COVID and diabetes, colliding in a public health train wreck

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COVID and diabetes, colliding in a public health train wreck
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After older people and nursing home residents, perhaps no group has been harder hit by the pandemic than people with diabetes. (via nytimes)

Compounding the concerns, some studies suggest that a coronavirus infection can heighten the risk of developing type 2 diabetes, a disease that is largely preventable through a healthy diet and exercise. Type 1, by contrast, is a genetic disorder that tends to emerge early in life and is sometimes referred to as juvenile diabetes. More than 90% of all diabetes cases in the United States are type 2.

Although the number of new diagnoses has begun to decline, the overall number of Americans with diabetes has doubled in the past two decades, an increase that mirrors the alarming rise of obesity, which affects more than 42% of adults. Inflammation triggers the release of cytokines, tiny proteins that regulate the body’s immune response to infection or injury. Cytokines are a critical component of the normal healing process, but for people with diabetes and underlying chronic inflammation, all those cytokines can damage healthy tissue. COVID, it turns out, can provoke an uncontrolled release of cytokines, and the resulting “cytokine storm” can wreak havoc on vital organs like the lungs, leading to dire outcomes and death.

But many advancements have been unevenly distributed. The uninsured cannot afford the latest glucose monitoring or insulin delivery devices, and in economically disadvantaged communities with low digital literacy, experts say that doctors are less likely to offer new technologies and treatments to Black and Hispanic patients, even when they are covered by insurance.

“When you are uninsured and working two or three jobs it’s difficult to regularly see a doctor like you should,” said Angeles, who has managed her own diabetes for nearly three decades.

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