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

More than 400 million people are already living with type 2 diabetes and the number is rising on every continent. In the COVID-19 pandemic, diabetes has emerged as one of the most threatening underlying illnesses that complicates effective treatment. Diabetes was also a risk factor for severe disease and mortality in the SARS, MERS and H1N1 outbreaks. And impaired immunity response in diabetics then – as now – poses an additional risk. The currently diagnosed diabetics, and the more than 350 million people said to be at risk of developing the disease, make matters urgent for well-being and accessible care worldwide.  Furthermore, as many as half of those who have diabetes are unaware of it.

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. Erratic blood sugar levels in diabetics can wear out blood vessels of the heart and indeed, the most prevalent cause of mortality in people with diabetes is cardiovascular disease. This diabetes-heart disease link has been demonstrated in some research findings: 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.

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 healthy food choices, tobacco abstinence and regular physical exercise can keep risk at bay or minimise its impact. In addition to increasing awareness of the risks of diabetes and the healthy steps we can take, critical changes in policy approaches are urgently needed. These changes include fair access to appropriate care and the opportunities and means to afford heart-healthy choices in our daily lives.

Encompassing affordable healthcare, targeted medication, monitoring, education and access to healthy lifestyle options, the worldwide diabetes problem requires intervention on many levels. The World Heart Federation’s practical roadmap provides a framework to guide countries in developing their approaches to preventing heart disease and diabetes. The roadmap includes data at a glance, recommendations for effective interventions, and examples of best practice in diagnosis and management.

The numbers across the globe consistently reflect the compounded impact of the current pandemic on diabetes patients. One Lancet study that looked at 61 million medical records in the U.K showed that at least one-third of COVID-19 deaths occurred in diabetic patients. In early data from China, USA, and developing countries as well, diabetes and heart disease showed up among the top risk factors for complications with COVID-19. In Brazil, diabetes and cardiovascular disease have been described as 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.  But what about the other way around – could COVID-19 also cause diabetes? It is an avenue of research being explored as scientists look at the impact the disease might be having on patients with no previous diabetic issues.

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.

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, policymakers and patients whose respective skills and experience can ensure the most beneficial outcome.