With the emergence of COVID-19, there has been an endless surge of warnings and speculations about how the virus affects those with underlying conditions. Diabetes has been mentioned as a condition that puts people at an increased risk for developing the severe symptoms associated with COVID-19. While it is easy to say that diabetes as such is a condition which makes people more susceptible to developing more serious clinical features, what has not been answered is whether it is poorly controlled diabetes (i.e, high blood sugar which is known to weaken one’s immune system) or diabetes as such rather than the associated specific comorbidities which play the most important role.

As with all health discussions, each person brings a variety of factors that impact their clinical outcomes.  For example, no two people with type 2 diabetes will have the same stage of the disease, treatment plan, or lifestyle. Therefore, it would be reckless to say that all those affected with diabetes will have the same impact if infected with COVID-19. As research continues into the connection between diabetes and COVID-19, a consensus emerges that, in addition to age, there at least three stronger risk factors than diabetes itself. More specifically, obesity, cardiovascular, and kidney disease are associated with severe course and death among those infected with COVID-19.

Studies have found, for example, that obesity puts people at risk for developing more serious symptoms of COVID-19 partly because those patients tend to carry a significant amount of extra weight in their abdomen, below the diaphragm. Every time you breathe, your diaphragm moves down and with the extra weight, this makes breathing more difficult. While this is the case for any respiratory disease, COVID-19 is also shown to separate the membranes separating lung airway sacs and blood vessels which allow fluid to enter the airways, consequently making it harder for oxygen from the air to get to the blood.

Another major risk factor is to consider for those who develop severe symptoms or are hospitalized are cardiovascular issues. For instance, many COVID-19 patients develop inflammation of the heart muscle, also referred to as myocarditis. When the heart muscle becomes weak, dangerous irregular heart rhythms may develop, possibly leading to death. It is important to keep in mind, however, that it is still unclear whether the myocarditis is a result of the direct attack from the virus on the heart muscle or due to the person’s overactive immune response to the viral infection.

Lastly, kidney disease has been found to be a predictor of poor outcome from COVID-19. Apparently; severe kidney disease, as seen among those on dialysis, leads to the weakening of the immune system, which makes it harder to fight infections.

Overall, initial studies into the connection between diabetes and COVID-19 point to the above factors and complicating any firm conclusions at this point. While there are many precautions one should prevent infection by COVID-19, in those persons with diabetes it is critical to implement frequent monitoring and best possible management of blood sugar levels.