Covid-19: how vulnerable are people with diabetes? podcast
The The Guardian welcome to another episode of Science Weekly. We're continuing to take scientific questions about Corona virus outbreak and explore them in detail. We would love to keep hearing from you so please continue to send your questions fire foam. We've set up head over to the GUARDIAN DOT COM forward slash covert nineteen questions all in one word in today's episode. We'll be looking at something. Lots of you've been writing in about diabetes and whether patients with the condition are at high risk of developing severe symptoms of copied nineteen. We suspect there is altered or reduced effectiveness of the immune system in people with diabetes Mellitus. And this is more seen in people with Higher Blood Glucose levels or higher levels of diabetes. This is Depeche Patel. We're also beginning to think that actually abdominal fat which is increased in many patients with type. Two diabetes seems to be a potential for more access inflammation and that excess information is seen more commonly in people suffering from severe illness. Welcome to another episode of Science Weekly. I'm Sarah Bosley I'm Doug Depeche Patel. I'm a consultant in diabetes endocrinology. I'm also a honoree associate professor at UC l. So Depeche. You're currently working on the front line. I believe helping with the nineteen outbreak. Could you tell us a little bit? About how the last few weeks have been so confessed to my daytime specialty walking which is mainly outpatient based we've been assigned to ward work which is very different but I must say one of the most striking things about working on the front line on general medical wards is the fantastic junior doctors that we work with and we have to help us and their levels of dedication. I must say partly due to them. Morale is good and healthy and to seeing on a daily basis. Examples of team work putting together and focusing on our patients. You're a specialist in diabetes and more broadly and chronology very briefly. Could you tell us what is diabetes? So diabetes is a process of a reduction. In the body's ability to regulate blood glucose and this results in elevation of Blood Glucose detectable and if it is untreated for long periods of time this can lead to complications such as I disease kidney disease and lower amputation. They're boarded two categories of diabetes to type one and type two diabetes and Taiwan diabetes really correspondence to an insufficient amount of insulin. Produced by the body were as type two. Diabetes Is a process where that incident that's being produced is produced Sufficiently but incidents become less effective both processes lead to an elevation in blood glucose levels with your work on the ward. I'm assuming that you're doing. Also things are not just diabetes. Is that correct? That's right. We're seeing patients with general medical problems older patients who are suffering from curve in nineteen related issues so on average at any given week in adult inpatients Anywhere between fifteen percent to twenty five percent of patients having diabetes Militas At the moment although we don't have any official data within the hospital old UK. My feeling is we're seeing more patients than that due to the current cove nineteen Pat Democ other needs statistics in fact on that for the UK or globally as to the proportion of people with Kevin. Nineteen who do have diabetes one social the other way. We're still waiting for the official data from the UK. There are some data. That's come out of China and the prevalence of diabetes reportedly has been around ten percent. But I guess the also the important thing to notice. It appears that patients with diabetes seemed to be susceptible for developing more of a severe type of illness and it's reported that the risk of death is increased in patients with diabetes. Why do we think that people with diabetes might be more at risk so this is quite an interesting question that we will be asking ourselves? We know that people with Diabetes Amel vulnerable to sudden severe research infections. And I I guess that's one of the reasons why we offer old faced with diabetes an influenza vaccine every year. We suspect there is altered or reduced effectiveness of the immune system in people with type and this is more seen in people with high blood glucose levels or high levels of diabetes. We're also beginning to think that actually abdominal fat which is increased. Many patients with type two diabetes seems to be a potential for more accessible inflammation and that access information is seen more commonly in people suffering from severe illness. Yes I've noticed. In fact that the cases reported on from intensive care have shown up that there is a higher proportion of people with raised BMI. Exactly right and that's what we're seeing here would. Also I've seen some republic dates from New York showing also the rates of hospitalization being much higher in people who have obesity but also much higher than people who have more severe greats of peace ity. So we we now know that this is also a signal in terms of vulnerability to buy hospitalization animal survey disease and that might be linked directly to inflammation we know that people who have excess amounts of abdominal fat Already have a low level of inflammation more so than people with normal levels of donal front. Does this mean the borough saying hi case numbers for people with other metabolic disorders? That could lead to hypoglycemia. Usually these people have an underlying susceptibility to either diabetes or prediabetes on. It's the illness does unmasked that. But we're not seeing it really. In cases who do not have any predisposition to diabetes or prediabetes and some of our listeners including mark in Guilford have written in to ask whether there's a difference between what we're seeing in type one and type two patients. That's a really interesting question. I don't think we have any official data but we need to bear in mind that about ninety percent of all cases of diabetes in the UK. type two diabetes clearly. That's much more common form but also patients with type. Two diabetes are older and are more likely to have other commodities such as high tension or heart disease and we know that they are also seemed to be vulnerability factors in patients presenting with Kobe Tilmis it is also found that a lot of patients who have type one diabetes amish younger and maybe they also have a greater level of physiological reserve by the sole fact that they younger so I think we have any official on says but certainly local league in my hospital. We're seeing many more cases of type two diabetes rather than type. One Time Ts. Is there any chance? Toll that certain types of medication might be playing a role. I mean the medication. That people with diabetes might be taking. There has been some evolving discussion about a type of medication. Class called ACE inhibitors. It is salt. The Cova Nineteen virus enters the cell afire attaching itself to a receptor. That is cold. The H two receptor and we think that as two levels may be increased in patients with type two diabetes medications that patients use may also increase levels. Whoever I must stress this is still theoretical. And we just don't have the data to support this and something that's going to be subject to think significant investigation research in the coming months terrific number things. We don't know in fact on their about this. Absolutely I mean there are many many medical fields that are still learning a lot not just about the virus but how the virus also impacts on their special series of practice other listeners including Deborah have asked why diabetes is not currently on the list of most vulnerable conditions. Do you think this needs to be reconsidered? I think to Debra. That thing is a very good question I am. I guess slightly surprised that it's not on the list of foldable conditions. However we just simply don't have the data to support this in younger patients as Sedalia majority of patients with type. Two diabetes are one both older but also have other associated medical conditions that made them even more vulnerable to. We have data to support that. It's difficult to advise any advice. You'd give to those people with diabetes during these times things important not to worry excessively. It's difficult to I. Guess put in practice but it's important to check blood glucose levels regularly and best to do the things that we advise patients to do is to get plenty of sleep eat a well-balanced diet drink plenty of water. I would sign post the diabetes UK websites as a wealth of information for patients both covert nineteen related and general sick day rules the other very good portal of information for this including youtube videos for patients is the European Association for the Study of Diabetes. Ea SD thank you very much for giving us your time to bash and on behalf of all of us science weekly thank you so much for your clinical work. Thanks for asking me. Pleasure thanks to Depeche for joining me. This week diabetes. Uk are constantly updating their advice for patients. Sir If you want to find out more please. Head over to diabetes DOT ORG DOT UK. We'll also linked both organizations that depeche mentioned in the episodes description at the Guardian Dot Com. We would love to keep hearing from you so please continue to send your questions fire foam. We've set up head over to the GUARDIAN DOT COM forward slash Kovic. Nine thousand nine questions. Oman word from all of us here at science. Weekly stay safe. Stay inside and we'll see you soon. Put costs from the Guardian. The Guardian Dot Com put costs.