How Covid and diabetes collide in a public health train crash

Diabetes is an insidious disease that greatly increases the risk of premature blindness, stroke, and circulatory and neurological problems that can lead to infections requiring the amputation of gangrenous toes and feet. As with many chronic diseases, the poor and people of color are diagnosed with diabetes at disproportionately higher rates. Blacks and Latinos are more than twice as likely to be diagnosed with diabetes as whites, and poor access to medical care can make it harder for them to juggle complex diets, monitoring and treatment that can avoid its devastating complications. Although many researchers don’t understand, many believe that uncontrolled diabetes greatly amplifies the dangers of a Covid diagnosis. This is because a sedentary lifestyle, gaining weight, or not monitoring blood sugar levels closely fuels chronic inflammation inside the body, which can increase insulin resistance and weaken the immune system.

Inflammation triggers the release of cytokines, tiny proteins that regulate the body’s immune response to infection or injury. Cytokines are an essential part of the normal healing process, but for people with diabetes and underlying chronic inflammation, all of these cytokines can damage healthy tissue. Covid, it turns out, can cause an uncontrolled release of cytokines, and the resulting “cytokine storm” can wreak havoc on vital organs like the lungs, leading to disastrous outcomes and death.

People with type 2 diabetes tend to fare worse than those with type 1, in part because those with type 1 tend to be younger.

In some ways, the pandemic has already had positive effects on diabetes care by increasing the adoption of technologies that enable remote management of the disease. The growing adoption of telemedicine, for example, has allowed healthcare providers to spot a worrying foot injury in a homebound patient.

Early in the pandemic, the Food and Drug Administration allowed hospitals and long-term care facilities to distribute continuous blood glucose monitoring devices to coronavirus patients to reduce risk to healthcare workers. Clinicians have also learned the nuances of caring for hospitalized diabetics with Covid through more intensive blood sugar monitoring and management.

But many advances have been unevenly distributed. Uninsured people can’t afford the latest blood sugar monitoring or insulin delivery devices, and in economically disadvantaged communities with low digital literacy, experts say doctors are less likely to offer new technologies and new treatments to black and Hispanic patients, even when covered by insurance.

“The advances in recent years have been amazing, but not everyone has access to it and that’s just tragic,” said American Diabetes Board Member Dr. Ruth S. Weinstock. Association.

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