Diabetes : A red flag for COVID-19

May 11, 2020

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The novel coronavirus (SARS-CoV-2) which causes COVID 19 has different levels of severity when it affects different individuals. People with underlying medical conditions like chronic heart disease, diabetes, asthma, liver disease, severe obesity etc., are at higher risk for severe illness.

Diabetes, a global health concern, may put people at higher risk for severe illness from COVID 19. Most of the fatal cases of COVID 19 are underlying the medical condition – diabetes. It is because of the impaired immune response of diabetic patients.

According to WHO, as of 2014, approximately 422 million people were affected with diabetes. India, the diabetes capital, has more than 50.9 million with diabetes, according to the Diabetes Foundation India. It is expected that this number will go to 80 million by 2025. Medical experts and agencies such as the CDC have stated that people with diabetes are at higher risk for severe illness when affected by COVID 19, which means more than 422 million people around the world are at higher risk for severe illness.

Also Read: 10 Ways to Defend Yourself Against Covid-19 (Coronavirus)

Diabetes – biology, and mechanism

Our cells need the energy to survive and to function properly. Energy is made from sugar/glucose which we get from the food that we eat. Disruption of sugar levels in the blood is called diabetes.

In a healthy person, the glucose enters into the cells with the help of a hormone called insulin. Insulin is made in the pancreas and secreted into the blood. Sometimes the body doesn’t make enough/any insulin or doesn’t use insulin well. Glucose then stays in the blood and doesn’t reach your cells which results in the rise of sugar levels.

Type 1 diabetes, type 2 diabetes, and gestational diabetes are the most common types of diabetes.

Type 1 diabetes is an autoimmune disease in which the immune cells attack and destroy the insulin-producing cells in the pancreas.

In type 2 diabetes (T2D), the body still makes insulin but the cells in the muscles, liver, and fat tissue are inefficient at absorbing the insulin and cannot regulate glucose well. As a result, the pancreas pumps out more insulin to compensate which ultimately results in the pancreas slowly losing the ability to produce insulin. Due to this, the cells don’t get the energy they need to function properly. It is the most common type of diabetes.

Gestational diabetes develops only during pregnancy. In most cases, it goes away after the baby is born.

Also Read: Autoimmunity – Causes, Mechanism and how it affects COVID outcomes

Impact of genes on type 2 diabetes

Genetic variants that affect insulin function, cellular metabolism, and energy balance have been identified as candidates for T2D development. Large-scale genome-wide studies have established strong genetic predictors of T2D, in genes that play an important role in regulating blood sugar levels through different mechanisms – maintaining proinsulin: insulin ratio, pancreatic beta-cell functioning and fasting plasma glucose, metabolic profile, lipid levels, food intake and energy balance, fat storage, transport and metabolism, beta islet cell (pancreas) proliferation, potassium channel current, insulin exocytosis, caloric intake/expenditure, weight regulation energy balance and adipose metabolism.

Impact of diabetes on the immune system

In response to high blood sugar levels as well as the presence of inflammatory mediators produced by adipocytes and macrophages in fat tissue, inflammatory responses are issued by the immune system. This chronic inflammation damages the pancreatic beta cells, which leads to insufficient insulin production, which causes hyperglycemia. Hyperglycemia in diabetic people is thought to cause dysfunction of the immune response, which results in failure to control the spread of invading pathogens. This is why diabetic individuals are known to be more susceptible to infection.

Impact of coronavirus on diabetic individuals

People with diabetes are at higher risk for severe illness and may lead to fatality when affected by COVID 19.

A study says that COVID-19 increases glucose metabolism through a phenomenon known as a cytokine storm. Cytokines are the signalling chemical compounds that are released by many different cells that activate immune cells. Individuals affected with coronavirus have a dramatic spike in cytokine numbers.

When coronavirus enters the lungs it triggers an immune response. This results in the accumulation of more immune cells in the same region resulting in localized inflammation. In the case of individuals with underlying medical conditions like diabetes, excessive or uncontrolled levels of cytokines are released which then activate more immune cells, resulting in hyper inflammation. Hyper inflammation can lead to severe illness and this is why diabetic people are at higher risk for severe outcomes, sometimes fatal. This also explains why some people have a severe reaction to coronaviruses while others only experience mild symptoms.

Dr Shi Liu, of Wuhan University in China, said that a spike in immune cells often happens in the lungs and increases the risk for severe outcomes in diabetics – sometimes, fatal

Also Read: Know Your Immunity Genes – HLA

How MapMyGenome can help you

GenomepatriTM Immunity is a DNA-based assessment of your immune response. The report helps you know your genetic risk for severe illness when affected by coronavirus. This report is a comprehensive genetic assessment of factors which affect COVID-19 susceptibility and severity :

Nutritional parameters
Immune response
Autoimmune diseases
Drug response
Health risks (eg., heart disease, diabetes, blood pressure)

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