The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes

What does it mean to be immunocompromised?

Simply put, the word “immunocompromised” means that the person’s immune system is not functioning properly to fight off infections. This could be due to a number of reasons, including underlying health conditions, or specific medications that the person is taking.

For example, patients who are HIV-positive are thought of as immunocompromised. This is because HIV invades the T cells (a type of white blood cell), which are a major component of our immune system. When functioning normally, T cells help to effectively clear various infections. Because HIV affects the T cells, the immune system of these patients may not respond as effectively, and they may struggle with complications from infections that most healthy individuals would easily recover from.

Similarly, some classes of medications can directly inhibit immune system responses. For instance, patients who are taking anti-rejection medications following an organ or tissue transplant are considered immunocompromised. This is also the case for patients who take immunosuppressive agents for other reasons, including for the treatment of certain autoimmune conditions and cancers.

Also, because immune system role is underdeveloped in extremely young children and declining in the very elderly, one may consider that the very young and the very old are immunocompromised to a degree (because the immune system is not functioning quite as efficiently as it does in a healthy adult).

So, what about diabetes? Could diabetes, on its own, affect our immune system position to such a degree that would be considered “immunocompromised”?

Are people with diabetes immunocompromised?

It’s complicated. Diabetes does not, in and of itself, necessarily mean that a patient is immunocompromised. However, many patients with diabetes do have impaired immune systems, due to the impression of both short-term and long-term hyperglycemia.

Immune system dysfunction in diabetes ultimately stems from high blood glucose levels, due to several mechanisms. High blood sugar causes “cytokine production, defects in phagocytosis, dysfunction of immune cells, and failure to kill microbials.” We can see the results in the medical data: patients with high blood glucose levels tend to have worse outcomes in retort to infections. As a result, experts have suggested that optimal blood glucose management is of “paramount importance” to prevent and fight off infectious diseases.

During the recent COVID-19 pandemic we learned that short-term glycemic control was critical for the health of patients battling severe infections, as it is in other illnesses. Doctors made managing blood sugar a priority for hospitalized patients, whether or not they had diabetes. Many studies have shown that people with diabetes are no more likely to contract COVID-19, but once they have it, they are more likely to suffer bad outcomes.

Chronic high blood sugar (over a period of months or years) can also contribute to immune system dysfunction in many different ways. Patients with long-term complications such as neuropathy, retinopathy, and kidney disease are also more likely to suffer from immune system impairment.

On the other hand, it is also well-established that patients with diabetes who achieve the recommended A1C levels have a markedly lowered risk for developing infections or complications from infections as compared to those with higher A1C’s. You can read more about the link between blood glucose levels and health complications here.

One expert commentary published in the Canadian Medical Association Journal explains,

“The evidence indicates that an immunocompromised state occurs only in the context of poor glycemic control with severe complications such as diabetic ketoacidosis or in adults with vasculopathy and peripheral neuropathy.” [emphasis added]

What about the autoimmunity of type 1 diabetes? Although type 1 diabetes is itself caused by immune system dysfunction, that autoimmune disorder does not appear to negatively affect other elements of the immune system.

It’s important to remember that when talking about an entire population of people with diabetes, on average, these patients are more likely to be immunocompromised. In addition to (generally) having higher than ordinary blood glucose levels for a considerable proportion of time, many people with diabetes are more likely to also have other health conditions that may negatively affect their immune system function. Obesity, for example – common in patients with type 2 diabetes – is known to negatively impact immune function.

The Bottom Line

Diabetes does not, all by itself, cause immune system impairment. But many patients with diabetes (types 1 and 2) can reasonably be considered immunocompromised.

To determine whether a certain patient with diabetes is immunocompromised, a doctor would consider their overall health, including other health conditions, the medications that they use, as well as their age and glycemic management. Patients with diabetes that maintain healthy glycemic management and that are otherwise healthy should probably be considered immunocompetent – that is, they have a normal immune response.

However, for patients who frequently experience very high blood glucose levels (or have a long history of hyperglycemia), especially those that have begun to experience diabetic complications, immune system function may well be negatively affected. This subset of patients might be considered immunocompromised.

Diabetes Daily

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes