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The last time Sahar Hillel left the house beyond going to work or walking her dog was March 7.

Even then, she wore blue latex lab gloves nearly everywhere she went. Now she has her mom do her grocery shopping and has limited her trips to solitary walks with her Catahoula golden retriever mix, Wilbur.

Weeks before Gov. Phil Murphy issued a stay-at-home order to state residents, Hillel already had hunkered down, taking every precaution against the coronavirus.

A Type 1 diabetic for eight years, Hillel, 23, had seen how the disease made it difficult for her body to fight off even minor infections. Now, the East Brunswick resident is not taking any chances exposing herself to the potentially deadly novel virus.

Ive basically been in isolation for three weeks, Hillel said. With diabetes, you can end up in the hospital for little things. But this is not the time to end up in the hospital for something.

Hillel already heeded a dire warning now being issued by some health officials: People with diabetes are at high risk for serious complications from COVID-19 and should take extra precautions.

Older adults and people who have serious underlying medical conditions such as heart disease, chronic lung disease or severe obesity also are vulnerable, according to the Centers for Disease Control and Prevention. But early studies from China, as well as growing evidence in the United States, suggest people with diabetes should be especially vigilant.

Of 191 adults diagnosed with the virus early on in Wuhan, China the epicenter of the pandemic about half had underlying medical conditions, most commonly diabetes and high blood pressure, according to a study by Chinese doctors. Fifty-four of them died, with diabetes or coronary heart disease emerging as factors increasing the likelihood of death.

People with diabetes who contracted the coronavirus had a fatality rate of 7%, according to a CDC report based on 44,000 confirmed cases in China as of Feb. 11. The rate for those without an underlying medical condition was just 0.9%.

More than 30 million people in the United States or about 10% of the population have diabetes, according to the CDC. In 2017, it was the seventh-leading cause of death in the country.

Its safe to say people with diabetes should be considered among those at risk for worse outcomes with a COVID-19 infection, said Robert H. Eckel, president of science and medicine at the American Diabetes Association. The patient with diabetes needs to wake up to the fact that they will be at increased risk, and if they get the infection, they do less well.

Sahar Hillel with her dog, Wilbur.

The message came into focus early in New Jersey. During a press briefing March 10, state officials announced the first person in the state to die from coronavirus was a 69-year-old man from Bergen County with a history of health issues including diabetes.

Type 2 diabetics, who make up the majority of people with diabetes, tend to deal with chronic, low-grade inflammation that causes the immune system to operate at an abnormal state, according to Eckel. In addition, the bodys ability to fight infection by mounting a white blood cell count is impaired, Eckel said.

Taken together, diabetics have trouble fighting viral and bacterial infections, while also at increased risk of contracting common infectious diseases.

Diabetes is a condition that predisposes to many complications, some of which are short term, while others are more long term, said Michael Steinberg, chief of general internal medicine and vice chair for research at Robert Wood Johnson Medical School in New Brunswick.

Diabetes has an impact on overall immune system functioning, and elevated blood sugars themselves can increase infection risk. Therefore, people with diabetes may be at increased risk of many infections, possibly including COVID-19.

Eckel said more research is needed to fully understand the relationship between diabetes and coronavirus.

Patients with diabetes doing more poorly with this specific infection has been suggested by the Chinese, he said. But we dont have an adequate data collection in the U.S. yet to really know whether this is going to play out here.

With coronavirus spreading across New Jersey state numbers swelled to 4,402 cases and 62 deaths as of Wednesday Steinberg and Eckel said people with diabetes should be extra vigilant.

Diabetics should maintain healthy diets, exercise, limit exposure and make certain their blood sugar levels remain in optimal range.

This includes making sure they have an ample supply of their medications and that they take them regularly, Steinberg said. We know that elevated blood sugar can increase risk of infections, and this likely includes pulmonary infections, such as COVID-19.

Hillel already is heeding that advice. Diagnosed with diabetes when she was 15, the Middlesex County resident has taken health precautions for almost a decade. When she saw coronavirus reached Seattle in February, she thought it was a matter of time before it made its way to New Jersey.

She began working from home March 16.

I recognized what was going to happen, Hillel said. Im a little more conscious of stuff like that than everyone else.

I literally havent gone anywhere, she added. The last time I went to the grocery store was March 7.

Steinberg and Eckel said Hillel is making all the right decisions.

Be safe, stay at home, take your medications and avoid contact with others who could spread the infection, Steinberg said.

Matthew Stanmyre may be reached at mstanmyre@njadvancemedia.com. Follow him on Twitter @MattStanmyre. Find NJ.com on Facebook.

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People with diabetes are at high risk for coronavirus complications. Heres how to stay safe. - NJ.com

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