Why COVID-19 is killing U.S. diabetes patients at alarming rates

By Chad Terhune, Deborah J Nelson and Robin Respaut

Devon Brumfield could hear her father gasping for breath on the phone.

Darrell Cager Sr, 64, had diabetes. So his youngest daughter urged him to seek care. The next day, he collapsed and died in his New Orleans home.

The daughter soon learned the cause: acute respiratory distress from COVID-19. His death certificate noted diabetes as an underlying condition. Brumfield, who lives in Texas and also has type 2 diabetes, is “terrified” she could be next.

“I'm thinking, Lord, this could happen to me,” she said of her father's death in late March.

She has good reason to fear. As U.S. outbreaks surge, a new government study shows that nearly 40% of people who have died with COVID-19 had diabetes. Among deaths of those under 65, half had the chronic condition. The U.S. Centers for Disease Control and Prevention analyzed more than 10,000 deaths in 15 states and New York City from February to May. Jonathan Wortham, a CDC epidemiologist who led the study, called the findings “extremely striking,” with serious implications for those with diabetes and their loved ones.

A separate Reuters survey of states found a similarly high rate of diabetes among people dying from COVID-19 in 12 states and the District of Columbia. Ten states, including California, Arizona and Michigan, said they weren’t yet reporting diabetes and other underlying conditions, and the rest did not respond - rendering an incomplete picture for policymakers and clinicians struggling to protect those most at-risk.

America’s mortality rates from diabetes have been climbing since 2009 and exceed most other industrialized nations. Blacks and Latinos suffer from diabetes at higher rates than whites and have disproportionately suffered from COVID-19.

“Diabetes was already a slow-moving pandemic. Now COVID-19 has crashed through like a fast-moving wave,” said Elbert Huang, a professor of medicine and director of the University of Chicago’s Center for Chronic Disease Research and Policy.

Keeping diabetes under control - among the best defenses against COVID-19 - has become difficult as the pandemic disrupts medical care, exercise and healthy eating routines.

The high price of insulin has also forced some people to keep working - risking virus exposure - to afford the essential medicine. And as the country grapples with an economic crisis, millions of Americans have lost their jobs and their employer-sponsored health insurance.

Much of this could have been anticipated and addressed with a more comprehensive, national response, said A. Enrique Caballero, a Harvard Medical School endocrinologist and diabetes researcher. Top health officials should have done more to emphasize the threat to people with diabetes and assuage their fears of hospital visits, he said, while also focusing more on helping patients manage their condition at home.

Policymakers had ample warning that COVID-19 posed a high risk for diabetes patients. In 2003, during the coronavirus outbreak known as SARS, or Severe Acute Respiratory Syndrome, more than 20% of people who died had diabetes. In 2009, during the H1N1 flu pandemic, patients with diabetes faced triple the risk of hospitalization. Most recently in 2012, when the coronavirus Middle East Respiratory Syndrome, or MERS, emerged, one study found 60% of patients who entered intensive care or died had diabetes.

The COVID-19 pandemic, however, has unearthed previously unknown complications because it has lasted longer and infected many more people than earlier coronavirus epidemics, said Charles S. Dela Cruz, a Yale University physician-scientist and Director of the Center of Pulmonary Infection Research and Treatment.

Doctors warn that the coronavirus pandemic may indirectly lead to a spike in diabetes-related complications - more emergency-room visits, amputations, vision loss, kidney disease and dialysis.

“My fear is we will see a tsunami of problems once this is over,” said Andrew Boulton, president of the International Diabetes Federation and a medical professor at the University of Manchester in England.


Researchers have scrambled for months to unravel the connections between diabetes and the coronavirus, uncovering an array of vulnerabilities.

The virus targets the heart, lung and kidneys, organs already weakened in many diabetes patients. COVID-19 also kills more people who are elderly, obese or have high blood pressure, many of whom also have diabetes, studies show.

On the microscopic level, high glucose and lipid counts in diabetes patients can trigger a “cytokine storm,” when the immune system overreacts, attacking the body. Damaged endothelial cells, which provide a protective lining in blood vessels, can lead to inflammation as white blood cells rush to attack the virus and may cause lethal clots to form, emerging research suggests.

“It’s all one big puzzle,” said Yale’s Dela Cruz. “It’s all interrelated.”

Many of their vulnerabilities can be traced to high blood sugar, which can weaken the immune system or damage vital organs. COVID-19 appears not only to thrive in a high-sugar environment but to exacerbate it. Recent evidence suggests the virus may trigger new cases of diabetes.

David Thrasher, a pulmonologist in Montgomery, Alabama, said up to half of COVID-19 patients in his local hospital ICU have diabetes. “They are often my most challenging patients,” he said, and the immune system response may be a big reason why.


The pandemic has ripped through several southern states with some of the nation’s highest diabetes rates. A Reuters examination of state data found that nearly 40% of COVID-19 deaths were people with diabetes in Alabama, Louisiana, Mississippi, North Carolina, South Carolina and West Virginia. Much of this area lies within what the CDC calls the “diabetes belt.”

Alabama has the highest percentage of adults with diabetes at 13.2%, or more than 550,000 people, CDC data show. Diabetes patients accounted for 38% of the state’s COVID-related deaths through June, officials said. Karen Landers, Alabama’s assistant state health officer, said she is particularly heartbroken at the deaths of diabetes patients in their 30s and 40s.

Medical professionals in these states say they struggle to keep patients’ diabetes under control when regular in-person appointments are canceled or limited because of the pandemic.

Sarah Hunter Frazer, a nurse practitioner at the Medical Outreach Ministries clinic for low-income residents in Montgomery, Alabama, said diabetes is common among her COVID-19 patients. With clinic visits on hold, she stays in touch by phone or video chat. If a problem persists, she insists on an outdoors, face-to-face meeting. “We meet them under a shade tree behind the clinic,” Frazer said.

In similar fashion, doctors at the University of North Carolina stepped up their use of telemedicine to reach at-risk rural patients. Despite those efforts, John Buse, a physician and director of the university’s diabetes center, said he’s certain some foot ulcers and dangerously high blood sugars are being missed because people avoid health facilities for fear of the virus.


Many diabetes patients with severe or deadly cases of COVID-19 were in good health before contracting the virus.

Clark Osojnicki, 56, of Stillwater, Minnesota, had heard early warnings about the risks of the coronavirus for people with diabetes, said his wife, Kris Osojnicki. But the couple didn’t think the admonitions applied to him because his glucose levels were in a healthy range.

“He was incredibly active,” she said.

On a Sunday in mid-March, Osojnicki jogged alongside his border collie, Sonic, on an agility course for dogs inside a suburban Minneapolis gym. Three days later, Osojnicki developed a fever, then body aches, a cough and shortness of breath. He was soon in the hospital, on a ventilator. Clark, a financial systems analyst, died April 6 from a blood clot in the lungs.

Osojnicki is among 255 recorded deaths in Minnesota of people with COVID-19 and diabetes mentioned on their death certificate as of mid-July, according to state data. The records describe people who died as young as 34.


For years, the skyrocketing cost of insulin has fueled much of the national outrage over drug prices. Early in the pandemic, the American Diabetes Association asked states to eliminate out-of-pocket costs for insulin and other glucose-lowering medications through state-regulated insurance plans.

But no state has fully followed that advice, the ADA said. Vermont suspended deductibles for preventive medications, like insulin, starting in July. Other states ordered insurers to make prescription refills more available but didn’t address cost.

Robert Washington, 68, knew his diabetes put him at risk from COVID-19. When his employer, Gila River’s Lone Butte Casino in Chandler, Arizona, reopened in May, he decided to keep working as a security guard so he could afford insulin.

Washington’s supervisors had assured him he could patrol alone in a golf cart, said his daughter, Lina. But once back at work, he was stationed at the entrance, where long lines of gamblers waited, most without masks, Robert told his daughter.

“He was terrified at what he saw,” Lina said.

He tested positive for the virus in late May and was admitted to the hospital days later. He died from complications of COVID-19 on June 11, his daughter said.

A week after Washington’s death, the casino again closed as COVID-19 cases exploded in the state. The casino did not respond to a request for comment.

“It’s hard to accept he is gone. I have to stop myself from wanting to call him,” said Lina, a sports anchor and reporter at a Sacramento, California, TV station. “A lot of these deaths were in some way preventable.”

© Thomson Reuters 2020.

©2020 GPlusMedia Inc.

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as i have stated before in my other post, this virus is causing an uncontrolled auto-immune response targeting the ace2 (angiotensin converting enzyme) responsible for proper blood pressure management and these receptors are found primarily in the lungs and blood vessels resulting to blood clots and thrombi being lodged into the peripheral blood vessels causing diminished blood circulation and necrosis. A healthy person is generally safe but an uncontrolled diabetic or obese person has one big problem, the body has more than enough supply of blood sugar which increases the ability of the virus to multiply rapidly. To add to the problem are the fat cells where the virus hide and continuously infects the body for a prolonged period of time. Of course it is not a rare phenomenon for virus to hide so it can survive, just look at HIV, herpes, Marburg virus and many more.

So A diabetic person has already compromised blood vessels (fats accumulating on the blood vessel walls because of too much sugar), and with that there is diminished blood flow, increased blood sugar slows down the immune system (yes, the body killer cells are slow and not functioning properly for diabetic persons) and of course heart diseases. Most people with uncontrolled diabetes have high blood pressure and are at risk of congestive heart failure and stroke. The virus multiplies faster with high sugar. and hides in fat cells so the virus life is prolonged and the person infected has no ability to kill the virus because the immune system is compromised.

This is not a puzzle.

2 ( +5 / -3 )

I have had pre-diabetes several times. Too much cola and American breakfast cereal. The irony is the breakfast cereal I used to eat was supposedly "plain" grain and I would add a supposedly healthy granola mix to it. Nope. Both were loaded with sugar I later realized. I was fine when I gave up the cereal and cut my intake of cola dramatically. But before then I beat pre-diabetes by eating lots of lettuce and getting more exercise. Lettuce and other leafy vegetable containing chromium will increase your insulin effectiveness by 40 percent.

I have also been reading about high fructose corn syrup. This is a factory produced item it must be said. Its not something some farmer can make. Its most unnatural stuff. I read that your body does not even understand the stuff and doesn't produce insulin in response to it like it does with sugar even though you need the insulin to balance it out.

The U.S. government really needs to step up to the plate on diabetes and obesity. But its beholden to big corporations and that is why we are having so many public health crises like diabetes and mass covid 10 death.

5 ( +5 / -0 )

And the biggest cause of diabetes is....?

Its obesity. The one single action to improve health in most western countries would be to lose weight. Stop eating garbage and get off your sofas!

4 ( +4 / -0 )

 The one single action to improve health in most western countries would be to lose weight. Stop eating garbage 

Thanks for reminding me to cut down on my consumption of tonkatsu, tempura, instant ramen and polished white rice.

5 ( +5 / -0 )

"Robert Washington, 68, knew his diabetes put him at risk from COVID-19. When his employer, Gila River’s Lone Butte Casino in Chandler, Arizona, reopened in May, he decided to keep working as a security guard so he could afford insulin"

If the U.S. had universal healthcare, as we do in Japan, Robert Washington would not have to work for his insulin and still be alive today.

12 ( +12 / -0 )

When the dust settles about this pandemic, I predict the final death rates will reflect the general health of the population, especially the elderly population in various countries.

-4 ( +0 / -4 )

he was stationed at the entrance, where long lines of gamblers waited, most without masks, 

This is also part of the problem, people's attitude towards mask wearing and other mitigation measures.

8 ( +8 / -0 )

Sad to say but for the vast majority, you get the diabete type 2 from your own way of life you decide. Same as wearing a mask about the chance you mitigate the catching factor for covid-19.

It is association of obesity and diabete that makes it high risk since 7,9% of Japanese population has diabete (Idf organization) compare to 10% for USA (2020 CDC estimate) being diabetic whereas 32% of obese (3.6% for Japan).

It is just not financially and medically sustainable against covid-19...

-4 ( +0 / -4 )

I think most of us are lucky to remember our grandparents who were raised on healthy diets. When in doubt, eat like grandma! My grandfather is 101 years old. I always saw him eating homemade soups with lots of tomatoes and garlic. He ate as much as he want, no holding back, but healthy as an ox. I stick to one egg, one piece of toast and fruit with coffee for breakfast. I love cereal but it is probably one of the worst foods to start your day. And it goes without saying that soda is like toxic fluid. Stick to water, coffee, tea, beer and wines.

-2 ( +1 / -3 )

One of the biggest problem I find with food labelling in Japan is that they hardly ever show a full breakdown of the carbohydrates or fat. Saturated fat or transfat? And what fat? Palm fat? How much of the carbs is added sugar? That's never given. It's as if they don't want to frighten Japanese consumers. Cereals are good as long as it's not loaded with sugars, but they mostly are. I eat All-Bran and even that has sugar. Muesli (without added sugar) is great but I have to go to the import shops. And most places either don't have oatmeal or have run out. Cereal aside, everything else in Japan is loaded with sugar. It's an absolute myth the Japanese are healthy. They have scant knowledge of what constitutes healthy food. And shredded cabbage is not going to make up for your lack of fruit and vegetables. Since Japan taxes rice imports at several 100%, I'm stuck with diabetes-inducing Japanese white rice, and I keep that to a strict minimum.

The coronavirus should also be a wake-up call. People should be looking after their bodies and eating in a healthy way.

1 ( +4 / -3 )

It is criminal that insulin is so expensive over here.

Get rid of high fructose corn syrup, and the incidence of obesity will go down.

I don't drink much soda, but the other day I was served a Pepsi, made in Mexico, with sugar instead of high fructose corn syrup, as the sweetener. It tasted the way Pepsi used to taste, back when I was young.....much, much better than the way Pepsi made in the States tastes. So, going back to cane or beet sugar, instead of corn sugar, will improve taste, and is healthier for humans.

1 ( +2 / -1 )

interesting thought...rice is diabetic inducing diet, i wonder why there is too much diabetes and obesity in the west then? funny

-2 ( +0 / -2 )

When I was in California, I still remember very fat young people ate very big ice cream in bucket at beach. I was amazed they ate a lot of sugar and I thought that so many people would die of diabetes someday.

4 ( +4 / -0 )

They should try treating with HCQ, might save some lives.

-4 ( +1 / -5 )

I was amazed they ate a lot of sugar

Or was it high fructose corn syrup? At any rate, it was also no doubt not ice cream, but a bunch of chemical junk that should not be allowed to have the label "ice cream" on it at all. I had some in my freezer that was old so I left in on the counter to melt so as to wash it down the drain. It didn't melt even after a whole day. I now pay the higher price for real ice cream.

Obesity and diabetes are a corporate concerted effort.

2 ( +2 / -0 )


Oh you found a similarity between the Japanese diet and US diet that allows you to say that?

There is no comparison between the health of your average person here and in the US as a general statement. The American diet and lifestyle is 100% why they die.


Japanese have no idea about health food or health labeling.

Man you guys are something else! Kindly show me the examples from where you come from on how the populace can lead healthy lifestyles through their food choices.

0 ( +1 / -1 )

1glenn, sorry, sugar is sugar and none of it is good for you. Appalling how much sugar is added to nearly all breakfast cereals, even cornflakes. Basically cut them all out and eat unprocessed foods and you not only avoid the added sugar but all the unnecessary chemicals (the food industry claim they are needed to improve shelf life which translates as profit, they are all unnecessary to the human body,)

All “soda” is bad for you, stick to water, tea or not over strong coffee. Alcohol in moderation.

1 ( +2 / -1 )

Bottom line is we should eat just enough, and exercise for good measure.

It doesn't matter what we eat, if we eat more than we need we become overweight and the risk for diabetes increases.

If course its a lot easier to consume more than we need if our diet consists mainly of food high in carbohydrates esp sugars.

-2 ( +0 / -2 )

Traditional Japanese food is healthiest in the world. Seaweed is full of minerals.

1 ( +1 / -0 )


Besides the “it doesn’t matter what we eat” it sounds good.

Surely you don’t believe that 500 calories of chicken, spinach, and whole grains is equivalent to 500 calories of snickers bars. Cmon man!

2 ( +2 / -0 )

Yes I was referring specifically to calorie content, in which case the examples you mentioned are equivalent.

But regarding which group is healthier the first group of food you mentioned is of course healthier. Actually we can say the first group is healthy the other is not, by itself.

1 ( +1 / -0 )

I do believe in what you say though. A lot of people could be healthier through less caloric intake purely.

1 ( +1 / -0 )

what about the vaping kids?

1 ( +1 / -0 )

interesting thought...rice is diabetic inducing diet, i wonder why there is too much diabetes and obesity in the west then?

White rice is not good for diabetics. It's not the only thing that is not good for diabetics. There are plenty of other things, which will be more prevalent as a problem in the west, while rice will be more of a problem in the east. But it's not like rice isn't eaten in the west.

-1 ( +0 / -1 )

On the matter of diet among Japanese, and East Asians in general, I do notice that there is a much lower incidence of obesity among East Asians, even those living over here. However, not everything is ideal in the Japanese diet. I remember reading an article about stomach cancer in Scientific American magazine. The two countries with the highest rates of stomach cancer in the world are Japan and Norway, according to the article from about thirty years ago. I have often wondered why. Both countries have a low rate of obesity, but both eat a lot of cured fish.

As for the comment that sugar is sugar, I think that high fructose corn syrup as a sugar substitute is probably a bad idea. The obesity epidemic followed the transition to high fructose corn syrup as a sugar substitute.

0 ( +0 / -0 )

dear's diabetes patient's daily morning 45 minutes walking and evening 45 minutes walking and daily home hardworking loved ones to supporting Together cooking help, all family members clothes washing don't washing mechine own hands Washing clothes don't eating packed snacks,high salted foods,high sugar added snacks, oily foods etc, please keeping your health and families health please eating healthy food and enjoy don't mind set have a diabetes all Thing positively any disease out of bodies all loved people's dont bothering i am every day praying to the god without any disease Long life happy live on world and please brother's and sister's every day wear The mask and social distence. PEACE PREVAIL ON THE EARTH

0 ( +0 / -0 )

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