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The Links Between Type 2 Diabetes and Severe Covid-19 Illness

december 16, 2020

If you have been hiding in your pandemic bubble, you might have missed that chronic health conditions play a major role in the severity of Covid-19 illness. As I predicted in this early blog here based on preliminary data, those countries with the highest levels of diabetes (type 1 and type 2 diabetes), obesity and high blood pressure would be hit hardest… ahem the USA.  Sadly in Europe we are not too far behind, as more than 75% of the population has one or more risk factors for severe illness with Covid-19. (1) Unfortunately, many of these chronic health conditions couple with one another, so close to 50% have 2 or more of them. Not good! 

Type 2 diabetes is a common chronic condition that increases the risk of severe Covid-19 illness, caused by the SARS-CoV-2 virus. Several physiological changes that accompany Type 2 diabetes make the risk of infection, along with the severity of infection, much worse. This is due to:

  • Chronic inflammation – causes damage to our cells and tissues, making them more susceptible to viral infection. Also impairs our ability to form a proper immune response. (2)
  • Increased intestinal permeability – “Leaky gut” increases our baseline levels of inflammation and promotes a hyperactive immune response. (3, 4)
  • Increased Dipeptidyl peptidase-4(DPP4) expression – DPP4 is a receptor/enzyme that SARS-CoV-2 uses to infect cells. (5)
  • Increased Angiotensin converting enzyme-2(ACE2) expression – ACE2 is another receptor that SARS-CoV-2 uses to infect cells. (5)

This creates an internal environment where infection with SARS-CoV-2 is more likely and more severe. Fortunately, Type 2 diabetes is a condition that responds well to changes in lifestyle, particularly weight loss. Weight loss reverses the pathological changes that occur in Type 2 diabetes mentioned above. This includes decreased ACE2 expression (6), decreased DPP4 expression (7), and a resolution of both intestinal permeability (8) and chronic inflammation (9). 

Take Your Lifestyle Seriously and Avoid Type 2 Diabetes

Type 2 diabetes and severe Covid-19 outcomes are common. Diabetics are predisposed to SARS-CoV-2 infection and severe Covid-19 illness, a double-whammy. Fortunately, it is amenable to changes in lifestyle, particularly weight loss. The changes might include calorie restriction, increased physical activity, and consuming a diet higher in fiber and whole, unprocessed food. Losing weight reverses the pathological changes that accompany Type 2 diabetes, and thus, may be an effective way to decrease risk of infection and severity of illness. Time to take your lifestyle more seriously.


1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491580/
2. https://pubmed.ncbi.nlm.nih.gov/31657690/
3. https://www.medrxiv.org/content/10.1101/2020.11.13.20231209v1.full
4. https://www.researchgate.net/publication/309143282_Increased_intestinal_permeability_as_a_risk_factor_for_type_2_diabetes
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426477/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246964/
7. https://www.frontiersin.org/articles/10.3389/fendo.2019.00505/full
8. https://www.nature.com/articles/s41598-017-12109-9
9. https://pubmed.ncbi.nlm.nih.gov/30390883/

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