOULD BE EXEMPT FROM RETURNING TO WORK’
Eight million Britons with underlying health conditions should be exempt from going back to work when the coronavirus lockdown eases, scientists say.
Experts at University College London and Cambridge University fear not protecting society’s most vulnerable could see UK’s death toll rise to 73,000 within a year.
One in five people – more than 8million people in Britain – are at a higher risk of dying if they catch COVID-19 because of their age or poor health.
But most of this group are not deemed ‘extremely clinically vulnerable’ people, who were asked to ‘shield’ for 12 weeks by the Department of Health.
Britons with long-term conditions such as heart disease and diabetes would make up between 80 and 90 per cent of the fatalities, the researchers calculated.
And they said it means another 30,000 Brits could die unless everyone at high-risk is protected for as long as possible and not forced back to work post lockdown.
In a separate, worst-case scenario estimate they predicted up to 590,000 deaths if the government did nothing and 80 per cent of the population were infected within a year.
Office for National Statistics data today suggested more than 40,000 people have already died with COVID-19, confirming Britain’s status as the worst-hit nation in Europe. But the researchers said this is set to rise much higher.
If 10 per cent of people in England are allowed to catch the virus, the scientists said – and four per cent are already thought to have done so – the death toll could double.
Lead author Dr Amitava Banerjee, of the UCL Institute of Health Informatics, said: ‘I don’t think they should be rushing to go back to work until we have made sure that the infection rate is down, that transport is set up and that workplaces are safe.’
The study, published in The Lancet, looked at the medical records of 3.8million people and predicted what could happen after lockdown.
It said vulnerable people – including all over-70s and those who have high blood pressure or asthma – make up 20 per cent of the British population.
Dr Banerjee said: ‘This group is more likely to be admitted to hospital, to go to intensive care and to die.
‘Why are we even discussing them going back to work at this stage?’
Nearly 62 percent of patients with enlarged right ventricles – a chamber of the heart that pumps oxygen-poor blood to the lungs – died, according to an article that’s been accepted to a journal, but not yet published.
It comes as the US coronavirus death toll tops 90,000 and doctors continue to search for clues as to why some patients suffer only minor symptoms and others die of the infection.
Of the 110 patients that the Mt Sinai researchers recruited to their study, 21 ultimately died.
Early data out of China suggested that 19 percent of coronavirus patients had heart issues, and it’s a trend doctors across the US have since noted too.
So often is the case, that many US doctors are putting coronavirus patients on blood thinners as a matter of course, because many have developed potentially deadly clots.
Doctors closely monitor coronavirus patients for signs that their hearts may be under attack from the coronavirus.
All 110 patients in Mt Sina’s study – which has been accepted to the journal JACC: Cardiovascular Imaging, but not yet published – had indicators that suggested their hearts could be struggling and were given echocardiograms (EKGs) to assess their cardiac function.
Thirty percent of the patients given EKGs were already in critical condition, on ventilators to help them breathe.
EKGs revealed that 31 percent of the patients had ‘right ventricular dilation,’ meaning the lower right chamber of each heart was larger than normal.
Enlarged right ventricles are not typically a sign of heart disease itself. Instead, they usually signal that another condition is stressing the heart.
The patients with enlarged right ventricles were no more likely to have other health conditions, out-of-control inflammation or be on blood thinners than were other patients.
What’s more, the researchers did not find higher rates of enlarged left ventricles.
It’s not clear exactly why right ventricle, specifically, seemed to suffer more distress.
The research team suspects that multiple factors contribute to the development of the enlarged right chamber, including: low oxygen levels that trigger a tightening of blood vessels, direct damage from the virus, damage from inflammatory immune cells called cytokines and blood clots.
Scientists believe that coronavirus fights its way into human cells by binding to a receptor called ACE2, which is found most prevalently in the lungs, but is also on the surface of blood vessel cells.
Other studies have suggested that the virus’s attacks on the blood vessels can lead to all of the conditions that, in turn, the Mt Sinai researcher think contribute to enlargement of the right ventricle.
Forty-one percent of the patients with enlarged right ventricles died of coronavirus, compared to just 11 percent of those whose right ventricles looked normal on the EKG.
EKGs are easy to perform bedside, meaning infected patients don’t have to be transported out of their rooms, potentially exposing other patients and more hospital staff, and the new study suggests that performing the imaging exam might help doctors predict when someone with coronavirus is about to take a turn for the worse.