Preparedness attenuates COVID-19 risk among people with diabetes and obesity

30 Oct 2021
COVID-19, Type 2 diabetes

Reduce the risk of dying from COVID-19 by getting vaccinated, continuing to observe infection-prevention measures, and practising good self-care

A woman had Type 2 diabetes, hypertension (high blood pressure) and obesity. Fearing COVID-19, she did not go for her usual medical follow-up. However, she did receive her first dose of the COVID vaccine. She also made it a point to take every other precaution, such as staying home as much as possible.

Unfortunately, she caught COVID-19 and was admitted to a local hospital on day 6 of her illness in category 4. She deteriorated rapidly and was transferred to the Intensive Care Unit. Despite all measures, including mechanical ventilation, she succumbed from multiorgan failure 4 days after admission. She was only 49 years old.

Diabetes and obesity contribute to severe COVID-19

This tragic case reaffirms what was known since the beginning and still holds true – that the risk factors for severe COVID-19 and death include advancing age (over 60 years old), diabetes, hypertension, kidney problems, heart disease and obesity. [PLoS ONE 2020;15(12):e0243191] The more risk factors are present, the more it will be like living with a ticking time bomb.

Local statistics reaffirm those observed in other countries. Latest COVID-19 mortality data released by the Malaysian Institute of Clinical Research on 29 August 2021 revealed:

•          Approximately one Malaysian has died for every 1,000 persons infected with COVID-19 (case-fatality rate = 0.94%)

•          Men were more at risk (58% males vs 42 % females)

•          Six-in-10 deaths occurred in those older than 60 years of age

•          Eight-in-10 deaths (82 percent) occurred in people with at least one comorbidity – three-in-10 had hypertension; two-in-10 had diabetes; one-in-12 had kidney disease.

Diabetes is a major contributor to severe COVID-19 morbidity and mortality. High blood glucose impairs the immune function and reduces the body’s ability to fight infections. As such, individuals with poorly controlled diabetes prior to COVID infection will be at greater risk for severe COVID-19 disease, pneumonia, intensive care admission and death. [Diabetes Metab Res Rev 2021:e3476, Cell Metab 2020;31(6):1068–1077] 

This is evidenced by how three to four-in-10 people who required intensive care in hospital due to severe COVID-19, or who died from the viral infection, had diabetes. [Clin Infect Dis 2021;72(11):e695–e703] An equally sombre fact is that one-in-four people with diabetes who were admitted to ICU for COVID-19 ended up dying. [Arch Med Res 2020;51(7):700–709]


These statistics underscore why people with diabetes seriously need to prevent COVID-19. They are not more likely to catch the infection as anyone else. [J Endocrinol Invest 2020;43(6):867-869] However, once infected, they are three times more likely to develop severe COVID-19 pneumonia, other end-organ damage, and to die. [Diabetes Care 2021;44:526–532]

Obesity is another major COVID-19 risk factor. It was initially thought to be an innocent bystander because of its close association with diabetes, hypertension and cardiovascular disease which are known to predict risk of severe COVID-19.

However, recent data from large studies has confirmed that obesity is a strong and independent determinant of increased risk of severe COVID-19. In fact, obesity is thought to shift the risk of severe COVID-19 to younger age groups. [Lancet 2020;395(10236): 1544–1545] That means a younger overweight/obese person aged <50 years is more likely to suffer severe COVID-19 infection (like the patient described at the start of this article).

Obesity has truly exposed the underlying poor metabolic health of our population. Our 2019 National Health and Morbidity survey found that one-in-two adult Malaysians are overweight or obese; and one-in-five adult Malaysians has diabetes. These unfortunate facts are partly responsible for our COVID-19 statistics skyrocketing with the accompanying high mortality over the past 3-4 months.

For those with diabetes, prevention is essential

As social restrictions get lifted and people start travelling (possibly even to balik kampung), it is imperative that all the precautions to avoid catching and developing severe COVID-19 are maintained.

Remember to maintain physical distancing, wear a face mask, and wash/sanitise hands frequently. This is even more important when interacting with unvaccinated family members and friends.  

Research has confirmed that the currently used vaccines in Malaysia are effective, including for people with diabetes. Therefore, those who have not been vaccinated should get it immediately.

Unfortunately, as with most vaccinations, the protection is not 100 percent. Infection may still occur after getting vaccinated (breakthrough infection), but chances of severe disease and mortality is significantly reduced. In any case, patients should avoid situations that put them at risk of COVID-19 infection.

Extra precaution is necessary

People with diabetes often have other related risk factors eg, increasing age, hypertension, obesity, abnormal kidney function, and heart disease. By keeping healthy, they will avoid giving the virus opportunities to cause harm.

Unfortunately, throughout the pandemic, many such individuals neglected to control their blood glucose, hypertension, and body weight. Some even missed their doctors’ appointments. Perhaps they were thinking that their medical conditions would disappear just because they were staying home.

Persons with diabetes need to pay attention to their glucose control as it can significantly reduce their risk of severe COVID-19 infection and related mortality. Advise patients to take medications as prescribed, watch their diet, stay physically active, and monitor their glucose levels regularly. Also, be sure to manage their blood pressure and other chronic health conditions and reduce overweight/obesity. Last but not least, remind them to attend their medical follow-ups without fail.

COVID-19 has had a devastating effect on everyone, but most of all, on the population with diabetes and obesity. So, stay safe, keep healthy and ensure your patients have been vaccinated against COVID-19 to keep the virus at bay.

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