Diabetes in South Florida
Diabetes and prediabetes are on the rise among kids and adults in the United States. Here’s what has been going on in South Florida.
Diabetes and COVID-19 aren’t the best of friends. In fact, if you have diabetes, you have a higher risk of severe complications and hospitalization from COVID.
“Patients who have diabetes do have a higher risk of needing hospitalization and also have higher mortality rates,” said Dr. Amy Aronovitz, medical director of adult endocrinology at Memorial Healthcare System.
Getting vaccinated, controlling your weight and keeping tabs on your blood sugar level will help mitigate that risk.
“My first piece of advice to somebody who has diabetes is to make sure you get the vaccine, because we know that that’s the single easiest way to lower your risk for needing hospitalization or developing more severe forms of COVID,” Aronovitz said.
Obesity & COVID-19
Obesity alone can put you at higher risk for COVID, and because Type 2 diabetes is commonly associated with obesity, it compounds the problem, said Dr. Gianluca Iacobellis, endocrinologist and diabetes researcher, University of Miami Health System.
“Obesity alone is an independent major risk factor for COVID-19 complications and for higher severity of COVID-19 complications,” he said. In particular, with visceral obesity, when body fat wraps around abdominal organs deep inside your body, “there is a higher rate of complication from COVID, regardless of whether they’re diabetic or not,” he said.
How well a diabetic patient controls their blood sugar level and A1C also can affect COVID outcomes. “It’s not the case for everybody, but in general, diabetics will have a more severe course of COVID. It’s a vicious cycle,” said Dr. Pascual De Santis, endocrinologist at Baptist Health. “The more severe the disease, the higher the blood sugar, and the higher the blood sugar, the worse the outcome.”
People with diabetes, in general, are in a chronic inflammatory state, he said. “The inflammatory state seems to be a big issue in some patients who have a poor outcome in COVID,” De Santis said.
If you are diabetic and diagnosed with COVID, contact your physician. “They should be paying attention to how they’re feeling and what their symptoms are,” Aronovitz of Memorial said. “And they should keep an eye on their blood sugars to make sure that they’re not either very high related to the inflammatory responses of coronavirus, or alternatively, low, because they’re not eating as much.”
As long as they remain a good candidate for monoclonal antibodies, it is the best chance for someone in a high-risk category to avoid a severe outcome with COVID, De Santis of Baptist said.
COVID can lead to diabetes diagnosis
Besides seeing a higher risk of COVID complications with diabetics, medical experts are also seeing a curious trend. Some patients who are hospitalized for COVID are being newly diagnosed with diabetes. This can be for a number of reasons, they say.
Some may be previously undiagnosed, perhaps because of lack of healthcare. “About one-third of the American population is actually prediabetic, whether they know it or not, and sometimes in the context of being hospitalized for another problem, like a heart attack or pneumonia, they find out,” De Santis said. “That’s one possibility.”
At risk are people who don’t know they are prediabetic, including young people who don’t go to the doctor because they are not feeling bad. “That happens a lot, especially in men,” De Santis said. “If he’s obese, he has an ethnicity that puts him at risk for diabetes — and anything other than Caucasian is pretty much an ethnic group that is at risk for diabetes — they are sedentary, and now they get a severe form of COVID.
There is also evidence showing that COVID may cause an exaggerated inflammatory response that affects the pancreas and insulin secretion, which can contribute to hyperglycemia, Iacobellis of the University of Miami said. Steroid treatments for COVID also can affect blood glucose levels.
“So you have a cocktail of a combination of different factors, including obesity, unknown or diagnosed diabetes or prediabetes, COVID inflammation and steroids,” he said. “All of these definitely are major contributors for high blood sugar” and newly diagnosed Type 2 diabetes cases.
It’s a different disease, but some patients are also seeing autoimmune conditions like Type 1 diabetes being newly diagnosed after severe bouts of COVID, De Santis said.
“Who knows why they develop this severe inflammatory response, and right after that it triggers an autoimmune disease that wasn’t there before,” he said.
“Could this be somebody that had already antibodies and was moving towards developing Type 1 diabetes, and then COVID brought it up, or were those antibodies generated from the COVID infection. The question is whether COVID could be the trigger of the autoimmune disease. To some extent everything is speculative. It’s all hypothetical. We don’t really know.”
This story was originally published November 23, 2021 6:00 AM.