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Understanding coronavirus risks in people with diabetes

Dr Jamie Hartmann-Boyce has lived with type 1 diabetes for 26 years. She is also an Associate Professor at the Nuffield Department of Primary Care Health Sciences, University of Oxford. She has two small children and a black Labrador puppy, and loves nothing more than exploring the seashore with them in tow. Here Dr Jamie tells us about her research into coronavirus and diabetes. 

Dr Jamie Hartmann-Boyce

I’m a healthcare researcher at the University of Oxford, and before March 2020, hadn’t done any research on coronavirus risk and diabetes. This wasn’t because I wasn’t interested – it was because I worried I was too interested. I was diagnosed with type 1 diabetes when I was 10. It just felt safer to keep work separate. But then along came COVID-19.

Like many people with diabetes, I was immediately concerned that having diabetes would put me at greater risk. I started looking into if this was the case, and if so, how much of a greater risk. I pulled together the limited data I could find, trying to make sense of it. That came naturally to me, because a big part of my job is conducting systematic reviews. This means bringing all of the evidence together in a certain area, to help people make evidence-based decisions.

It struck me that if I was interested in this, other people would be, too. So I decided to put what I found out there, in a rapid review. The evidence then, in spring 2020, was scant, but it did suggest people with diabetes were at an increased risk. My interest grew from there.

I was delighted when, later in 2020, the World Health Organization approached me to review the evidence on COVID-19 risks in people with diabetes in more detail. Together with a wonderful team made up of clinicians, healthcare researchers, and students, we sifted through 112 systematic reviews looking at risks from Covid-19 in people with diabetes. Our research brought together the most comprehensive evidence we could find.

The results, which we recently published, were striking. The reviews provided clear, consistent evidence that diabetes is a risk factor for serious disease and death from Covid-19. There was less data available on admission to intensive care, but where available this data also signalled increased risk.

Coronavirus risk with diabetes

Within people with diabetes, higher blood sugar levels both prior to and during COVID-19 illness were associated with worse outcomes. Type 1 diabetes was associated with worse outcomes compared to type 2 diabetes.

Over the course of this research, I was often struck by all the ways in which people with diabetes have been affected by this pandemic. Many of these aren’t to do with the direct risks of COVID-19, which are worrying enough, but with the indirect effects, including on things like access to healthcare and medications.

Though none of these were findings I welcomed, it felt like finally I was able to use my experience of living with diabetes in a positive way.

Biting the bullet and diving into diabetes research has been indescribably rewarding. It has been eye opening to work with researchers and clinicians in this field, and a new experience for me to wear both a ‘patient’ and ‘researcher’ hat at the same time.

I hope the findings from our review help healthcare providers and policymakers continue to make decisions that support people with diabetes, during COVID-19 and beyond.

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