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