More than 35 million people in the United States have diabetes, which has been linked to worse outcomes from COVID-19. During National Diabetes Month, Keck Medicine of USC experts discuss how the pandemic has affected people with diabetes and what they can do to protect their health.


The unique risk COVID-19 poses for people with diabetes

“Diabetes does not necessarily make you more likely to contract COVID-19 but does increase the risk of becoming severely ill or dying from complications. Patients with both Type 1 and Type 2 diabetes have hyperglycemia, which means their glucose (blood sugar) levels are high. High blood sugar levels can impair a person’s ability to fight off infection, such as the SARS-CoV-2 virus that causes COVID-19. People with diabetes also have more inflammation throughout their body, which can impair organ function. COVID-19 is also associated with inflammation, so having both diabetes and the coronavirus can be dangerous.

“The majority of people with Type 2 diabetes are also overweight or obese, and obesity has been found to be another risk factor for severe COVID-19. Type 1 diabetes, however, is not usually connected with being overweight, so these patients typically do not share this secondary risk.”

Katie Page, MD, is a diabetes specialist with Keck Medicine and an associate professor of medicine and co-director of the Diabetes and Obesity Research Institute at the Keck School of Medicine of USC.


Preventive steps people with diabetes can take to protect their health if they get COVID-19

“Data shows that people with diabetes who have COVID-19 have better outcomes if they have more normal blood sugar levels. One way to control blood sugar levels is through diet and exercise. Patients with both Type 1 and Type 2 diabetes should follow a healthy diet (more fresh fruits and vegetables and less refined carbohydrates) and get at least 30 minutes of aerobic exercise five times a week. One exercise session can lower blood sugar levels for up to 36 hours afterward. Over time, a healthy diet and regular exercise can also lead to weight loss, which also lowers glucose levels. In addition, it’s important that people with diabetes stay on top of their medication regimens during the pandemic.

“This advice is especially critical for Latinos who, in Los Angeles County, are nearly twice as likely as non-Hispanic whites to have diabetes and who make up 73% of all hospitalized COVID-19 patients.

“However, my message to everyone with diabetes is the same: You can make a difference in your health. The better you control your diabetes, the greater your chance of having better outcomes should you contract COVID-19.”

Anne Peters, MD, is director of the USC clinical diabetes programs and a professor of medicine (clinical scholar) at the Keck School.


COVID-19 treatments for people with diabetes and the possibility of a COVID-19-induced diabetes

“We have not yet seen any COVID-19 treatment to be specifically beneficial for patients with diabetes. However, diabetes may affect the risk and benefits of a treatment. For example, steroids, which are used to treat some COVID-19 patients, can cause blood sugar levels to rise sharply, particularly in someone with diabetes. So, the possible benefits of using this therapy for a COVID-19 patient with diabetes may be outweighed by the risk.

“Interestingly, we are also seeing what some might call COVID-19-induced diabetes. In one study, hyperglycemia occurred in 14.3% of hospitalized COVID-19 patients who did not have preexisting diabetes. COVID-19 patients with hyperglycemia are often given insulin to lower their blood sugar levels. In some cases, a patient may continue to have hyperglycemia after recovering from COVID-19. In general, however, COVID-19-induced high blood sugar should not be a permanent condition once the patient has healed unless the person had undiagnosed diabetes before contracting the coronavirus. More research will need to be done to fully understand this phenomenon.”

Trevor Angell, MD, is a diabetes, endocrinology and metabolism specialist with Keck Medicine and an assistant professor of clinical medicine at the Keck School.


How the pandemic is affecting foot ulcers, one of the most common and dangerous side effects of diabetes

“Half of all people with diabetes will develop diabetic neuropathy, which causes numbness as a result of dying nerves, usually in the feet. With this condition, people may develop a foot sore without knowing it. If the wound becomes infected, this may result in the foot having to be amputated. In fact, there is an amputation around the world every 20 seconds due to foot ulcers caused by diabetes.

“During the pandemic, we are urging patients to seek regular checkups because foot sores can creep up silently and quickly. The Keck Medicine wound healing and limb preservation team sees patients in-person or through virtual visits and asks them to send foot selfies so we can track and treat any wounds. A recent study showed that telemedicine is just as effective as office visits in stopping diabetes-caused foot infections. In fact, telemedicine has worked so well for Keck Medicine that we have actually seen a downturn in hospitalizations for foot ulcers during the pandemic.”

David G. Armstrong, DPM, PhD, is a surgical wound care specialist with Keck Medicine and a professor of clinical surgery at the Keck School.