The Center for Disease Control (CDC) has been warning of increased rates of diabetes in America for sometime. It refers to this as "prevalence," and in 1958 the "prevalence of diagnosed diabetes" was less than one percent. In 2015, it was 7.40%. One difficult question may be how much has actual prevalence increased, as the use of "diagnosed" suggests that some population may have suffered that disease in silence in the earlier period or even still. So, either diagnosis or the disease itself is notably increasing. This is particularly important because it is a percentage of population, which is also increasing. The raw numbers were 1.6 million in 1958 and 23.4 million in 2015.
That is of concern for a variety of reasons. First, diabetes is potentially debilitating. It is listed "in the Social Security Administration's impairment listing manual," or "Blue Book." The diagnosis alone is not sufficient to be determined disabled, but the results of the disease may rise to that level. Beyond disability, diabetes is expensive. The CDC says that $237 billion is spent annually on "direct medical costs and another $90 billion on reduced productivity." It is, according to the CDC, "the most expensive chronic condition in our nation."
Early in the pandemic, there were many reports of comorbidities that were noted in the delivery of care for those infected by SARS-CoV-2, COVID-19. In August 2020, Role of comorbidities like diabetes on severe acute respiratory syndrome coronavirus-2: A review was published in the Journal of Life Science. This article acknowledged that hypertension, cardiovascular disease, and chronic obstructive pulmonary disease (COPD) were major worries as regards COVID-19.
However, researchers also noted that
"The severity of COVID-19 disease intensifies in patients with elevated glucose level probably via amplified pro-inflammatory cytokine response, poor innate immunity, and downregulated angiotensin-converting enzyme 2."
In short, people with diabetes, particularly those who were not in that moment in control of their blood sugar, faced risk of a more severe bodily reaction to COVID-19. The journal articles were of academic interest to many. In a true "whose ox" or "whose backyard" mindset, I heard one speaker address this threat with simply "so only diabetics would be interested in that." False. I found the speaker's inclination to disinterest quite intriguing.
So, in summary, diabetes or diagnosis of diabetes has been increasing for decades, the disease is notably expensive, and those who have it potentially faced serious challenges from COVID-19.
But, in 2022, surprising news of a corollary nature. The CDC in 2022 published a study in which it monitored "more than half a million children under the age of 18." That is what they call a large study population, see Understanding Study Size. The conclusion in the CDC study is that "children who had COVID were more likely to be diagnosed with diabetes compared to those who have not had it." As yet, there has been no similar corollary regarding "hypertension, cardiovascular disease, and chronic obstructive pulmonary disease." In other words, having hypertension is potentially problematic if you contract COVID-19, but as yet there is no suggestion that if you contract COVID-19 you are more likely to be later diagnosed with hypertension.
In some part, this recent CDC finding regarding increased risk of suffering diabetes is tied in with the concept of the "long COVID." I noted the potential for a regressive impact of COVID-19 in COVID-19 Regressive Impact (May 2020), and further in Always on My Mind (February 2021). I was worried about its potential early and persistently. The idea that SARS-CoV-2 infection could produce lasting effects is absolutely not new. But, the suggestion that such an infection might predispose people, particularly young people, to a life-long disease process like diabetes is an intriguing and somewhat scary discussion.
Worse still, the CDC report documents the potential for an intensive care stay for such children with COVID-19 related to diabetes is also more likely. The treatment of their diabetes, it seems, is more challenging if the diagnosis or onset follows after a COVID-19 infection. From various perspectives, this news is significantly troubling.
First, the prevalence of infection with the Omicron variant is predicted to lead to the conclusion that "Most Americans eventually will be infected with the virus." That may be the "classic" COVID-19 or the "new" COVID-19 (at whatever point the infection occurs, we may be out of Greek letters by then). Possibly, some variants may produce less severe symptoms and perhaps will be less likely to predispose to diabetes, but the risks remain potentially significant.
Second, the rates of diabetes are increasing (or the diagnosis is) already. The increase in the volume of patients will drive greater volumes of necessary treatment and therefore expense. Notably, the CDC says that 60% of all diabetic costs are for people "mainly paid by Medicare." Thus, the expense is for us all. It represents a significant public health challenge, rates of diagnosis are increasing, and this pandemic is increasing the chances of the young suffering the disease; a disease they will likely then live with and treat for many years as they age and mature.
Finally, in the realm of workers' compensation, the CDC study regarding diabetes may suggest a heretofore unpredicted propensity for "long COVID" implications and expense. A result of COVID-19 as a workplace condition may result in a lifetime of treatment and benefits related to diabetes if a scientific cause and effect is demonstrated appropriately. In this regard, it is as important that we are less than two years into this pandemic. So, whether SARS-CoV-2 infection is similarly a cause of other more familiar disease process diagnoses, as is not seemingly suspected. But, it is possible that other diseases will have some tie back to COVID-19 as effects are researched in the coming years of study and research.
At a minimum, there will likely be increasing volumes of diabetic Americans. There will be more American workers suffering from this condition, and the potential that can present for comorbidity with workplace injuries cannot be ignored. Its presence in the workplace, as a potential aggravator of symptomatology for an injured worker, cannot be ignored by those who predict and price risk through workers' compensation insurance premiums.
So, does COVID-19 damage the pancreas in some manner and "cause" diabetes onset? Is there some underlying genetics that is somehow prone to diabetes and are triggered by the virus or the body's reaction to it? It is an intriguing consideration, added to our already growing list of questions we have about this virus and our futures.
