Top expert warns advanced age, diabetes and frailty could worsen COVID-19 outcomes
A top professor has warned of the impact frailty may have among those with diabetes who develop COVID-19.
Professor Alan Sinclair, who recently launched the International Foundation for Diabetes and Ageing, has discussed this important observation in a recent Commentary1.
Writing with Dr Abdelhafiz from Rotherham, Professor Sinclair reviewed the findings of several key publications at the early phase of the pandemic.
Professor Alan Sinclair (right) is a leading expert in frailty and diabetes
These included an analysis of 72,314 cases of COVID-19 pneumonia reported in China between the ages of 30-79 years with more than 60% being older than 60 years, and the fatality rate increasing proportionally with age.
What makes older people with diabetes particularly susceptible to COVID-19 is not fully known but it is likely that multiple factors are operating. Diabetes may increase the risk of viral infection because it can have an inhibitory effect on macrophage and lymphocyte function, and it is known that people with COVID-19 who required intensive care (IC) treatment were more likely to have diabetes (22.2% v 5.9%) compared with those who did not require IC admission.
Other factors operating to increase the risk of COVID-19 seem to include the likely presence of other background comorbidities such as respiratory or cardiovascular disease, and age-related impairment of the immune system sometimes referred to as InflammAgeing since it is characterised by a low grade and chronic inflammatory state.
Another key player would be the presence of frailty which is also marked by a multisystem dysregulation leading to a decline in physiological reserve and increase in poor health outcomes. Frailty is also known to be associated with a poor post-vaccination immune response.
Professor Sinclair said: “A part of the diabetes population which has not received a great deal of attention so far in this pandemic is the large number of care home residents with diabetes who are a highly comorbid group with excess rates of frailty.
“Unless significant preventative actions can be organised, it is likely that transmission and dissemination of the virus within these settings will have a deadly effect. A multi-agency stakeholder group is in the process of providing guidance for this vulnerable population.”
[1] A.J. Sinclair, A.H. Abdelhafiz. Age, Frailty and Diabetes – triple jeopardy for vulnerability to COVID-19 infection. EClinicalMedicine (In Press: April, 2020)
Available at: https://info.thelancet.com/eclinm-covid-19
Picture credit: CDC