Question: I have heard recently that people with diabetes are at especially higher risk of mortality with COVID. Do you know of anything that distinguishes between type of diabetes, BMI, age, general health?

Answer: So far, we have no evidence that people with diabetes are more likely to contract SARS-CoV-2. That’s good news. The bad news is that once someone with diabetes contracts COVID, their risks of severe outcomes so far appear much higher as compared with someone without diabetes. Preliminary findings reported by CDC align with findings from China and Italy in showing that people with diabetes are more likely to experience severe outcomes and even death from COVID. The mechanism by which people with diabetes become more susceptible to severe outcomes is still unknown and a recent review of available literature on diabetes and COVID-19 published in the Journal of Clinical Hypertension highlights the many gaps in the current data and our understanding, concluding “the influence of diabetes on severity and outcome in COVID‐19 patients is not clear because of large gap in evidence.” Here, the authors cite the problem of unaccounted confounders — type of antidiabetic therapy used, other diabetes-associated conditions like obesity and age, how well diabetes is controlled, etc. More evidence is needed.

In this vein, the British National Health Service just released estimates of severe outcomes among patients hospitalized with COVID-19. These data, as reported by Diabetes UK, show that “People with type 1 diabetes were found to be 3.5 times more likely to die, and people with type 2 diabetes twice as likely to die, than people who don’t have diabetes when in hospital with coronavirus.” The full NHS paper on diabetes and COVID-19 is here. This paper also found that the presence of other factors — obesity, and age — further increased risk of death among people with diabetes.

Finally, the American Diabetes Association offers an FAQ on diabetes and coronvirus that you may find helpful too.