COVID-19 outbreak

Latest updates on the coronavirus and heart disease

Find out more

The diabetes-heart connection and the threat of COVID-19

Most or all viruses often affect those with underlying illnesses more critically than those in relatively good health. COVID-19 (Coronavirus Disease-2019) is caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) which was identified at the end of 2019. The underlying illnesses that exacerbate risk to patients are diabetes, cardiovascular disease (CVD), and lung conditions, and some of these illnesses can often occur together. Understanding the inter-relationship of factors and treatment options make up one of our greatest challenges.

Many of us probably know that diabetes is a disease linked to levels of sugar (glucose) in the blood and the body’s production and use of insulin – and sometimes resistance to insulin — the hormone that helps keep those sugar levels safe. Perhaps less known is the fact that over time, erratic blood sugar levels in diabetics can eventually wear out blood vessels of the heart. Age, gender, ethnicity and socio-economic background play a role in our likelihood of developing diabetes and related heart disease. At the same time, diabetes has been called a ‘lifestyle’ disease because factors such as food choices, not smoking, and maintaining regular physical exercise can keep risk at bay or minimise the impact of illness.

The diabetes-heart disease link has been demonstrated in some research findings: for example at least 68% of people aged 65 or older with diabetes die from a form of heart disease and adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes. It has been noted that diabetes was also a risk factor for severe disease and mortality in the SARS and MERS outbreaks as well as in the A H1N1 pandemic in 2009, lasting longer in twice as many patients who were obese. And impaired immunity response in diabetics then – as now – has been an additional risk.

Looking at early data from China, USA, UK and developing countries as well, diabetes and heart disease show up among the top risk factors for complications with COVID-19. In Brazil, diabetes and cardiovascular disease are the leading underlying illnesses linked to death from COVID-19. The pattern seems to appear elsewhere, such as in small island states where diabetes is prevalent, with one paper citing Fiji and Mauritius as examples. As much as 73% of the COVID-19 deaths in India are reportedly linked to underlying health issues such as diabetes, hypertension, cardiovascular and respiratory diseases.

Reports from the Centers for Disease Control and Prevention (CDC) and other national health centres and hospitals showed that the risk of a fatal outcome from COVID-19 is up to 50% higher in patients with diabetes than in those who do not have diabetes. This pattern sends alarm signals for management of diabetes and heart disease, especially considering that 374 million people are currently at increased risk of developing type 2 diabetes, according to the International Diabetes Federation. Awareness is key in non-pandemic times, and even more so now. Diabetics do not always know that they are diabetic: in India, for example, more than of the 77 million diabetes patients in India are said to be unaware that they are diabetic and therefore ill-equipped to monitor and treat the illness.

‘Knowledge is power’ goes the age-old adage. Yes, awareness is key, but it is key across all sectors, not just among those directly impacted by diabetes or by heart disease. As Dr. Michael Mark — Boehringer Ingelheim’s former Head of Global CardioMetabolic Diseases Research Department — commented as part of World Heart Day 2019 ‘Heart Heroes’: “The most prevalent cause of mortality in people with diabetes is cardiovascular disease … Yet even today we have to educate many people, including endocrinologists and cardiologists, to consider this link between diabetes and cardiovascular disease.”

In addition to raising-awareness, critical changes in policy approaches are urgently needed. “A key pillar of CVD prevention among people living with diabetes is access to affordable and uninterrupted health services, comprehensive care and medicines. Improved education, access to care, and medical therapies are only possible with a health-in-all-policies approach, in addition to increased funding,” said Dr. Laurence Sperling, Katz Professor in Preventive Cardiology, Professor of Global Health, and Founder of the Emory Heart Disease Prevention Center. A practical roadmap to help prevent heart disease and diabetes gives us data at a glance, provides recommendations for effective interventions, and shares best practice in diagnosis and management.

Prevention of CVD in people with diabetes is a necessity and preventive strategies mostly focus on lifestyle management and risk factor interventions.  “Diabetes and CVD cuts across all sectors and income-levels but a disproportionate burden falls on low-and middle-income countries, struggling to provide preventive and medical care. A robust action plan must address and improve lifestyle practices including nutrition and exercise, with strategies to reduce risk factors or mitigate their impact,” said Karen Sliwa, President, World Heart Federation.

Meeting the challenge of treating those most at risk from COVID-19 is critical to enhancing care in the long-term. The pandemic is accelerating learning as we experiment and exchange among peers and patients alike. Management and treatment plans for COVID-19 might lead to medical approaches for diabetes, heart disease and hypertension further afield, also through increased applications of technology and digital innovation.  In addition, there could be increased emphasis on patient self-care. With diabetes being a lifestyle disease, the recent lockdowns worldwide might have generated or encouraged lifestyle changes and a strong connection to distance-learning initiatives that aid in self-management. Interestingly, a group of eminent diabetologists have recently published an article looking at whether COVID-19 may actually cause diabetes and have set up the COVID-19 diabetes tracker.

“It is more important than ever that we gain a deeper understanding of type-2 diabetes management and develop new solutions to address unmet patient needs”, commented Joris Silon, Senior Vice President, CVRM, AstraZeneca. “The Discover-NOW Hub is a unique partnership that brings together industry, technology, academic, research and health partners with an aim to revolutionise the way health information is used to treat and prevent disease in the future.”

The World Heart Federation is on a mission to bring about heart health for everyone. Especially with what we know about diabetes and heart health being heavily affected by lifestyle, it is truly a question of ‘leaving no heart behind.’ This means connecting the branches of science, government, industry, policy-makers and patients whose respective skills and experience can ensure the most holistic outcome.