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, 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.

References

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/

This is a guest post. Any opinions expressed are the writer’s own.
Photo by Heather Barnes on Unsplash.