opinion: pandemic is changing the face of diabetes

by:  zoey jones, jennifer akerman & robin mason

for people living with diabetes, the daunting headlines trumpeting the risks of covid-19 have been alarming and often confusing, resulting in anxiety, fear and the physical manifestations that often come with those emotions.

these secondary impacts of the pandemic may be changing the face of diabetes. lest you think that this is an issue confined to a small group of the population, one in three canadians has diabetes or prediabetes.

at women’s college research institute, we have been working with the diabetes action canada research network to study peoples’ experiences of diabetes. we interviewed 15 cisgender women and men with either type 1 or type 2 diabetes, ranging in age, ethnicity and race. the negative impacts of covid-19 were clear — even for those who had not contracted it. people with diabetes discussed feeling vulnerable, having sleep problems, economic hardship and high levels of stress, factors that changed how diabetes manifests in their day-to-day lives.

for one, stress-related hormones can impact blood glucose levels. stress can lead to unpredictable fluctuations in blood glucose for people with type 1 diabetes. for those with type 2 diabetes, stress is more frequently associated with elevated blood sugar levels. both high and low glucose levels are known to impact peoples’ short- and long-term health in serious ways ranging from fatigue and dizziness to damaged immune function, amputations, heart attack and coma.

factors such as sex, gender, age, race and ethnicity also played a role in how stress impacted people living with diabetes. for example, “cynthia,” a multiracial woman in her late 50s, felt forced to “come out” as having diabetes to her coworkers to protect her health. working in close quarters meant that she needed to explain her heightened risk profile to colleagues despite keeping her diabetes secret for years; as she explained, “being a visible minority woman and working in a very white-dominated environment … that’s a very particular environment. you always have to show that you are (performing well) at your job … you could lose your job at any minute.” having an additional challenge or seeming difficult was not an option for her. disclosing her condition made her more vulnerable to the stress and mistreatment she already experiences at work as a woman of colour.

reduced in-person access to doctors also affected people differently. younger women tended to find that being at home more lent them more control over their environments and, accordingly, their diabetes management; one woman told us about riding her stationary bicycle while in the virtual “waiting room” for her doctor, while others spoke positively about the time they gained from not needing to commute to appointments.

however, “thomas,” an indigenous man in his 60s, expressed concern about the lack of in-person appointments. indigenous people have a higher rate of amputation due to diabetes-related complications and in-person check-ups are critical to catching complications early. after spending four days hospitalized for an infected sore, thomas was concerned for indigenous people with diabetes during the pandemic, explaining that many may not have the support to advocate for other treatment options and avoid unnecessary amputation.

these experiences must also be considered within the broader context of economic inequality. in the face of increased employment insecurity and job loss along with the high cost of living with diabetes, many of the women we spoke to felt concern for their economic welfare. “elizabeth” told us how her grocery budget and the cost of fresh food has “exploded” in a way she had never seen before. “heather’s” main concern was the worsening economy in alberta, impacting her ability to find a job that would cover her diabetes medications.

these trends suggest that other people with diabetes in canada who face various types of economic and social marginalization — including women, people of colour, lgbtq2s+ people, newcomers and more — disproportionately suffer secondary impacts of the pandemic.

people with diabetes will need tailored support as we begin to turn the corner on the pandemic and revisit the landscape of diabetes care. more than a year of lockdowns have impacted people with diabetes’ average blood sugars, their physiology, their sleep patterns, their diets, their access to medications and more. women and people of colour may be suffering from economic hardship, indigenous people may be at heightened risk of unnecessary amputation with reduced medical access, and older women may need support regaining access to community exercise opportunities that play a critical role in managing their condition.

as a medical community, we need to be prepared to manage this next wave of consequences — in particular for those communities that have been hardest hit by the aftereffects of more than a year in lockdowns. our research gives a glimpse into what is coming.

this research was approved by the women’s college hospital’s research ethics board. all participant names are fictionalized to protect identity.

zoey jones, phd, is a research project lead at women’s college research institute (wcri) investigating how peoples’ lived experiences of diabetes are shaped by sex, gender and other intersecting demographics.

jennifer akerman, mph, is a research coordinator at wcri specializing in sex- and gender-based analysis plus (sgba+).

robin mason, phd, is a scientist at wcri, women’s college hospital with expertise in gender-based violence and the integration of an intersectional sex and gender lens in health research.