Advice from health officials to diabetics to properly manage the disease over the Covid-19 pandemic could be “unrealistic”, a doctor has warned.Annabel Fountain, an endocrinologist and diabetes specialist, said that the Government’s list of “extremely clinically vulnerable” people who should be shielded from coronavirus infection did not include diabetics — but was based on a register drawn up by England’s National Health Service, which is funded through taxation.Dr Fountain said: “I think that using a guideline from the NHS is good because it’s well-researched, it’s cost-effective, but we must remember that in the UK there is universal healthcare and anybody who isn’t doing well can attend the doctor with no cost at the point of service.“So you’re getting a guideline from a place that has got a different set-up for their healthcare funding and provision.”She added: “In Bermuda, where we don’t have universal healthcare and we therefore have out-of-pocket payments for medications and medical appointments, this may mean that although it’s very nice to say that persons with diabetes or other non-communicable diseases should be managing their conditions well, it actually might be an unrealistic expectation.”The health ministry’s list of the highest-risk people included organ transplant recipients, some cancer patients, others whose immune systems were compromised by medical treatment as well as people with severe respiratory conditions.People in these groups were advised to stay to at home and limit non-essential contact with other members of their household.A health ministry spokeswoman said last weekend: “For persons with diabetes and obesity, it is not practical, nor medically necessary to shield them. “That would also represent a significant part of our population. “It is also why persons with diabetes or other non-communicable disease need to manage their conditions well. “These persons should continue to manage their conditions by visiting their doctors, taking their medication and caring for themselves.”She explained: “There is a difference between extremely clinically vulnerable and those who are vulnerable and the interventions that are needed. “For the extremely clinically vulnerable, they need additional assistance because they will need to stay home and should not be in public.”However, Dr Fountain said: “There are a lot of people who are avoiding routine medical care because of, first of all, anxiety and fear about contracting Covid-19.“They’re staying at home so they’re not being checked, or they’re afraid to go to the hospital for their appointments or they’re afraid to go anywhere where there might be other sick people, avoiding medical facilities.“Then, also, the economic pandemic that we are going to see is that many people are out of work or their family’s income will have been affected ... so there will be difficult choices between medication, monitoring and doctors’ appointments.”NHS England statistics showed last week that of 22,332 hospital patients who tested positive for Covid-19 at the time of their death, 5,873 — or 26 per cent — had diabetes.The figures were collected between March 31 and May 12.Kim Wilson, the Minister of Health, last month also included people with “severe obesity, defined as a body mass index of 40 or higher” as well as “those with poorly controlled chronic conditions” such as diabetes in a list of people who should be shielded.They were classed as “vulnerable persons ... who are at a high risk of severe illness from Covid-19 due to an underlying health condition, and may require an admission to hospital”.But a health ministry spokeswoman explained: “The previous shielding guidance was in the context of shelter-in-place when the risk of transmission was higher. “Now, in Phase 1 of reopening, the shielding guidance was tightened to the clinically extremely vulnerable to reflect the current level of risk.”Andrew Jamieson, a consultant endocrinologist at the Bermuda Hospitals Board, said that many people with diabetes had made their own decision to isolate themselves as far as possible to minimise risk from the coronavirus.He added: “I’ve been doing a lot of telephone consultations of patients, between 40 and 60 a week for the last couple of months, and virtually no patient with diabetes … I have spoken to, had any intention of going across the doorstep.“They were all staying inside, they had decided ‘I’ve got diabetes, I’m keeping my head under a blanket until this is all sorted out’.“You may well say that a lot of people have actually taken the initiative in this regard.”Dr Jamieson added: “The patients I have dealt with diabetes have all been extremely sensible in their approach to this by staying at home and I’ve been writing hundreds of prescriptions and doing stuff online for them to facilitate that.“The Bermuda Diabetes Association has been delivering prescriptions to their houses and things like that.”He emphasised: “The majority of people with diabetes and who get coronavirus infection will still survive it.”Dr Jamieson said that diabetes was one of several factors that could affect the end result of Covid-19 contraction — but that it was too early to say by how much.The Government’s 2014 Steps To A Well Bermuda survey showed that about 12 per cent of respondents reported having diabetes and that these people “tended to be aged 65 years and older”.