Why COVID-19 is killing diabetic patients in the US at an alarming rate

(Reuters)-Devon Bramfield was able to hear his father trying to hold his breath on the phone.

Darrell Cager Sr., 64, had diabetes. So his youngest child urged him to look after him. The next day he fell and died at his home in New Orleans.

The daughter quickly found the cause: acute respiratory distress due to COVID-19. His death certificate pointed out diabetes as the underlying condition. Living in Texas and suffering from type 2 diabetes, Brumfield is a “fear” she could come next.

“I think, Lord, this is what can happen to me,” she said about the death of her father at the end of March.

She has good reason to fear. As the outbreak in the US surged, nearly 40% of those who died of COVID-19 had diabetes, according to a new government survey.

Half of the deaths under the age of 65 were chronically ill. The Centers for Disease Control and Prevention analyzed over 10,000 deaths in 15 states and New York City from February to May.

Jonathan Wortham, a CDC epidemiologist who led the study, said the findings were “very impressive” and had a serious impact on people with diabetes and their families.

Another state study by Reuters found a similarly high rate of diabetes among those dying of COVID-19 in 12 states and the District of Columbia.

Ten states, including California, Arizona, and Michigan, have yet to report diabetes and other underlying conditions and the rest have not responded, struggling to protect the highest risk people. Has brought an incomplete situation to policy makers and clinicians.

Mortality from diabetes in the United States has increased since 2009, surpassing most other developed countries. Blacks and Latin Americans are more likely to have diabetes than whites and are biased toward COVID-19.

“Diabetes was already a slow pandemic. Today, COVID-19 is rapidly hitting the waves,” says Elbert Huang, a professor of medicine and director of the Center for Chronic Diseases Research and Policy at the University of Chicago. It was.

Managing the diabetes, one of the best defenses against COVID-19, has become difficult due to the pandemic disrupting medical, exercise and healthy eating routines.

The high price of insulin has also forced some people to continue working to provide essential medicines-the risk of viral exposure-. And as the country tackles the economic crisis, millions of Americans lost their jobs and their employer-provided health insurance.

A. Enrique Caballero, an endocrinologist and diabetic researcher at Harvard Medical School, said much of this was anticipated and could have been addressed by a more comprehensive national response.

Top health officials should make more efforts to highlight the threat to diabetics and mitigate the fear of visiting hospitals, while helping patients manage their condition at home. More focused on.

Policymakers had enough warning that COVID-19 poses a high risk for people with diabetes. In 2003, more than 20% of people who died had diabetes during the outbreak of the coronavirus known as SARS or severe acute respiratory syndrome.

In 2009, diabetics faced a triple risk of hospitalization during the H1N1 flu epidemic.

When the coronavirus Middle East Respiratory Syndrome (MERS) emerged most recently in 2012, one study found that 60% of patients admitted to intensive care or died had diabetes.

However, the COVID-19 pandemic uncovered previously unknown complications as it lasted longer than the previous coronavirus epidemic and infected many people. And treatment.

Doctors warn that coronavirus pandemics can indirectly lead to a surge in diabetes-related complications-emergency room visits, amputations, vision loss, kidney disease, and dialysis.

“What I’m afraid of will be a tsunami in trouble once this is over,” said Andrew Boulton, chairman of the International Diabetes Federation and professor of medicine at the University of Manchester, England.

“ONE BIG PUZZLE”

Researchers have scrambled for months to discover the link between diabetes and coronavirus and have discovered various vulnerabilities.

The virus targets the heart, lungs, kidneys, and organs that are already debilitated in many diabetics. COVID-19 also kills more elderly, obese, and hypertensive people, many of whom also have diabetes, studies show.

At a microscopic level, high levels of glucose and lipids in diabetics can cause a “cytokine storm” in which the immune system overreacts and attacks the body. Damaged endothelial cells, which provide a protective layer of blood vessels, can cause inflammation as white blood cells can be flooded to attack the virus and form deadly blood clots, new research says. Suggests.

“It’s all one big puzzle,” said Yale’s Dela Cruz. “It’s all interconnected.”

Many of those vulnerabilities can be due to hyperglycemia, which can weaken the immune system and damage important organs. COVID-19 does not only prosper in a high sugar environment, it seems to make it worse. Recent evidence suggests that the virus may cause new cases of diabetes.

David Slasher, a pulmonologist at Montgomery, Alabama, said that up to half of the COVID-19 patients in his local hospital ICU have diabetes. “They are often my most difficult patients,” he said, which may be because of the immune system’s reaction.

“Diabetes Belt”

The pandemic has struck several southern states and boasts the highest diabetes rates in the nation. A survey of state data by Reuters found that nearly 40% of COVID-19 deaths were in people with diabetes in Alabama, Louisiana, Mississippi, North Carolina, South Carolina, and West Virginia. Much of this area lies in what the CDC calls the “diabetes”.

According to CDC data, the proportion of diabetic adults in Alabama exceeds 13.2%, or more than 550,000. Diabetics accounted for 38% of state COVID-related deaths by June, officials said. Karen Landers, a health advisor to Alabama, said he was particularly worried about the deaths of diabetics in their 30s and 40s.

Health professionals in these states say they struggle to control their patients’ diabetes if their regular visit appointments are canceled or restricted because of a pandemic.

Salahunter Fraser, a nurse at the Medical Outreach Ministries Clinic for low-income residents of Montgomery, Alabama, said COVID-19 patients have common diabetes. She is in touch by phone or video chat because she has a pending visit to the clinic. If the problem persists, she requests an outdoor face-to-face meeting. “We meet them in the shade behind the clinic,” Fraser said.

In a similar fashion, doctors at the University of North Carolina have enhanced the use of telemedicine to reach at-risk rural patients. Despite all these efforts, John Buse, a doctor and director of the University’s Center for Diabetes, said that people are evading medical facilities because of fear of the virus, resulting in foot ulcers and dangerously high blood sugar He said he was confident that the value was overlooked.

“Under control”

Many diabetic patients with severe or fatal cases of COVID-19 were healthy before being infected with the virus.

Clark Osonitzki, 56, of Stillwater, Minnesota, had heard an early warning about the risk of coronavirus in people with diabetes, his wife, Chris Osonitzki, said. However, the couple did not think that the warning would apply to him because his glucose levels were in a healthy range.

“He was incredibly active,” she said.

On Sunday, mid-March, Osojnicki jogging with border collie Sonic on a dog agility course in a suburban Minneapolis gym. Three days later, Osoiniki had a fever, causing pain in his body, coughing and shortness of breath. He was immediately hospitalized on a ventilator. Financial system analyst Clark died on April 6 of a lung clot.

According to state data, Osozinki is one of the 255 deaths on the death certificate as of mid-July for people with COVID-19 and diabetes in Minnesota. The record lists people who died at the age of 34.

Work for insulin

For years, insulin’s soaring costs have fueled much of the country’s anger over drug prices. Early in the pandemic, the American Diabetes Association urged states to reduce out-of-pocket costs of insulin and other hypoglycemic drugs through state-regulated insurance plans.

However, ADA said no state is fully compliant with the advice. Vermont has suspended deductions for prophylactic drugs such as insulin since July. Other states have ordered insurers to make prescription refills more accessible, but did not mention costs.

68-year-old Robert Washington knew that his diabetes was at risk for COVID-19. When the employer of Lone Butte Casino on Gila River in Chandler, Arizona reopened in May, he decided to continue working as a security guard so he could buy insulin.

Washington’s supervisor had assured him that he could be patrolled alone in the golf cart, his daughter, Lina, said. But when he returned to work, Robert told his daughter that he was stationed at the entrance, where a long line of gamblers was waiting without a mask.

“He was scared of what he saw,” Lina said.

He was virus positive in late May and was hospitalized a few days later. He died from a complication of COVID-19 on June 11, his daughter said.

A week after Washington’s death, the casino was closed again after the COVID-19 incident exploded in the state. The casino did not respond to requests for comment.

“It’s hard to accept that he’s gone. Lina, a sports anchor and reporter for a television station in Sacramento, California, doesn’t want to call her.” Many of these deaths can be prevented in some way. was.”