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Pandemic Precautions For People With Diabetes & Obesity

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Reduce the risk of dying from COVID-19 by getting vaccinated, continuing to observe infection-prevention measures, and practising good self-care.

A woman had Type 2 diabetes, hypertension (high blood pressure) and obesity. Fearing COVID-19, she did not go for her usual medical follow-up. However, she did receive her first dose of the COVID vaccine. She also made it a point to take every other precaution, such as staying home as much as possible.

Unfortunately, she caught COVID-19 and was admitted to a local hospital on day 6 of her illness in category 4. She deteriorated rapidly and was transferred to the Intensive Care Unit. Despite all measures, including mechanical ventilation, she succumbed from multiorgan failure 4 days after admission. She was only 49 years old!

Diabetes & Obesity Contribute to Severe COVID-19

This tragic case reaffirms what was known since the beginning and still holds true – that the risk factors for severe COVID-19 and death include advancing age (over 60 years old), diabetes, hypertension, kidney problems, heart disease and obesity1. The more risk factors are present, the more it will be like living with a ticking time bomb!

Local statistics confirm those observed in other countries. Latest COVID-19 mortality data released by the Malaysian Institute of Clinical Research on 29 August 2021 revealed:

  • Approximately 1 Malaysian has died for every 1,000 persons infected with COVID-19 (case-fatality rate = 0.94%)
  • Men were more at risk (58% males vs 42 % females)
  • 6 out of 10 deaths occurred in those older than 60 years of age
  • 8 out of 10 deaths (82%) occurred in people with at least 1 co-morbidity – 3 out of 10 had hypertension; 2 out of 10 had diabetes; 1 out of 12 had kidney disease.

Diabetes is a main contributor to severe COVID-19 morbidity and mortality. High blood glucose impairs the immune function and reduces our ability to fight infections. As such, individuals with poorly controlled diabetes prior to COVID infection will be at greater risk for severe COVID-19 disease, pneumonia, ICU care and death2,3.

This is evidenced by how 3-4 out of 10 people who required intensive care in hospital due to severe COVID-19, or who died from the viral infection, had diabetes4. An equally sombre fact is that 1 in 4 people with diabetes who were admitted to ICU for COVID-19 ended up dying5.

These statistics underscore why people with diabetes seriously need to prevent COVID-19. They are not more likely to catch the infection as anyone else6. However, once infected, they are 3 times7 more likely to develop severe COVID-19 pneumonia, other end-organ damage, and to die.

Obesity is another major COVID-19 risk factor. It was initially thought to be an innocent bystander because of its close association with diabetes, hypertension and cardiovascular disease which are known to predict risk of severe COVID-19.

However, recent data from large studies has confirmed that obesity is a strong and independent determinant of increased risk of severe COVID-19. In fact, obesity is thought to shift the risk of severe COVID-19 to younger age groups8. That means a younger overweight/obese person aged <50 years is more likely to suffer severe COVID-19 infection (like the patient described at the start of this article).

Obesity has truly exposed the underlying poor metabolic health of our population. Our 2019 National Health and Morbidity survey found that 1 in 2 adult Malaysians are overweight or obese; and 1 in every 5 adult Malaysians has diabetes! These unfortunate facts are partly responsible for our COVID-19 statistics skyrocketing with the accompanying high mortality over the past 3-4 months!

If You Have Diabetes, Prevention Is Essential!

As social restrictions get lifted and people start travelling (possibly even to balik kampung), it is imperative that you maintain all the precautions to avoid catching and developing severe COVID-19.

So please REMEMBER to maintain physical distancing, wear a face mask, and wash/sanitise your hands frequently. This is even more important when interacting with unvaccinated family members, such as your grandchildren.

Get vaccinated against COVID-19 if you have not yet done so! Research has confirmed that the currently used vaccines in Malaysia are effective, including for people with diabetes. 

Unfortunately, as with most vaccinations, the protection is NOT 100%. You may still get infected after getting vaccinated (breakthrough infection), but chances of severe disease and mortality is significantly reduced. In any case, do not put yourself in a situation where you can get infected.

Take Extra Good Care of Yourselves

People with diabetes often have other related risk factors eg increasing age, hypertension, obesity, abnormal kidney function, and heart disease. By keeping healthy, they will avoid giving the virus opportunities to cause harm.

Unfortunately, throughout the pandemic, many such individuals neglected to control their blood glucose, hypertension and body weight. Some even missed their doctors’ appointments. Perhaps they were thinking that their medical conditions would disappear just because they were staying home.

As a person with diabetes, you need to pay attention to your glucose control as it can significantly reduce your risk of severe COVID-19 infection and related mortality. So, take your medications as prescribed, watch your diet, stay physically active, and monitor your glucose regularly. Also, be sure to manage your blood pressure and other chronic health conditions, and reduce overweight/obesity. Last but not least, attend your medical follow-ups without fail.

COVID-19 has had a devastating effect on everyone, but most of all, on the population with diabetes and obesity. So, stay safe, keep healthy and ensure you have been vaccinated against COVID-19 to keep the virus at bay.

Article contribution from the Malaysian Endocrine and Metabolic Society, October 2021


  1. Dorjee K, Kim H, Bonomo E, Dolma R. Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: a comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients. PLoS ONE 2020;15(12):e0243191
  2. Pratichizzo F, de Candia P, Nicolucci A, Ceriello A. . Elevated HbA1c levels in pre-covid infections increase risk of mortality: A systematic review and meta-analysis. Diabetes Metab Res Rev 2021:e3476
  3. Zhu L, She ZG, Cheng X et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes Cell Metab 2020;31(6):1068–1077
  4. Ko JY, Danielson ML, Town M, et al. COVIDNET Surveillance Team. Risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. Clin Infect Dis 2021;72(11):e695–e703
  5. Shang L, Shao M, Guo Q, et al. Diabetes mellitus is associated with severe infection and mortality in patients with COVID-19: a systematic review and meta-analysis. Arch Med Res 2020;51(7):700–709
  6. Fadini GP, Morieri ML, Longato E. Avogaro A. Prevalence and Impact of Diabetes among people infected with SARS CoV-2, J Endocrinol Invest, 2020;43(6):867-869
  7. Gregory JM, Slaughter JC, Duffus SH, et al. COVID-19 severity is tripled in the diabetes community: a prospective analysis of the pandemic’s impact in type 1 and type 2 diabetes. Diabetes Care 2021;44:526–532
  8. Kass, D. A., Duggal, P. & Cingolani, O. Obesity could shift severe COVID-19 disease to younger ages. Lancet 2020;395(10236): 1544–1545.