Diabetes: Evidence vs. Fiction

In this time of COVID-19, what should people with type 2 diabetes be doing?

If you have diabetes, then you are appropriately more concerned about your health than some others. Indeed, we know that patients with diabetes are prone to develop severe COVID-19 infections. Diabetes is a major risk factor for having severe infections whether it is associated with the COVID-19 pandemic or not. This is particularly true if you have already developed other diabetes-related complications such as chronic kidney disease.

My suggestion is to ask the question a little bit differently. What can you do to reduce the risk of having diabetes-related infection based on available scientific evidence?

Based on current evidence, the major modifiable risk factor for severe diabetes-related infections – the main factor you can actually change – is your glycemic control or hemoglobin A1c (HbA1c). The higher the HbA1c that you live with, the higher your chances of developing severe infections.

Since diabetes is a progressive condition, over time you will need different medications to optimize your HbA1c. During the first several years with the disease, you still secrete some insulin and thus weight loss or taking a pill such as metformin can be enough to optimize your HbA1c.

But eventually you will likely need additional medications since your body is continuing to lose its ability to secrete insulin. This is why, after a decade, you will probably require insulin injections to improve your HbA1c.

It is what we expect to happen: it is not your fault!

In my mind, it is less important how you optimize your HbA1c as long as you find a way to do it. It is important to remember that you will probably not be able to lower your HbA1c merely by eating differently or being physically active. As your disease progresses, you will need medication prescriptions in alignment with your changing needs. This is a complicated topic and is especially vital during this time of COVID-19.

Stay safe. Stay home. Be well.

Israel.

About Dr. Israel Hodish

Dr. Israel Hodish, MD, PhD, is the clinical research lead for Hygieia, the makers of the d-Nav Insulin Management Program. An endocrinologist and associate professor in the department of Internal Medicine at the division of Metabolism, Endocrinology and Diabetes of the University of Michigan Medical School, Dr. Hodish’s clinical and research interests are to advance the management of patients with adult-onset diabetes. Israel Hodish co-founded Hygieia in 2008 to develop the d-Nav Insulin Management Program.