One in ten Covid-19 patients who have diabetes and are hospitalised die within a week, a study has suggested.
Studies have repeatedly shown the condition is one of the high-risk conditions for developing a severe bout of the coronavirus.
French researchers looked at the outcomes of 1,300 hospitalised Covid-19 patients across the country, all of whom had diabetes.
Almost a third of them died or needed mechanical ventilation after seven days, the results revealed.
Diabetics with long-term complications of the disease affecting their blood vessels faced more than double the risk of death.
One expert claimed the bodies of diabetics may be slower at fighting any infections because key immune cells struggle to pass through their blood.
One in ten Covid-19 patients in hospital who have diabetes die within a week, a study has suggested
The study, published in the journal Diabetologia, is one of the first to analyse the effects of diabetes on hospitalised Covid-19 patients.
The CORONADO project tracked 1,317 patients who were admitted to 53 different hospitals between 10 and 31 March 2020.
The majority (89 per cent) of patients had type 2 diabetes, which makes up most diabetes cases generally. It is linked with obesity and lack of exercise.
One in ten patients had died by day seven. The study did not follow up how many patients died overall.
Considering most of the patients arrived at hospital five days after their symptoms started, it means 10 per cent died in two weeks of getting infected.
One in five had been intubated and placed on a ventilator in intensive care within a week. The machines help a person to breathe when their lungs are failing.
For comparison, the average time to hospital admission to ventilation in the UK is 12 days, NHS data shows. It is not clear what proportion need it by day seven.
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 defense 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.
Separate figures suggest around 18 per cent of all patients hospitalised with Covid-19 spend time in intensive care.
More than half of those (58 per cent) receive ‘invasive mechanical ventilation’, according to available data.
Some 18 per cent of the French patients were discharged home by day seven.
Commenting on the findings, Duncan Young, professor of intensive care medicine, University of Oxford, said ‘many more’ are likely to have died after day seven.
He told MailOnline: ‘On day seven… by far the majority were still in hospital at this point. The mortality of 10.3 per cent is very low and is only patients who died by day seven, many more would likely have died after.’
Encouragingly, there were no deaths in patients under 65 years old with type 1 diabetes, which the researchers said may reassure people with this type of diabetes.
However, they highlighted there were only 39 patients with type 1 diabetes in this study which is a small sample.
The study found that excess weight or common complications of the disease made matters worse.
Those with a higher body mass index (BMI) were more likely to reach the ‘end point’ – being either ventilated or dying by age seven. But looking at death by day seven alone, there was no higher risk for heavier patients.
The presence of microvascular or macrovascular complications, which are when blood vessels are damaged by diabetes, more than doubled the risk of death at day seven.
Almost half of the hospitalised patients had microvascular complications when they were admitted, which affects small blood vessels like those in the eyes, nerves or kidneys have been blocked.
And 41 per cent had macrovascular complications, when bigger arteries that supply the heart, brain and legs are blocked.
Long-term complications of diabetes develop gradually and are exacerbated if a patient has poor sugar control.
Dr Hajira Dambha-Miller, a GP and specialist in diabetes, told MailOnline: ‘Microvascular and macro vascular complications are a reflection of the severity of diabetes.
‘It’s why people with diabetes suffer with blindness, kidney failure and loss of sensation in the legs.
‘If blood vessels are blocked by sugar, the body can’t get blood around to where the immune cells are needed to fight off the virus. It’s also slower at responding.
‘Additionally, the long term high glucose damages the immune system so the immune cells don’t work as well.’
But the study found a lack of sugar control itself was not a risk factor for Covid-19 death in one week.
Experts have warned that people with any form of diabetes should tightly manage their blood sugars – which is normal treatment anyway – because it will improve their outcomes should they catch the coronavirus.
A THIRD OF VICTIMS IN THE UK HAD DIABETES
Almost a third of people who have died after testing positive for coronavirus in English hospitals had diabetes, NHS England research published on May 20 suggests.
Figures show that overall, 7,466 of coronavirus patients who have died in hospitals in England had type 2 diabetes. A further 365 who died had type 1 diabetes.
This is approximately 32 per cent of the 24,739 Covid-19 deaths recorded in English hospitals up to May 17.
People living with type 1 diabetes are at three and a half times the risk, and people living with type 2 are at double the risk of dying in hospital with the virus, compared to people without diabetes.
Lead author of the study, Professor Jonathan Valabhji called the findings ‘worrying news’ and said it ‘shows the extent of the risk of coronavirus for people with diabetes’.
He added: ‘Importantly it also shows that higher blood glucose levels and obesity further increase the risk in both types of diabetes.’
Charity Diabetes UK are calling on the Government to ensure that patients are kept safe at work and can access other support systems such as supermarket delivery slots and emotional support.
NHS England has called on people with diabetes to access help available to them, including a new dedicated helpline and online tools to help manage the condition during the outbreak.
There was also not link between high blood pressure in the diabetic patients and poor outcomes, even though hypertension has been found as one of the most prevalent underlying health condition in severe Covid-19 patients.
Men have been found to make up the most of Covid-19 fatalities but there was no gender differences in this group of patients, the researchers said.
Sarah Harper, a professor of gerontology at the University of Oxford told MailOnline, said the findings show similarities with our understanding of the impact of Covid 19 in the UK.
She told MailOnline: ‘Being male, over 70, with a high BMI and diabetes, all increase the risk of becoming ill, needing intensive care and, sadly, dying from the Covid 19 disease.
‘Indeed, these are all risk factors for increasing the likelihood of death from other causes. UK data shows that regardless of age, having diabetes doubles the risk of death from disease, though that risk is very small in the young and middle age.
‘Similarly is being overweight – so that a very overweight or obese British man in his early 60’s has the same mortality risk – or chance of dying – as a slim man in his early 70’s. And we know that being overweight increases your chances of getting type 2 diabetes.’
The findings also showed the sleep disorder sleep apnoea almost tripled the risk of dying after seven days, as did the presence of shortness of breath.
Dr Dambha-Miller said: ‘We know that the virus affects the lungs and causes mass inflammation in there (called cytokine storm). If the lungs are already in bad shape, they won’t do well once the virus enters the lungs.’
The authors plan to publish further work in the summer detailing outcomes of some 3,000 patients with diabetes hospitalised with COVID-19, looking at their status 28 days after admission to hospital.
A spokesperson for the NHS said: ‘The risk from COVID-19 for people living with diabetes is clear, and the NHS has put extra plans in place to help people and keep them safe, including clinical guidelines for patients who are admitted to hospital, online sites to support people to care for themselves and a dedicated new helpline for advice and support.’