What’s the real risk of dying from Covid 19 in diabetes?

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The risk of dying from covid 19 if you have diabetes

This week data was published looking into the chances of dying from Covid 19 if you have diabetes. On the face of it, the figures are grim and no doubt worrying for people with diabetes.

These are worrying times for everyone. I imagine many people are feeling anxious and stressed about what will happen in the future. Then throw this latest data on top of an already stressful situation and I suspect people with diabetes don’t know what to do.

In fact, we’ve been receiving calls at work and I’ve had many comments on our Facebook group with people asking what should they do? Should you go back to work? Should you continue to self isolate from anyone who has contact with the outside world.

Therefore, what I wanted to do today was publish a blog on how to interpret this data. My hope is to try help you reduce some of the stress and explain why it might not be as bad as it seems.

This shouldn’t mean you should throw caution to the wind and ignore all government advice. However, when interpreting data we often need to put it into context.

Hazard Ratios

Hazard ratios are used in health care to explain the risk of something happening. There are 2 components to this. Relative risk explains how likely something is to happen to you compared to the average person. Absolute risk looks at how likely something is to happen in the grand scheme of things.

Relative risk

If it is no less likely something will happen to you compared to the average person, the relative risk score is 1. Anything below 1 means you are less likely to have something happen to you. If the score is above 1 you are at greater risk.

Therefore, if you have a hazard ratio of 2, it means something is twice is likely to happen to you. If the score was 10, the risk is 10 times greater.

Data was published this week looking at the hazard ratio of people dying from Covid 19 if they have diabetes. It seems people with type 1 diabetes are 3.5x more likely of dying from Covid 19 compared to people without diabetes. Whereas people with type 2 diabetes are 2x more likely to die of Covid 19.

Absolute Risk

The total number of Covid 19 cases is unknown. Therefore, we have no idea what the true death rate is. At the time of writing it is assumed to be less than 1%. This means less than 1% of people catching Covid 19 will die from it. In other words, more than 99% of people will live.

To help highlight the absolute risk lets assume the death rate is actually 1%. If everyone caught Covid 19 in the UK around 65 million people will be infected. The population of the UK is slightly more than this but lets use this as it’s a nice round number.

1% of 65 million is 650,000 people. Therefore, the death rate is roughly 1 in 650,000 people and actually likely much less. Try to imagine 650,000 people lined up and only 1 person being picked out the line. The chances of it being you is very slim.

People with type 1 diabetes are 3.5x more likely to die of Covid 19. In other words, 3.5 people out of 650,000 people will die with Covid 19. With type 2 diabetes 2 people out of 650,000 people with die with Covid 19.

I appreciate this isn’t great if you are one of these 2-3.5 people but the overall risk remains very small of this happening to you.

High risk patients

We do need to address one elephant in the room. The vast majority of the people dying from Covid 19 are from high risk groups. The big risk factors appear to be age, gender, medical history, ethnicity and lifestyle. So the vast majority of people dying from Covid 19 will be made up of these people.

Therefore, this may increase the likelihood of you suffering complications with Covid 19 as we can exclude many low risk individuals from the 650,000 people. So the total number we compare 2-3.5 against is less.

Nonetheless, even the highest risk group which is people over 80, have a better chance of survival than death. 1 in 5 people once admitted to hospital are dying from Covid 19. A 20% chance of death. However, 80% live.

Don’t get me wrong. A 1 in 5 death rate is tremendous for an infectious disease. However, this is for the absolutely most vulnerable group and only looks at hospital data. There will be countless people over 80 who have caught Covid 19 and not been admitted to hospital. So we really don’t know the real relative or absolute risk. The chances of being admitted to hospital in the first place are very low.

If you are elderly, have diabetes, are from a black, asian or middle eastern heritage, overweight, unfit and eat unhealthy, then you begin to tick a lot of the high risk boxes. This does not automatically confine you to a death sentence though. It just increases your risk.

Ultimately, the risk remains very unlikely for everyone but those at higher risk just need to take more precautions compared to someone who is low risk.

HbA1c and the link to death

It seems the link between poorer health outcomes, covid 19 and diabetes has a lot to do with your glucose levels. People with higher glucose levels do not do as well if catching Covid 19.

This could be because high glucose levels suppress the immune system making it difficult for your body to fight infection.

We also need to keep in mind the relative risk stats will only reflect an average of all people with diabetes. For example, last year it was reported around 32% of people with type 1 diabetes achieved target glucose control. This is the highest it has ever been. However, it also means 68% of people were above target. I’m not saying it’s easy to reach target glucose levels and won’t pretend it is. The point is, if Covid 19 mortality is linked to HbA1c, then the 3.5 relative risk score in type 1 diabetes will be skewed because the majority of people in type 1 diabetes have, on average, high glucose levels.

The risk if you have target glucose control will therefore be lower. The same principle will apply with type 2 diabetes. A patient who is overweight, has high glucose levels, can’t walk very far and has multiple other health conditions has a very different risk compared to someone who has type 2 diabetes but is trying to live healthily with limited co-morbidities. Yet, both these patients will be stratified under the type 2 diabetes banner.

Summary

The hope for this post was to help reduce some of the anxieties you may be feeling by explaining the true risk of dying from Covid 19. The risk is very low.

Obviously, there are people dying with it so despite the risk being low, it is still happening to people. I guess it’s like getting struck by lightening or winning the lottery. The risk is very low but it does happen to someone.

So what can you do to lower your risk even further?

The first thing is try to get your glucose levels under control and within target as frequently as possible. Eat healthy and try be as active as possible. I know it’s not easy but these are the variables you can control. If you need a helping hand check out the other posts on this blog to see if there’s anything that can help you there.

If you’re really struggling, look at my type 2 diabetes recovery programme or my 1:1 consultancy services which are designed to help you lower your HbA1c’s and prevent the risk of complications long term.

I hope this has helped and I will see you next time.

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