DETROIT—Diabetes is one of the health risk factors—along with such conditions as lung, kidney, liver and heart disease, obesity and a weakened immune system—that experts cite as reasons Detroit’s COVID-19 positive cases and death rates were initially much higher than other areas.
Since March 2020, Detroit has recorded 50,623 positive tests of COVID-19 and 1,890 deaths, representing 7% and 12%, respectively, of Michigan’s total of 715,478 cases and 16,327 confirmed deaths as of April 7.
During the first COVID-19 surge last spring, Wayne, Oakland and Macomb counties represented 38% of the state’s total positive cases and 49% of the deaths by April 30, according to a Crain’s analysis.
Early in the pandemic, Dr. George Grunberger, an endocrinologist who heads up the Grunberger Diabetes Institute in Bloomfield Hills, said “quite a few of my patients had COVID” and “quite a few were hospitalized.”
“I’m not aware of a large number of my patients who died,” said Grunberger, who added most of his patients are diligent about maintaining healthy blood sugar levels. “If you’re in the hospital first, the medications you take can (interfere) with your diabetes even more.”
After Detroit experienced the first two initial COVID-19 surges in April and December, positive cases began to increase again for the third time in mid-February. On March 5, the seven-day average of daily cases in Detroit was 65, rising to 438 on April 5, according to the Detroit Health Department. Daily deaths in Wayne County are also creeping up again, rising from a 7-day average of two on March 19 to 10 on April 8, according to the New York Times database.
Grunberger said the majority of his patients have improved their diabetes condition during the pandemic. There are others, he said, who have become demoralized, depressed and stressed because of the lockdown and lack of social interaction.
“Diabetes is something you can actually control. Thankfully, for the most part, the awareness of importance of diabetes control is actually increasing,” said Grunberger.
“They’re locked in, and all of a sudden they have time to take care of themselves. They stopped eating out, going to parties. They’ve been at home cooking and are able to focus on exercise.”
In a January report on social determinants of health, Blue Cross Blue Shield of Michigan said the lack of access to nutritious food during the pandemic has contributed to COVID-19 infections of diabetic patients and others with chronic diseases.
Michigan doesn’t track contributing factors to COVID-19 deaths on a statewide level, but people with diabetes face a higher chance of experiencing serious complications, said the state Department of Health and Human Services.
In a national survey, diabetes was found to be the second most common underlying medical condition for people who died related to COVID-19, according to a July report by the U.S. Centers for Disease Control and Prevention.
Some 61% who died of COVID-19 had cardiovascular disease, followed by 40% with diabetes mellitus, 21% with chronic kidney disease and 19% with chronic lung disease, the CDC said.
Nationally, more than 34 million people in the U.S. have diabetes, according to the CDC. About 95% of them have Type 2 diabetes, where the body resists the effects of insulin it produces, or doesn’t produce enough. Type 1 diabetes is an autoimmune condition that occurs when the body’s immune system attacks cells in the tissue of the pancreas.
“Most people with Type 2 diabetes have other conditions” that include obesity, high blood pressure and high cholesterol, and tend to be older, Grunberger said. “People have more strokes, heart attacks, heart failure, and diabetes also is the leading cause of kidney failure.”
In Michigan, more than 1 million people have diabetes, 12.4% of the state’s population, and 260,000 of them don’t know they have it, greatly increasing their risks. Another 2.7 million people have pre-diabetes conditions, said the American Diabetes Association.
The Southeast Michigan Hospital Collaborative, a partnership of four local health systems, the Greater Detroit Area Health Council and the National Kidney Foundation of Michigan, have been working to identify the state’s 2.5 million people with pre-diabetes to enroll them in a national diabetes prevention program.
Kate Kohn-Parrott, the health council’s CEO, said according to the CDC the prevention program reduced the risk of diabetes among participants by 58%.
“SEMI-HC’s efforts are critical in our region where COVID-19 hit hard on top of a long history of poverty, homelessness, and disparities, and where chronic conditions like diabetes put people at greater risk for severe illness from COVID-19,” Kohn-Parrott said.
GDAHC’s health system partners in the diabetic initiative include Henry Ford Health System, St. Joseph Mercy Health System, Ascension Michigan and Beaumont Health.
A study last year found that 20% of all ICU admissions for COVID-19 involved people with diabetes, said the Journal of Clinical Endocrinology & Metabolism.
Eran Bashan, CEO and co-founder of Hygieia Inc., a medical device company based in Livonia that specializes in diabetic monitoring systems, said a diabetic patient with a hemoglobin A1c level of 6.5% is at no greater risk to contract COVID-19 than someone without diabetes.
“There is data to suggest that if you’re admitted to a hospital and you are at 8.3 or above you are 10 times more likely to die than someone with well managed diabetes,” Bashan said. “COVID definitely introduced a sense of urgency. But poorly managed diabetes, two-thirds of those are at above 7.0, those people are not doing particularly well. And that’s not a good sign.”
So far, Bashan said only “a handful” of Hygieia’s current patient population of several hundred in Michigan have contracted COVID-19.
“They are doing better,” he said. “It’s not that statistically significant, but like any other community, our members have been exposed and dealt with COVID.”
In the United Kingdom, where Hygieia has a larger patient population, the mortality rate for insulin users across the board is about 3.1%, but for Hygieia’s patients, those mortality rates drop to under 0.8%, Bashan said.
In 2018, Hygieia partnered with Blue Cross Blue Shield of Michigan in a pilot program to test the company’s d-Nav insulin guidance system.
“We saw 90% of patients improve within three months. And also there’s a significant reduction in cost of care,” Bashan said.
Over the past year, Hygieia has contracted with several insurers, including Priority Health, Health Alliance Plan, United Healthcare, Humana and Aetna. It also has become a specialty provider network for Blue Cross’ diabetic patients in some of its HMO, PPO, Medicaid and Medicare Advantage programs, said Bashan, adding that its goal this year is to enroll about 2,000 people.
From Grunberger’s patient population, who he described as motivated to get their diabetes under control, the pandemic gave them another reason to keep their blood glucose in check.
“Elevated blood glucose, uncontrolled sugar levels, hurts your immune system, people are more likely to get sick or any infection if your sugar is not controlled,” Grunberger said. “High sugar, by itself, makes the immune response weaker. Controlling your sugar decreases the chance that you get sick and become hospitalized. That’s a very powerful motivation.”
But Grunberger said Detroit’s diabetic population, on average, is not healthy to begin with. “Then you have COVID and the added stress, and those people will be suffering more,” he said.
To stay healthy, Grunberger said those with diabetes should monitor their sugar levels, take their medications, eat healthy and exercise. He also said they should be extra careful about interacting with strangers, maintain social distance, wear masks and make an appointment for a coronavirus vaccine.
“I do a lot of telemedicine and people ask me if they should get vaccinated. The data and studies have shown that the vaccines in the U.S. are safe for people with diabetes,” he said.
This story first appeared in our sister publication, Crain’s Detroit Business.