We are entering the third January with COVID-19 top of mind for many scientists, health care professionals, researchers, and people in general. We all hoped to be out of the pandemic by now, but alas, here we are. The good news is we have learned a lot about the virus since the beginning of the pandemic. Here’s a look at what we’ve learned about type 1 diabetes and COVID-19.
1. People with T1D are not at an increased risk of contracting the COVID-19 virus.1
We’re starting with some good news, which, hopefully, you already know. A systematic review of risks related to SARS-CoV-2 infection (COVID-19) in people with diabetes showed that, out of 112 studies reviewed, there was no strong evidence that people with type 1 diabetes were more likely to catch COVID than their peers.1
2. People with T1D are at higher risk for severe outcomes if they have COVID.1
At the start of the pandemic, the data collected by the National Health System (NHS) in the United Kingdom showed that PWD were more likely to be hospitalized and even die of COVID than people without diabetes.2 This caused many people with type 1 to become quite anxious about the risks of COVID. In fact, researchers in Poland concluded that people with T1D were more anxious about the pandemic than their healthy peers.3
The good news is that as more data emerged, the more it showed that the risks of having severe COVID were mainly for people over 55 years old according to NHS in the UK,4 or over 40 years according to the T1D Exchange data from the US.5 The data from the UK also showed that higher BMI, worse kidney function, and having microvascular complications increased the risk for being admitted to intensive care and risk of death. However, they suggest the risk of severe COVID-19 was, reassuringly, very low for people under 55 years who do not have microvascular or macrovascular disease.
So, if you are an otherwise healthy individual with T1D and are under age 55, your risks are not something that should keep you up at night. However, if you do end up with the virus, keeping your blood sugars in range as much as possible should be your goal. The T1D exchange data also showed that higher HbA1c was associated with higher risk of hospitalization. Earlier studies also showed that high blood sugar increased risk for poor outcomes from COVID, regardless of diabetes status.
3. Vaccines for COVID-19 reduce the risk of severe outcomes from COVID-19.6
If you haven’t already, talk to your healthcare team about getting vaccinated to help reduce your risk of severe outcomes from COVID-19. Most vaccines are in two doses, and an additional booster is available after you have completed the first two. There are some studies which suggest that in the week following vaccination, blood glucose levels are more out of range than usual,7 and others which suggest there is no difference in CGM data before and after vaccination. The bottom line is, even if the vaccine causes you to have higher BGs than usual, it’s still less risky than contracting a severe COVID infection, which will certainly mess up your BG levels!
4. Newly diagnosed people with T1D have been in DKA more than before the pandemic.9,10
You may have seen some headlines about people going into DKA more often when diagnosed with diabetes, and it looks like this data is holding true into December 2021. It is still unclear whether or not the COVID virus itself has played a direct role in increased incidences of DKA, or if it were circumstantial to COVID in that people are delaying healthcare unless it’s emergent.10 Regardless, the increase of DKA at diagnosis continues, making diagnosis experiences more intense for people with diabetes and their families.
There has also been a dramatic increase in children diagnosed with type 2 diabetes throughout the pandemic in the US, with a reported 182% increase compared to years prior.9 In both T1D and T2D, youth who are non-Hispanic black had worse outcomes compared to their peers, which aligns with the growing body of evidence on health disparities and inequities in the US healthcare system.
5. The COVID-19 pandemic has greatly altered the lives of all of us, including PWD.
For some, the pandemic provided an opportunity to create healthy habits, eat healthier food, and maintain exercise routines. For others, it caused financial insecurity, loss of physical activity, and worsening of diabetes care.11 One thing that is for sure is that the inequities in people throughout the US, and worldwide, have been put into the spotlight and the gaps have widened.12
For diabetes care, the same has been shown true. Some people achieved better glycemic control, where others saw a worsening of control or time in range. It depends on a variety of factors, many of them psychosocial or due to social determinants of health. Although this feels defeating in some ways, the positive side is that there are now many options to finding help for diabetes and other needs, many of which are online now.
There have been many challenges throughout these last two years, but also some good things that have come out of it. One of those things is CWD’s virtual events, which will continue well past the pandemic, to allow people from anywhere to connect and get diabetes education and social connection with other families with T1D. Up until 2020, CWD only held in person events, so at least the pandemic has given us diabetes Zoom parties.
Until this pandemic ends, stay safe, wash your hands, and get vaccinated when you can.
References:
- Risks of and From SARS-CoV-2 Infection and COVID-19 in People With Diabetes: A Systematic Review of Reviews
- Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study
- Type 1 Diabetes and COVID-19: the level of anxiety, stress and the general mental health in comparison to healthy control
- A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection
- Age and Hospitalization Risk in People With Type 1 Diabetes and COVID-19: Data From the T1D Exchange Surveillance Study
- COVID-19 Vaccines Work
- The change in glycaemic control immediately after COVID-19 vaccination in people with type 1 diabetes
8. Short-term safety profile of Sars-Cov2 vaccination on glucose control: Continuous glucose monitoring data in people with autoimmune diabetes - Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic
- Alarming increase in ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the first wave of the COVID-19 pandemic in Israel
- COVID-19 hinterland: surveilling the self-reported impacts of the pandemic on diabetes management in the USA (cross-sectional results of the iNPHORM study)
- The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
