Exploring COVID-19 in Diabetes: A Look at Disease Management & Risk

Written by John Buse, M.D., Ph.D.
ReachMD Host 

Exploring COVID-19 in Diabetes: A Look at Disease Management & Risk

It’s pretty clearly established that people with obesity and people with diabetes are at higher risk of poor outcomes in the setting of COVID-19. What isn’t quite as well-established is whether people with diabetes with excellent glycemic control, as reflected by a hemoglobin A1C less than seven percent is associated with excess risk outside of the risk associated with comorbidities like coexistent cardiovascular or renal disease. The bulk of the evidence suggests that there probably is some modest, inherent risk in the setting of diabetes. But certainly, there’s much less risk in the setting of well-controlled diabetes than poorly controlled diabetes.

How about the issue of the COVID-19 vaccine in the setting of diabetes? There is very little in the way of specific studies in sub-populations with diabetes, but a subgroup analysis from vaccine trials suggests that the vaccines perform equally well in people with diabetes and with obesity as they do in the general population.

My advice to patients with diabetes is to get the COVID-19 vaccine as soon as they can. I do think that the COVID-19 is a potentially life-threatening disease. There are concerns about persistent symptoms and poor physical functioning in patients who have COVID-19 infections. So not only is the threat of COVID-19 the risk of hospitalization, prolonged intensive care, or death; but the notion that somehow, COVID-19 may result in prolonged disturbing or disabling problems even in those with milder infection. So, for all these reasons, I think that patients with diabetes, or at risk for diabetes in the setting of overweight or obesity, should all be vaccinated against the SARS-CoV-2 virus as soon as possible.