Those with diabetes, dementia and chronic pulmonary disease at high risk

[BeforeIPutOnMyMakeup]

According to Sky News if you have diabetes, dementia or chronic pulmonary disease you are at high risk of dying from Covid-19.

They can't clarify whether it is type 1 or type 2 diabetes.

news.sky.com/story/coronavirus-a-quarter-of-covid-19-patients-who-died-in-england-had-diabetes-11988326

I've done a bit of research into dementia due to genetic history and it often links with cardiovascular disease, it seems, in particular vascular dementia so could be a link there. And of course the very elderly as well (much higher rate in over 80s)

I thought most elderly had hypertension. Need to know hypertension rates among the survivors to know if it's that important.

So are diabetics finally going to be put on the shielding list? Given they're the most clinically vulnerable.

They are not necessarily the most clinically vulnerable.

The numbers of cases are also related to the number of people with the condition.

The shielding list have, based on data from other countries and experience with similar illnesses, an exceptionally high chance of death it life-changing severity of illness. Without knowing the number of people living with diabetes, we don't really know if the number of deaths is anywhere near the level of those expected from the 'shield' comorbidities. Where of course we are seeing fewer deaths because they are barely going out (advice I'd medical appointments only), and are advised to isolate even from their cohabitants in the home. And to do so indefinitely.

I know that sounds unsympathetic. But shielding is a huge and tough thing to ask of someone. And I think you need to be very clear that the risk to the population with diabetes really is that severe before making such a massive demand on them.

Diabetes UK say that 6% of the UK have diabetes. I imagine there are larger numbers with prediabetes, but the difference in the figures is significant.

Found more information here:
covid.joinzoe.com/post/diabetes-covid-risk

Diabetics are at higher risk than the general population but they don't know why and are doing more research.

I'm type 1
Why aren't we shielded then.
I've been working in a public facing role since this started.
Joy

@jellybeanz1212 the problem is the shielded list keeps changing.

If your diabetes is under control so you have no other health issues you are on the vulnerable list and you should ask your employer to do a risk assessment. However unless you are in an union and/or have a nice employer you have f-all chance of getting that.

Def F all chance, I just look after myself best I can, not worth dying for min wage

I think a paper is going to be published this week in a medical journal (?BMJ) with more details about the type1/type 2 break down. With the previous reports about obesity, abdominal fat, metabolic disorder and inflammation and Covid-19 it sound like type 2 is likely to be more of a factor. However, I suppose I shouldn't pre-empt the research!

nether the data from the very start, as soon as we had info out of China, back in January and February, showed diabetes as one of the highest risks of all. It was always shocking that the government didn't include them on the shielding list. They've included people taking immunosuppressants despite evidence suggesting these drugs might have a protective effect. It's early days obviously and it's good they're being cautious by protecting potentially vulnerable people. But it seems odd to include them whilst excluding clearly higher risk diabetics.

The number of hospital deaths for those with diabetes homtested positive for CV is 5873, of a population of those with diabetes of 4.8million. So that represents - on crude and very incomplete data (nothing on co-morbidities or age) about 0.1%

The death rates for the conditions in the shield list, based on data from overseas mainly, is over 5%. But the crude numbers are lower because there are fewer people.

I know where the gaps/assumptions are in how I have set this out! But I thought it was worth doing because I wanted to write out the version which does not show the same level of scaremongering.

Yes, deaths appear to show an overrepresentation. But that's really ott the whole story. And that's what the charities are saying too.

I hope there can be a proper study, controlled for age, sex, race, other comordities and factors we already know to relevant; and that this is done before imposing the shield, a tough and indefinite regime, on a further group

They've included people taking immunosuppressants despite evidence suggesting these drugs might have a protective effect.

Do you mean Brutons TKIs? Or other meds?

I ask because the blood cancer drugs which help regulate WBC production are being examined as a treatment. However, all blood cancer patients - whatever stage and type - are on the shielding list.

Generally though, immunosuppressant drugs have a 'protective' effect because a patient who requires them is likely to be in considerably worse nick if unmedicated.

Have you got a link for the death rate comorbidities please. I'd be interested to see. There's still so much to learn. I've been following this since January and what jumped out at me from the start, when figures first came out of China, was the very high death rate amongst diabetics. It was something like 10% of all dead from Covid. I've come on here before breakfast (must take a break!) but I'll try to find some links later. The highest death rates going back to January were diabetes, cardiovascular issues, and severe respiratory conditions (but not necessarily asthma, which is less clear).

Some of the drugs that doctors have used to treat patients (worldwide) include tocilizumab, steroids, and immunoglobulin. Any drug is still in trial stage but some countries have found these, amongst other drugs, helpful with preventing or treating severe immune overreactions with Covid.

The shield isn't a tough and imposing regime. It's not mandatory. It does, however, give the person protection if they want it. They don't have to take the protection if they don't want to.

Extremely vulnerable people not on the shielding list can be forced back to work regardless of the risks. They don't get priority for delivery slots leaving them potentially unable to self isolate. It's also morally wrong to give false reassurance. Some people might assume not being shielded means they're not high risk. It doesn't sit well with me. Not when one in four deaths are in diabetics. Like I say other conditions including asthma are very common yet the highest death rates are amongst diabetes. Clearly it's very high risk.

This thread shows a total failure to distinguish between Type 1 and Type 2 diabetes. The term 'diabetes' is being used as a synonym for Type 2. There are significant differences between Type 1 and Type 2. This is a parenting website. For any parents with a Type 1 child, when these figures are analyzed, it is likely that they will show a dominance of Type 2.

Type 2 can be managed and even reversed with diet changes and exercise, there are many NHS programmes to help with this.

if it were me I'd be looking at working on that to be honest

Remission is possible www.diabetes.org.uk/diabetes-the-basics/type-2-reverse

The figures are unclear whether it's all types (some experts believe there are four or more different types).

I suspect you're right. It looks like there's a link between obesity and obesity related conditions including type 2. They think it could be related to inflammation particularly linked to abdominal fat. I'm not sure if type 1 is also a risk. Researchers are looking into autoimmune links. It's possibly the case that all types are a risk but young age counteracts that?

I believe type 2 is increasingly seen by experts as autoimmune rather than metabolic. I don't know if there's a consensus on this or whether it's being debated. It's worth noting whilst obesity is one of the most common links there are other causes. At least 10-25% of cases.

I'm sure I've read remission doesn't work for all type 2 cases. I wonder whether perhaps it depends on the cause?

Like I said upthread I'm not speaking for myself. I don't have diabetes. I'm concerned for other people. I see every life as valuable and think the condition with the highest death rate should be on the shielding list.

I very much doubt somebody could do enough to go into remission in time to be protected from Covid. If it works it would take months. Given the strong links between poverty and obesity it's clearly also not as simple as telling somebody to 'eat less and exercise more'. Lots of people gain weight because of poor mobility (often whilst waiting months and months for treatment) or poor MH. Either the actual MH issues or side effects of some psychiatric drugs. Other non MH medications and conditions like thyroid issues can also cause weight gain.

Toffee

I suspect you're right. It looks like there's a link between obesity and obesity related conditions including type 2

It has been described as a 'diabesity' epidemic. The statistics are stark. Type 2 accounts for 90 percent of diabetics. The risk factor? Weight. The word 'diabetes' has been colonised by Type 2. When people use the word diabetes? The image they have is of a stereotypical Type 2. These Covid statistics; without relevant analysis which differentiates between Type 1 and Type 2, which includes comorbidities such as obesity and whether the patient has rigorously controlled blood sugar or elevated, uncontrolled blood sugar? They are not helpful to Type 1s. Not at all.

www.diabetes.co.uk/type2-diabetes.html

www.diabetes.co.uk/diabetes-and-obesity.html

Well it might not work for some but I'm just saying that if I had type 2 it would be well worth a try if it could get me out of a vulnerable group...

yes the virus seems to be worse in those with metabolic obesity related health conditions...most of which are preventable...

10% of type 2 Diabetes cases aren't caused by obesity. Whilst it's the biggest cause it's clearly not the only reason.

It's unfair to say they've 'colonised' diabetes. It's not their fault how it's reported. It's equally unfair that the media all too frequently links the word 'choice' with 'lifestyle'. It happens all too frequently when obesity is discussed. I've outlined the complex issues around obesity and the strong link to poverty in my previous post.

I agree with you that it would be more helpful for all diabetics if there was clearer distinction and better awareness about all types. It's very wrong, however, to victim blame type 2. I'm not suggesting you were doing that btw. It's just something I see too often.

I agree @Orangeblossom78
A lot of it is preventable. The government could tackle poverty. Provide proper housing with proper access to cooking facilities and storage, ensure people could afford a varied diet of fresh healthy food, overhaul the NHS - focus on preventative care, early treatment before people lose mobility, end the practice of dismissing patient's symptoms (particularly women) as anxiety (very common with thyroid conditions for example), consider different non weight gain causing psychiatric drugs for long-term use, provide MH treatment for comfort eating.
Yes all possible.

In the meantime people are vulnerable to Covid right now. It's impossible to change anything overnight. They need to be on the shielding list regardless of what long-term help might be given to enable them to try for remission.