People with diabetes have a higher risk of severe illness or death if they get COVID-19. However, new studies are showing that patients with well-managed diabetes tend to have less adverse impacts from the illness, a Spokane professor said.

Generally, diabetic patients are more likely to develop serious symptoms when infected with any virus, including the coronavirus, said Josh Neumiller, professor at Washington State University College of Pharmacy and Pharmaceutical Sciences.

“We know in just having diabetes, it’s a little more difficult for them once they contract an illness to get over an infection in general, and they can have worse outcomes with infectious diseases,” said Neumiller, also an expert for the American Diabetes Association.

“What’s being talked about with COVID is not only people with diabetes having risk of worse outcomes, but also a lot of people with obesity are having issues, as well. Inflammation seems to play a big role in COVID.”

With COVID-19 and other viral infections, a diabetes patient’s ability to fight off an infection is compromised. The risk increases if there’s a secondary condition such as heart disease.

The Centers for Disease Control and Prevention outlines that people of all ages seem to be at higher risk of severe COVID-19 symptoms if they have serious underlying chronic medical conditions such as lung disease or a weakened immune system.

That’s particularly true if underlying serious medical conditions aren’t well-controlled, the CDC says, including for diabetes, moderate to severe asthma, severe obesity and chronic kidney disease.

Diabetes and emerging news

The CDC says more than 30 million people nationwide live with diabetes, a disease that occurs when the body does not properly process food for use as energy.

While information is rapidly evolving about COVID-19 and diabetes, recent studies are supporting what experts have suspected – better-managed diabetes results in improved outcomes, Neumiller said. Even when he did an ADA podcast more than a month ago, that wasn’t yet clear.

“At that point (of the podcast), it was theorized that having better diabetes control would impart better outcomes, but information looking at outcomes in people with COVID-19 was not yet available,” Neumiller said. “Over the last several weeks, studies have been published looking at the impact of glucose control on COVID outcomes.

“People who have better control of their blood sugar before contracting COVID had less intensive interventions to manage COVID, less death, less need for ventilator treatment,” he said.

In particular, one study in China looked at differences in outcomes in people hospitalized with COVID-19 and diabetes based in part on their hemoglobin A1C, a three-month average of blood glucose control, Neumiller added.

“The group with good control that had an A1C right around 7% had much better outcomes when compared with a group with an average A1C of around 8%. If people can stay in better control of diabetes, if they do contract COVID, it improves their chances of coming out of it well.”

Neumiller said he has talked to people with diabetes in recent months, most who don’t have COVID-19, but they’re worried about running out of supplies for care. They also ask if they should do regular blood sugar monitoring. He tells them yes and that he’s not aware of any supply shortages.

He is a certified diabetes educator and a fellow of the American Society of Consultant Pharmacists. With a doctorate in pharmacy, his research interests focus on issues in the management of chronic diseases such as diabetes and kidney disease. Other research surrounds medication safety during transitions of care.

If you have diabetes

Neumiller said some people with diabetes who get COVID-19 can potentially remain home to recover if they have a milder form of the illness and stay in touch with their health care provider. Also key is they aren’t having severe respiratory symptoms or having trouble managing blood glucose levels.

“If someone becomes quarantined at home, it is important that they are in close communication with their primary health care provider about continued or modified use of their diabetes medicines and to be sure they have an adequate supply of all of their medicines and glucose testing supplies,” he said.

Generally, he ecourages all diabetic patients to have an adequate supply of medications and testing supplies at home. That limits trips to the pharmacy and decreases risk of exposure, he said, and provides for any quarantine needs.

Drive-thru pharmacies also help limit exposure. “Many pharmacies are allowing 90-day refills.”

Don’t stop any medications because of concerns you might hear about, he added, and people with any questions should run it by their physician, such as continued use of metformin if they’re ill or dehydrated.

Metformin is an oral diabetes medicine that helps control blood sugar levels, sometimes used together with insulin or other medications.

Meanwhile, the ADA and Neumiller also cite the lack of clear data regarding potential interactions between COVID-19 and ibuprofen, as well as a class of drugs called ACE inhibitors, sometimes recommended for persons with Type 2 diabetes.

“There was one paper that came out and hypothesized these could worsen illness or put you at higher risk for developing COVID or more severe COVID,” he said, while adding that other studies show potential benefits of using them.

“Most organizations such as the American Heart Association and the American College of Cardiology say there is no justification to stop these medications if people are taking them as prescribed for pain relief or blood pressure or heart disease.

“I’m encouraging people not to overreact.”

Neumiller also recommends that health care providers get an accurate listing of a diabetic patient’s medications if they’re admitted to a hospital for COVID-19 symptoms. In that situation, drugs such as metformin and SGLT2 inhibitors can impact patients under respiratory distress, he said.

Neumiller said his overall comments about diabetes are mainly talking about Type 2 diabetes.

Type 1 also requires intensive management, and when people with the condition become ill and experience stress, “Diabetes becomes very complicated and needs control,” Neumiller added.

He said for all people with diabetes, it’s even more important during the pandemic for continued monitoring along with healthy habits.

“Something I’m talking to people a lot about as we’re several months into social distancing is that with diabetes, some of the best things they can do is eat healthy and make sure they’re getting in physical activities,” Neumiller said.

“That might be harder staying home, but I encourage them to get outside and get some physical activity. It’s important more than ever to continue healthy lifestyle habits that not only help with blood sugar levels but will help with outcomes, as well.”