Why is COVID-19 killing diabetes patients in the US at alarming rates?

(Reuters) – Devon Brumfield could hear his father breathless on the phone.

Darrell Cager Sr., 64, had diabetes. Then his youngest daughter urged him to seek attention. The next day, he collapsed and died at his New Orleans home.

The daughter soon discovered the cause: COVID-19 acute respiratory distress. Her death certificate listed diabetes as an underlying condition. Brumfield, who lives in Texas and also has type 2 diabetes, is “terrified” that she may be next.

“I am thinking, Lord, that this could happen to me,” he said of his father’s death in late March.

She has good reason to fear. As outbreaks increase in the United States, a new government study shows that nearly 40% of people who have died with COVID-19 had diabetes.

Among the deaths of those under 65, half had the chronic condition. The U.S. Centers for Disease Control and Prevention analyzed more than 10,000 deaths in 15 states and New York City from February to May.

Jonathan Wortham, a CDC epidemiologist who led the study, called the findings “extremely surprising,” with serious implications for people with diabetes and loved ones.

A separate Reuters poll of the states found a similar rate of diabetes among people who die from COVID-19 in 12 states and the District of Columbia.

Ten states, including California, Arizona and Michigan, said they still did not report diabetes and other underlying conditions, and the rest did not respond, representing an incomplete picture for policymakers and doctors struggling to protect those in increased risk.

Diabetes death rates in the United States have increased since 2009 and exceed most other industrialized nations. Blacks and Latinos suffer from diabetes at higher rates than whites and have disproportionately suffered from COVID-19.

Diabetes was already a slow-moving pandemic. Now COVID-19 has crashed like a fast-moving wave, “said Elbert Huang, professor of medicine and director of the University of Chicago Center for Chronic Disease Research and Policy.

Keeping diabetes under control, one of the best defenses against COVID-19, has become difficult as the pandemic disrupts medical care, exercise, and healthy eating routines.

The high price of insulin has also forced some people to continue working, risking exposure to the virus, to pay for the essential drug. And as the country grapples with an economic crisis, millions of Americans have lost their jobs and their employer-sponsored health insurance.

Much of this could have been anticipated and addressed with a more comprehensive national response, said A. Enrique Caballero, an endocrinologist and diabetes researcher at Harvard Medical School.

Senior health officials should have done more to emphasize the threat to people with diabetes and allay their fears of hospital visits, he said, while focusing more on helping patients manage their condition at home.

Policymakers widely warned that COVID-19 posed a high risk for patients with diabetes. In 2003, during the coronavirus outbreak known as SARS or Severe Acute Respiratory Syndrome, more than 20% of people who died had diabetes.

In 2009, during the H1N1 flu pandemic, patients with diabetes faced three times the risk of hospitalization.

Most recently, in 2012, when the Coronavirus Middle East Respiratory Syndrome, or MERS, emerged, a study found that 60% of patients who entered intensive care or died had diabetes.

However, the COVID-19 pandemic has uncovered previously unknown complications because it has lasted longer and infected many more people than previous coronavirus epidemics, said Charles S. Dela Cruz, medical scientist at Yale University and Director of the Center. for Investigation of Lung Infections. and treatment.

Doctors warn that the coronavirus pandemic can indirectly lead to an increase in diabetes-related complications: more emergency room visits, amputations, vision loss, kidney disease, and dialysis.

“My fear is that we will see a tsunami of trouble once this is over,” said Andrew Boulton, president of the International Diabetes Federation and professor of medicine at the University of Manchester in England.

‘A GREAT PUZZLE’

Researchers have struggled for months to unravel the connections between diabetes and the coronavirus, uncovering a number of vulnerabilities.

The virus targets the heart, lung and kidneys, organs already weakened in many patients with diabetes. Studies show that COVID-19 also kills more elderly, obese, or people with high blood pressure, many of whom also have diabetes.

At the microscopic level, high glucose and lipid counts in patients with diabetes can trigger a “cytokine storm,” when the immune system overreacts and attacks the body. Damaged endothelial cells, which provide a protective coating on blood vessels, can cause inflammation as white blood cells rush to attack the virus and can cause lethal clots to form, new research suggests.

“It’s all a great puzzle,” said Dela Cruz of Yale. “Everything is related”.

Many of its vulnerabilities can be attributed to high blood sugar, which can weaken the immune system or damage vital organs. COVID-19 seems to not only thrive in a high sugar content environment but also exacerbate it. Recent evidence suggests that the virus may trigger new cases of diabetes.

David Thrasher, a pulmonologist in Montgomery, Alabama, said that up to half of COVID-19 patients in the ICU of the local hospital have diabetes. “They are often my most challenging patients,” he said, and the response of the immune system may be one of the main reasons.

«DIABETES BELT»

The pandemic has wiped out several southern states with some of the highest diabetes rates in the country. A Reuters review of state data found that nearly 40% of COVID-19 deaths were people with diabetes in Alabama, Louisiana, Mississippi, North Carolina, South Carolina, and West Virginia. Much of this area falls within what the CDC calls the “diabetes belt.”

Alabama has the highest percentage of adults with diabetes at 13.2%, or more than 550,000 people, according to CDC data. Diabetes patients accounted for 38% of the state’s COVID-related deaths through June, authorities said. Karen Landers, Alabama state health aide, said she is particularly heartbroken over the death of diabetes patients in their 30s and 40s.

Medical professionals in these states say they fight to keep patients’ diabetes under control when regular in-person appointments are canceled or limited due to the pandemic.

Sarah Hunter Frazer, a nurse practitioner at the Medical Outreach Ministries clinic for low-income residents in Montgomery, Alabama, said diabetes is common among her COVID-19 patients. With clinic visits on hold, you stay in touch by phone or video chat. If the problem persists, she insists on a face-to-face meeting outdoors. “We found them under a shade tree behind the clinic,” said Frazer.

Similarly, doctors at the University of North Carolina stepped up their use of telemedicine to reach rural at-risk patients. Despite those efforts, John Buse, a doctor and director of the university’s diabetes center, said he is sure some dangerously high foot ulcers and blood sugar levels are overlooked because people avoid the facility. health for fear of the virus.

‘UNDER CONTROL’

Many patients with diabetes with severe or fatal cases of COVID-19 were in good health before contracting the virus.

Clark Osojnicki, 56, of Stillwater, Minnesota, had heard early warnings about the risks of the coronavirus for people with diabetes, said his wife, Kris Osojnicki. But the couple did not believe the warnings applied to him because his glucose levels were in a healthy range.

“He was incredibly active,” he said.

One Sunday in mid-March, Osojnicki jogged with his border collie, Sonic, on a dog agility course inside a suburban Minneapolis gym. Three days later, Osojnicki developed a fever, then body aches, a cough, and shortness of breath. She was soon in the hospital with a ventilator. Clark, a financial systems analyst, died on April 6 of a blood clot in the lungs.

Osojnicki is among the 255 Minnesota deaths of people with COVID-19 and diabetes listed on his death certificate in mid-July, according to state data. The records describe people who died as young as 34.

WORKING FOR INSULIN

For years, the skyrocketing cost of insulin has fueled much of the national outrage over drug prices. At the beginning of the pandemic, the American Diabetes Association asked states to cut out-of-pocket costs for insulin and other glucose-lowering medications through state-regulated insurance plans.

But no state has fully followed that advice, the ADA said. Vermont suspended deductibles for preventive medications, such as insulin, beginning in July. Other states ordered insurers to make prescription refills more available, but did not address the cost.

Robert Washington, 68, knew that his diabetes put him at risk for COVID-19. When his employer, the Gila River Lone Butte Casino in Chandler, Arizona, reopened in May, he decided to continue working as a security guard in order to pay for insulin.

Supervisors in Washington assured him that he could patrol alone in a golf cart, his daughter Lina said. But once he returned to work, he was stationed at the entrance, where long lines of players, most without masks, were waiting, Robert told his daughter.

“I was terrified of what he saw,” said Lina.

He tested positive for the virus in late May and was admitted to the hospital days later. He died of COVID-19 complications on June 11, his daughter said.

A week after Washington’s death, the casino closed again when COVID-19 cases exploded in the state. The casino did not respond to a request for comment.

“It is difficult to accept that he left. I have to avoid wanting to call him, “said Lina, a presenter and sports reporter on a Sacramento, California television station.” Many of these deaths were somehow preventable. ”