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Tajdar D, Lühmann D, Walther L, Bittner L, Scherer M, Schäfer I. Effects of Two COVID-19 Lockdowns on HbA1c Levels in Patients with Type 1 Diabetes and Associations with Digital Treatment, Health Literacy, and Diabetes Self-Management: A Multicenter, Observational Cohort Study Over 3 Years. Diabetes Ther 2024; 15:1375-1388. [PMID: 38642263 PMCID: PMC11096287 DOI: 10.1007/s13300-024-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Short-term studies reported improved glycemic control and a decrease in eHbA1c (estimated hemoglobin A1c) in patients with type 1 diabetes during COVID-19 lockdown, but long-term changes are unknown. Therefore, the main objectives are to (1) analyze whether laboratory-measured HbA1c changed during and after two lockdowns and (2) investigate potential variables influencing HbA1c change. METHODS In this cohort study, 291 adults with type 1 diabetes were followed over 3 years including the prepandemic phase and two lockdowns. The data from medical records and validated questionnaires assessing health literacy (HLS-EU-Q16), diabetes self-management (DSMQ-R27), general self-efficacy (GSE), and social support (F-SOZU-K14) were used to analyze associations with HbA1c levels (N = 2370) by performing multivariable linear regressions. RESULTS The median age was 54 (38-63) years and 159 (54.6%) were male. All phases of the COVID-19 pandemic were associated with a significant increase in laboratory-measured HbA1c levels in percent (e.g., during first lockdown β = 0.23, 95% confidence interval (CI) 0.07-0.39, p = 0.005; during the second lockdown, β = 0.27, 95% CI 0.15-0.38, p < 0.001). HbA1c change during lockdowns was significantly affected by the number of checkups (β = -0.03, 95% CI -0.05 to -0.01, p = 0.010), the value of HbA1c at previous observation (β = 0.33, 95% CI 0.29-0.36, p < 0.001), educational level (secondary versus tertiary: β = 0.22, 95% CI 0.06-0.38, p = 0.008; primary versus tertiary: β = 0.31, 95% CI 0.10-0.52, p = 0.004), health literacy score (for each point: β = -0.03, 95% CI -0.05 to - 0.002, p = 0.034), and diabetes self-management score (for each point: β = -0.03, 95% CI -0.04 to -0.02, p < 0.001). The use of continuous glucose monitoring or insulin pump had no effect on HbA1c change. CONCLUSIONS Lockdowns can lead to worsening glycemic control in patients with type 1 diabetes. Particularly patients with few check-ups, poor blood glucose values, deficits in diabetes self-management, low health literacy, and a low level of education seem to be at greater risk of worsening glycemic control during lockdowns and, therefore, require special medical care, e.g., through telemedicine. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04821921.
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Affiliation(s)
- Daniel Tajdar
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dagmar Lühmann
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Walther
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lasse Bittner
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Scherer
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ingmar Schäfer
- Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Schäfer I, Tajdar D, Walther L, Bittner L, Lühmann D, Scherer M. Impact of two COVID-19 lockdowns on HbA1c levels in patients with type 2 diabetes and associations with patient characteristics: a multicentre, observational cohort study over three years. Front Public Health 2024; 11:1272769. [PMID: 38249413 PMCID: PMC10796585 DOI: 10.3389/fpubh.2023.1272769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Glycemic effects of COVID-19 lockdowns on patients with type 2 diabetes (T2D) are controversial. In this long-term observation, we aimed (1) to analyze changes in HbA1c levels during lockdowns in Germany, and (2) to investigate whether diabetes medication, comorbidities, and sociodemographic data influenced these changes. Materials and methods This cohort study observed 1,089 patients aged ≥18 years over the years 2019 to 2021. Patients were recruited from 14 physicians specialized on diabetes. As dependent variable, 7,987 HbA1c values were analyzed by multivariable linear regression adjusted for random effects of physicians and patients. Results Patients had a median age of 68 (60/76) years and 623 (57.2%) were male. Before the pandemic, median HbA1c level (in %) was 6.9 (6.3/7.7). Average HbA1c level increased during first lockdown (0.21,0.11/0.31,p < 0.001), after first lockdown (0.23,0.18/0.28,p < 0.001), during second lockdown (0.40,0.33/0.47,p < 0.001) and after second lockdown (0.27,0.18/0.36,p < 0.001). The increase of HbA1c levels was more pronounced in male patients (0.08,0.01/0.15,p = 0.019), if patients did not have German as native language (0.12,0.01/0.23,p = 0.041) and if they were widowed (0.19,0.05/0.32,p = 0.008). End organ damages (0.12,0.01/0.23,p = 0.039), atherosclerotic cardiovascular disease (ASCVD; 0.23,0.10/0.36,p = 0.001) and cardiovascular events (0.25,0.10/0.40,p = 0.001) as well as oral medication (0.09,0.03/0.15,p = 0.002), intermediate- or long-acting insulins (0.24,0.16/0.32,p < 0.001), and fast-acting or mixed insulins (0.30,0.23/0.36,p < 0.001) were also related to a greater increase in HbA1c levels. Conclusion Both lockdowns resulted in a significant increase in HbA1c levels. In particular, patients with ASCVD, cardiovascular events, and insulin therapy appear to be at risk for worsening glycemic control in crisis and thus require special medical attention. Clinical Trial Registration ClinicalTrials.gov (NCT04821921).
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Hu Z, Youn HM, Quan J, Lee LLS, Mak IL, Yu EYT, Chao DVK, Ko WWK, Wong ICK, Lau GKK, Lau CS, Lam CLK, Wan EYF. The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis. Prim Care Diabetes 2023; 17:229-237. [PMID: 36872178 PMCID: PMC9977626 DOI: 10.1016/j.pcd.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The effect directly from the coronavirus disease 2019 (COVID-19) infection on health and fatality has received considerable attention, particularly among people with type 2 diabetes mellitus (T2DM). However, evidence on the indirect impact of disrupted healthcare services during the pandemic on people with T2DM is limited. This systematic review aims to assess the indirect impact of the pandemic on the metabolic management of T2DM people without a history of COVID-19 infection. METHODS PubMed, Web of Science, and Scopus were systematically searched for studies that compared diabetes-related health outcomes between pre-pandemic and during-pandemic periods in people with T2DM and without the COVID-19 infection and published from January 1, 2020, to July 13, 2022. A meta-analysis was performed to estimate the overall effect on the diabetes indicators, including hemoglobin A1c (HbA1c), lipid profiles, and weight control, with different effect models according to the heterogeneity. RESULTS Eleven observational studies were included in the final review. No significant changes in HbA1c levels [weighted mean difference (WMD), 0.06 (95% CI -0.12 to 0.24)] and body weight index (BMI) [0.15 (95% CI -0.24 to 0.53)] between the pre-pandemic and during-pandemic were found in the meta-analysis. Four studies reported lipid indicators; most reported insignificant changes in low-density lipoprotein (LDL, n = 2) and high-density lipoprotein (HDL, n = 3); two studies reported an increase in total cholesterol and triglyceride. CONCLUSIONS This review did not find significant changes in HbA1c and BMI among people with T2DM after data pooling, but a possible worsening in lipids parameters during the COVID-19 pandemic. There were limited data on long-term outcomes and healthcare utilization, which warrants further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022360433.
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Affiliation(s)
- Zhuoran Hu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Hin Moi Youn
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Jianchao Quan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Lily Luk Siu Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - David Vai-Kiong Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong Hospital Authority, Hong Kong Special Administrative Region of China
| | - Welchie Wai Kit Ko
- Department of Family Medicine and Primary Health Care, Hong Kong Hospital Authority West Cluster, Hong Kong Special Administrative Region of China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - Gary Kui Kai Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China.
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Panza E, Kip KE, Venkatakrishnan K, Marroquin OC, Wing RR. Changes in body weight and glycemic control in association with COVID-19 Shutdown among 23,000 adults with type 2 diabetes. Acta Diabetol 2023; 60:787-795. [PMID: 36894712 PMCID: PMC9998005 DOI: 10.1007/s00592-023-02056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/19/2023] [Indexed: 03/11/2023]
Abstract
AIMS To examine the association between COVID-19 Shutdown and within-subjects changes in body weight, body mass index (BMI), and glycemic parameters using electronic health record (EHR) data from 23,000 adults with type 2 diabetes (T2DM). METHODS Patients with T2DM with outpatient visit data on body weight, BMI, hemoglobin A1c (HbA1c), and blood glucose (≥ 2 measures before and after 3/16/2020) recorded in the EHR at the University of Pittsburgh Medical Center were included. A within-subjects analysis compared average and clinically significant changes in weight, BMI, HbA1c, and blood glucose during the year POST-Shutdown (Time 2-3) compared to the same interval during the PRE-Shutdown year (Time 0-1) using paired samples t-tests and the McNemar-Bowker test. RESULTS We studied 23,697 adults with T2DM (51% female; 89% White; mean age = 66 ± 13 years; mean BMI = 34 ± 7 kg/m2; mean HbA1c = 7 ± 2% [53 ± 21.9 mmol/mol]). Weight and BMI decreased during both the PRE- and POST-Shutdown intervals, but the changes were statistically smaller during the year POST-Shutdown relative to PRE (0.32 kg and 0.11 units, p < 0.0001). HbA1c showed statistically greater improvements during the POST-Shutdown interval compared to PRE (- 0.18% [-2 mmol/mol], p < 0.0001), but changes in glucose did not differ for the two intervals. CONCLUSIONS Despite widespread discussion of weight gain in association with the COVID-19 Shutdown, study data showed no evidence of adverse effects of Shutdown on body weight, BMI, HbA1C, or blood glucose in a large sample of adults with T2DM. This information may help to inform future public health decision-making.
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Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Kevin E Kip
- Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kripa Venkatakrishnan
- Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Oscar C Marroquin
- Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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The Impact of a Lockdown for the COVID-19 Pandemic on Seasonal HbA1c Variation in Patients with Type 2 Diabetes. Life (Basel) 2023; 13:life13030763. [PMID: 36983918 PMCID: PMC10054572 DOI: 10.3390/life13030763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Glycemic control in patients with type 2 diabetes may be disrupted due to restricted medical service access and lifestyle changes during COVID-19 lockdown period. This retrospective cohort study examined changes of HbA1c levels in adults with type 2 diabetes 12 weeks before and after May 19 in 2021, the date that COVID-19 lockdown began in Taiwan. The mean levels of HbA1c-after were significantly lower than HbA1c-before in 2019 (7.27 ± 1.27% vs 7.43 ± 1.38%, p < 0.001), 2020 (7.27 ± 1.28% vs 7.37 ± 1.34%, p < 0.001), and 2021 (7.03 ± 1.22% vs 7.17 ± 1.29%, p < 0.001). Considering the seasonal variation of HbA1c, ΔHbA1c values (HbA1c-after minus HbA1c-before) in 2020 (with sporadic COVID-19 cases and no lockdown) were not significantly different from 2021 (regression coefficient [95% CI] = 0.01% [−0.02%, 0.03%]), while seasonal HbA1c variation in 2019 (no COVID-19) was significantly more obvious than in 2021 (−0.05% [−0.07, −0.02%]). In conclusion, HbA1c level did not deteriorate after a lockdown measure during the COVID-19 pandemic in Taiwan. However, the absolute seasonal reduction in HbA1c was slightly less during the COVID-19 pandemic compared with the year without COVID-19.
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Olausson JM, Brady VJ, Storey S. Effect of COVID-19 on Type 2 Diabetes Self-Care Behaviors: A Rapid Review. Diabetes Spectr 2023; 36:228-244. [PMID: 37583557 PMCID: PMC10425230 DOI: 10.2337/ds22-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes. Methods A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist. Results Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%). Conclusion The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.
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Papachristoforou E, Liatis S, Psoma O, Kountouri A, Lambadiari V, Tsimihodimos V. Effect of the first and second COVID-19 associated lockdown on the metabolic control of patients with type 2 diabetes in Greece. J Diabetes Complications 2023; 37:108363. [PMID: 36542895 PMCID: PMC9703856 DOI: 10.1016/j.jdiacomp.2022.108363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the effect of the COVID-19 lockdown periods on the metabolic control of patients with type 2 diabetes (T2D) in three academic diabetes centers in Greece. There was a slight improvement in BMI, blood pressure and lipid values while the remaining parameters remained stable.
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Affiliation(s)
- Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ourania Psoma
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Aikaterini Kountouri
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Vasilis Tsimihodimos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Rajan R, Athale U, Ewusie JE, McAssey K, Thabane L, Samaan MC. An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study. Front Pediatr 2022; 10:1038345. [PMID: 36467474 PMCID: PMC9716184 DOI: 10.3389/fped.2022.1038345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes. Objectives We aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada. Subjects Patients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included. Methods This was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018-March 14, 2020) to the first year of the pandemic (March 15, 2020-March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis. Results There were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, -0.28, 0.01; p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71; p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73; p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49; p = 0.484) were noted. These results were retained in the sensitivity analysis. Conclusions Glycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period.Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.
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Affiliation(s)
- Raeesha Rajan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Hematology Oncology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Joycelyne Efua Ewusie
- The Research Institute Biostatistics Unit,St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Karen McAssey
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute Biostatistics Unit,St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Centre for Evaluation of Medicines, Hamilton, ON, Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Alyahya MS, Okour NS, Khader Y, Al-Sheyab N. Retrospective study on the impact of COVID-19 lockdown on patients with type 2 diabetes in Northern Jordan. BMJ Open 2022; 12:e065148. [PMID: 36351713 PMCID: PMC9644081 DOI: 10.1136/bmjopen-2022-065148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE During COVID-19 pandemic, complete lockdown of cities was one of the measures implemented by governments worldwide. Lockdown had a significant impact on people's lifestyles and access and utilisation of health services. This study aimed to assess the impact of the lockdown on glycaemic control among patients with type 2 diabetes mellitus (T2DM). DESIGN AND SETTING This was a retrospective study, electronic medical records at a leading University Hospital in Northern Jordan were used to extract study data. PARTICIPANTS All outpatients with T2DM. PRIMARY AND SECONDARY OUTCOME MEASURES Glycated haemoglobin (HbA1c), blood glucose and lipid profile for patients with T2DM, 6 months before and 6 months after the full COVID-19 lockdown. RESULTS A total of 639 patients (289 (45.2%) males and 350 (54.8%) females) were included in this study. Their age ranged from 18 to 91 years, with a mean (SD) of 59.9 (13.8) years. The overall means of HbA1c (8.41 vs 8.20, <0.001), high-density lipoprotein (1.16 vs 1.12, <0.001), low-density lipoprotein (2.81 vs 2.49, <0.001) and total cholesterol (4.45 vs 4.25, p<0.001) levels were significantly higher in the period before lockdown compared with the period after the lockdown. However, triglyceride and fasting blood glucose levels were not affected significantly after the lockdown. CONCLUSIONS The glycaemic control and lipid profile had significantly improved after COVID-19 pandemic lockdown. The availability of medication and medical advice delivery systems (monthly medicine deliveries) during the lockdown in Jordan might have positive impact on patients with diabetes.
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Affiliation(s)
- Mohammad S Alyahya
- Health Management and Policy, Faculty of Medcine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nadeen Saeed Okour
- Health Management and Policy, Faculty of Medcine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medcine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya Al-Sheyab
- Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Bellini B, Nreu B, Francesconi P, Mannucci E. Covid-19 pandemic, diabetes and glycemic control: Results of a retrospective cohort study of 230.000 persons with diabetes in tuscany. Nutr Metab Cardiovasc Dis 2022; 32:2588-2593. [PMID: 36064691 PMCID: PMC9356641 DOI: 10.1016/j.numecd.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic affected the processes of routine care for chronic patients due to disrupted delivery care. The aim of the present study is to verify the COVID-19 pandemic effects on diabetes control and management. METHODS AND RESULTS The study was designed as a retrospective observational study, performed on two cohorts of patients with diabetes in 2019 and 2020. Data used for the analyses were gathered from administrative and laboratory databases, which do not include any sensible information on COVID-19. The Tuscany Regional Health Agency is data controller for current administrative databases and has been working to produce available information for policy decision-making. In 2020, in comparison with 2019, a relevant reduction of the number of patients measuring HbA1c was observed during the March-April lockdown, and again during the second pandemic wave in Autumn. A similar pattern was observed for specialist visits for diabetes, for which the introduction of televisits only partly compensated for the reduction of traditional office visits. The number of patients receiving drugs for diabetes each week in 2020 was very similar to 2019. The mean HbA1c values and the proportion of HbA1c values > 8% for each week, were higher during the 2020 Spring and Autumn lockdown. CONCLUSION COVID-19 pandemic negatively impacts diabetes management, reducing specialist visits and HbA1c determinations during the first and second pandemic wave. Despite a satisfactory continuity in pharmacological treatment, short-term impairment of average glycemic control was detected, particularly in Autumn.
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Affiliation(s)
| | - Besmir Nreu
- Diabetology, Careggi Hospital, Florence, Italy; University of Florence, Italy.
| | | | - Edoardo Mannucci
- Diabetology, Careggi Hospital, Florence, Italy; University of Florence, Italy
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11
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Di Gangi S, Lüthi B, Diaz Hernandez L, Zeller A, Zechmann S, Fischer R. Quality outcome of diabetes care during COVID-19 pandemic: a primary care cohort study. Acta Diabetol 2022; 59:1189-1200. [PMID: 35780277 PMCID: PMC9329414 DOI: 10.1007/s00592-022-01920-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022]
Abstract
AIM Management of diabetes care can be affected by COVID-19 pandemic control measures. This study aimed to determine the impact of the pandemic, during 17.03.2020-16.03.2021, on quality outcomes of diabetes care in general practice in Switzerland. METHODS In this retrospective cohort study, diabetes mellitus patients (≥ 18 years) with at least one consultation at a general practitioner, during 17.03.2018-16.03.2019 (cohort 1) and 17.03.2019-16.03.2020 (cohort 2) were included and followed-up for two years. Quality indicators and outcomes of diabetes care, at patient and practitioner level, were compared before and during the pandemic. Logistic regression was performed to identify patient's risk factors for dropout from follow-up. RESULTS Data from 191 practices, 23,903 patients, cohort 1 and 25,092 patients, cohort 2, were analyzed. The fraction of patients lost to follow-up, attributable to the pandemic, was 28% (95% confidence interval: 25%, 30%). During the pandemic, compared to the previous year, regular measurement of weight, HbA1c, blood pressure and serum creatinine were less frequent and less patients per practitioner reached HbA1c and blood pressure target outcomes. Factors associated with continuity of care during the pandemic were: patient age 41-80 years, longer diabetes duration, diagnosis of hypertension or dyslipidemia, influenza vaccination during the last year. Risk factors for dropout were age > 80 and receiving only insulin as anti-diabetic medication. CONCLUSION A considerable quality reduction in diabetes mellitus care could be observed during the pandemic. Though the most vulnerable patients were not the most affected by the pandemic, key factors that might reduce dropout from follow-up were identified.
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Affiliation(s)
- Stefania Di Gangi
- Institute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Benjamin Lüthi
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | | | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Stefan Zechmann
- Institute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
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12
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Tannus LRM, Zapelini RM, Cabizuca CA, Abi-Abib RC, Matheus ASM, Calassara PC, Pozzan R, Cobas RA. Effect of the COVID-19 pandemic on glycemic control in Brazilian patients with type 2 diabetes. Endocrine 2022; 77:455-460. [PMID: 35838896 PMCID: PMC9284486 DOI: 10.1007/s12020-022-03137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the effect of restrictive measures the COVID-19 pandemic imposed on glycemic control of patients with type 2 diabetes (T2D) and its associated factors. METHODS Outpatients with T2D who had an appointment scheduled during the social distancing period were eligible for telemonitoring. Clinical and laboratorial data were collected from medical records in the last consultation before and from the first visit after the COVID-19 pandemic lockdown period. RESULTS From the 1241 eligible patients, 816 (65.7%) could be contacted by phone, 137 (11%) attended the unit for consultation during the social distancing period, and 1040 (83.8%) returned up to 12 months after the end of the lockdown period. We observed a meaningful reduction of glycated hemoglobin (HbA1c) (7.9 [7-9] vs. 7.7 [6.9-8.8] p = 0.004) and no difference in body mass index (29.5 [26-33.7] vs. 29.6 [26.2-34.1], p = 0.17) before and after the social distancing period. According to insulin use at baseline, the HbA1c variation was +0.6 (-0.7 to +2) and -0.6 (-2.1 to +0.7) in patients without and with insulin, respectively (p < 0.001). In the multivariate model, insulin therapy was the only independent significant predictor of HbA1c reduction. CONCLUSION This study observed an improvement in glycemic control after the lockdown. The only independent predictor found was previous insulin use. Probably, the longer time available to perform frequent blood glucose self-monitoring at home and adjustments in insulin therapy could explain our findings.
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Affiliation(s)
- L R M Tannus
- Department of Internal Medicine, Diabetes Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - R M Zapelini
- Department of Internal Medicine, Diabetes Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - C A Cabizuca
- Department of Internal Medicine, Diabetes Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - R C Abi-Abib
- Department of Internal Medicine, Diabetes Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - A S M Matheus
- Department of Internal Medicine, Diabetes Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - P C Calassara
- Faculdade de Ciências Médicas, FCM, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - R Pozzan
- Department of Internal Medicine, Diabetes Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - R A Cobas
- Department of Internal Medicine, Diabetes Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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13
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O'Mahoney LL, Highton PJ, Kudlek L, Morgan J, Lynch R, Schofield E, Sreejith N, Kapur A, Otunla A, Kerneis S, James O, Rees K, Curtis F, Khunti K, Hartmann‐Boyce J. The impact of the COVID-19 pandemic on glycaemic control in people with diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2022; 24:1850-1860. [PMID: 35603919 PMCID: PMC9347483 DOI: 10.1111/dom.14771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022]
Abstract
AIM To identify, appraise and synthesize the available evidence on the impact of the coronavirus disease 2019 (COVID-19) pandemic and lockdown (LD) on glycaemic control in people with diabetes. MATERIALS AND METHODS We searched multiple databases up to 2 February 2021 for studies reporting HbA1c, time in range (TIR), average or fasting glucose, severe hypoglycaemia and diabetic ketoacidosis. Data were pooled using random effects meta-analysis and are presented as mean difference (MD) with 95% confidence intervals (CI). This review was preregistered on PROSPERO (CRD42020179319). RESULTS We include 59 studies; 44 (n = 15 464) were included in quantitative syntheses and 15 were narratively synthesized. Pooled data were grouped by diabetes type. Results from 28 studies (n = 5048 type 1 diabetes [T1D] and combined diabetes participants) showed that TIR increased during LD compared with before LD (MD 2.74%, 95% CI 1.80% to 3.69%). Data from 10 studies (n = 1294 T1D participants) showed that TIR increased after LD compared with before LD (MD 5.14%, 95% CI 3.12% to 7.16%). Pooled results from 12 studies (n = 4810 T1D and type 2 diabetes participants) resulted in average glucose decreasing after LD compared with before LD (MD -6.86 mg/dl, 95% CI -8.54 to -5.18). Results for other outcomes, including HbA1c, were not statistically significantly different. CONCLUSIONS The COVID-19 pandemic was associated with small improvements across multiple outcomes of glycaemic control, although there was insufficient evidence to suggest that this led to changes in HbA1c. Most evidence came from people with access to diabetes technologies in high-income countries; more research is needed in less advantaged populations.
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Affiliation(s)
| | | | - Laura Kudlek
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Rosie Lynch
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | | | - Ajay Kapur
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | | | - Sven Kerneis
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Olivia James
- Medical Sciences DivisionUniversity of OxfordOxfordUK
| | - Karen Rees
- Freelance Systematic ReviewerWarwickshireUK
| | - Ffion Curtis
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
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14
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Tsukaguchi R, Murakami T, Yoshiji S, Shide K, Fujita Y, Ogura M, Inagaki N. Year-long effects of COVID-19 restrictions on glycemic control and body composition in patients with glucose intolerance in Japan: A single-center retrospective study. J Diabetes Investig 2022; 13:2063-2072. [PMID: 35980313 PMCID: PMC9538039 DOI: 10.1111/jdi.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Instruction During the coronavirus disease 2019 (COVID‐19) pandemic, the lockdowns in Europe raised concerns about negative effects on glycemic control and body composition in patients with diabetes. In Japan, voluntary‐based restrictions were imposed as the declaration of a state of emergency (DSE), whose metabolic consequences have not been fully investigated. We carried out a single‐center retrospective study to evaluate changes in glycemic control and body composition in outpatients with glucose intolerance after the DSE. Materials and Methods We enrolled outpatients with glucose intolerance: (i) for whom longitudinal data about body composition were available; (ii) who participated in dietary follow up with nutritionists; and (iii) whose laboratory data included glycated hemoglobin (HbA1c) levels before and after the DSE. Results Among 415 patients, we found no significant changes in HbA1c overall after the DSE. Bodyweight and fat mass increased significantly, whereas skeletal mass decreased significantly. HbA1c changes after the DSE were significantly correlated with changes in bodyweight and fat mass. In 128 patients whose HbA1c levels increased ≥0.3%, changes in bodyweight and fat mass were significantly larger than those in the other 287 patients. With regard to lifestyle changes, increased snacking was likely to worsen glycemic control (odds ratio 1.76, P = 0.036). Conclusions COVID‐19 restrictions in Japan had unfavorable metabolic consequences for patients with glucose intolerance, highlighted by increased bodyweight and body fat, and decreased skeletal muscle. In addition, lifestyle changes, such as increased snacking, might worsen glycemic control. Clinical attention and interventions are required to prevent such metabolic changes.
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Affiliation(s)
- Ryo Tsukaguchi
- Department of Diabetes, Endocrinology, and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takaaki Murakami
- Department of Diabetes, Endocrinology, and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Yoshiji
- Department of Diabetes, Endocrinology, and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenichiro Shide
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Yoshihito Fujita
- Department of Diabetes, Endocrinology, and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahito Ogura
- Department of Diabetes, Endocrinology, and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology, and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Olesen K, Joensen LE, Madsen KP, Willaing I. How has the COVID-19 Pandemic Affected Diabetes Self-Management in People With Diabetes? - A One-Year Follow-Up Study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:867025. [PMID: 36992738 PMCID: PMC10012120 DOI: 10.3389/fcdhc.2022.867025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/10/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND AIM In Denmark, the COVID-19 pandemic resulted in two lockdowns, one from March to May 2020 and another from December 2020 to April 2021, which had severe impact on everyday life. The aim of this study was to explore changes in diabetes self-management behaviors during the pandemic and to examine how specific population characteristics were associated with changes in diabetes management. METHODS AND PARTICIPANTS In a cohort study from March 2020 to April 2021, two online questionnaires were collected from a total of 760 people with diabetes. Descriptive statistics were used to assess the proportion of participants experiencing improvements, deterioration, and status quo in diabetes self-management during the pandemic. Using logistic regressions, baseline characteristics were explored as potential predictors of change. RESULTS Approximately half of the participants reported that they experienced lower physical activity in April 2021 compared to before the pandemic, approximately one fifth reported diabetes self-management to be more difficult than prior to the pandemic, and one fifth reported eating more unhealthily than before the pandemic. Some participants reported higher frequency of high blood glucose levels (28%), low blood glucose levels (13%) and more frequent blood glucose variability (33%) compared to before. Easier diabetes self-management was reported by relatively few participants, however, 15% reported eating more healthily, and 20% reported being more physically active. We were largely unable to identify predictors of change in exercise activities. The few baseline characteristics identified as predictors of difficulties in diabetes self-management and adverse blood glucose levels due to the pandemic were sub-optimal psychological health, including high diabetes distress levels. CONCLUSION Findings indicate that many people with diabetes changed diabetes self-management behaviors during the pandemic, mostly in a negative direction. Particularly high diabetes distress levels in the beginning of the pandemic was a predictor of both positive and negative change in diabetes self-management, indicating that people with high diabetes distress levels could potentially benefit from increased support in diabetes care during a period of crisis.
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Affiliation(s)
- Kasper Olesen
- Health Promotion Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lene Eide Joensen
- Health Promotion Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristoffer Panduro Madsen
- Health Promotion Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ingrid Willaing
- Health Promotion Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
- Section of Health Services Research, Department of Public Health, Copenhagen University, Copenhagen, Denmark
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16
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Steenblock C, Hassanein M, Khan EG, Yaman M, Kamel M, Barbir M, Lorke DE, Rock JA, Everett D, Bejtullah S, Heimerer A, Tahirukaj E, Beqiri P, Bornstein SR. Diabetes and COVID-19: Short- and Long-Term Consequences. Horm Metab Res 2022; 54:503-509. [PMID: 35724689 PMCID: PMC9363150 DOI: 10.1055/a-1878-9566] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
When the corona pandemic commenced more than two years ago, it was quickly recognized that people with metabolic diseases show an augmented risk of severe COVID-19 and an increased mortality compared to people without these comorbidities. Furthermore, an infection with SARS-CoV-2 has been shown to lead to an aggravation of metabolic diseases and in single cases to new-onset metabolic disorders. In addition to the increased risk for people with diabetes in the acute phase of COVID-19, this patient group also seems to be more often affected by long-COVID and to experience more long-term consequences than people without diabetes. The mechanisms behind these discrepancies between people with and without diabetes in relation to COVID-19 are not completely understood yet and will require further research and follow-up studies during the following years. In the current review, we discuss why patients with diabetes have this higher risk of developing severe COVID-19 symptoms not only in the acute phase of the disease but also in relation to long-COVID, vaccine breakthrough infections and re-infections. Furthermore, we discuss the effects of lockdown on glycemic control.
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Affiliation(s)
- Charlotte Steenblock
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mohamed Hassanein
- Department of Diabetes and Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - Emran G Khan
- Endocrinology and Diabetology, King's College Hospital London, Dubai, United Arab Emirates
| | - Mohamad Yaman
- Building 6, Nesmah Technology, Dubai, United Arab Emirates
| | - Margrit Kamel
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mahmoud Barbir
- Department of Cardiology, Harefield Hospital, Harefield, United Kingdom of Great Britain and Northern Ireland
| | - Dietrich E Lorke
- Department of Anatomy and Cellular Biology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - John A Rock
- College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Dean Everett
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Adrian Heimerer
- Research Unit, College Heimerer, Prishtina, Republic of Kosovo
| | - Ermal Tahirukaj
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Petrit Beqiri
- Research Unit, College Heimerer, Prishtina, Republic of Kosovo
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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17
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Zhang S, Yuan F, Liu X, Liu Y. miR-33-5p Ameliorates β Cell Dysfunction and PI3K/AKT Signaling-Mediated Insulin Secretion in Diabetes via Targeting RND2. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.1161.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scoccimarro D, Giove G, Silverii A, Dicembrini I, Mannucci E. Effects of home confinement during COVID-19 outbreak on glycemic control in patients with type 2 diabetes receiving telemedicine support. Acta Diabetol 2022; 59:281-284. [PMID: 34773181 PMCID: PMC8589090 DOI: 10.1007/s00592-021-01817-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Daniele Scoccimarro
- University of Florence, Florence, Italy.
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Gianluca Giove
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Antonio Silverii
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Ilaria Dicembrini
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Edoardo Mannucci
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
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Ojo O, Wang XH, Ojo OO, Orjih E, Pavithran N, Adegboye ARA, Feng QQ, McCrone P. The Effects of COVID-19 Lockdown on Glycaemic Control and Lipid Profile in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031095. [PMID: 35162117 PMCID: PMC8834313 DOI: 10.3390/ijerph19031095] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023]
Abstract
The impact of the COVID-19 lockdown on glycaemic control and other metabolic parameters in patients with type 2 diabetes is still evolving. Aim: This systematic review and meta-analysis aims to examine the effects of COVID-19 lockdown on glycaemic control and lipid profile in patients with type 2 diabetes. Methods: The PRISMA framework was the method used to conduct the systematic review and meta-analysis, and the search strategy was based on the population, intervention, control and outcome (PICO) model. The Health Sciences Research databases was accessed via EBSCO-host, and EMBASE were searched for relevant articles. Searches were conducted from inception of the databases until 17 September 2021. Results: The results identified three distinct areas: glycaemic control, lipid parameters and body mass index. It was found that COVID-19 lockdown led to a significant (p < 0.01) increase in the levels of glycated haemoglobin (%) compared with pre-COVID group (gp) with a mean difference of 0.34 (95% CI: 0.30, 0.38). Eleven studies contributed to the data for glycated haemoglobin analysis with a total of 16,895 participants (post-COVID-19 lockdown gp, n = 8417; pre-COVID gp, n = 8478). The meta-analysis of fasting plasma glucose (mg/dL) also showed a significant (p < 0.05) increase in levels of post-COVID-19 lockdown gp compared with pre-COVID gp, with a mean difference of 7.19 (95% CI: 5.28, 9.10). Six studies contributed to fasting plasma glucose analysis involving a total of 2327 participants (post-COVID-19 lockdown, n = 1159; pre-COVID gp, n = 1168). The body mass index (BMI) (kg/m2) analysis also demonstrated that post-COVID-19 lockdown gp had a significantly (p < 0.05) higher BMI than the pre-COVID gp with a mean difference of 1.13 (95% CI: 0.99; 1.28), involving six studies and a total of 2363 participants (post-COVID-19 lockdown gp, n = 1186; pre-COVID gp, n = 1177). There were significantly (p < 0.05) lower levels of total cholesterol (mmol/L), triglyceride (mmol/L) and LDL cholesterol (mmol/L), and higher levels of HDL cholesterol (mg/dL) in the post-COVID-19 lockdown gp compared with pre-COVID gp, although these results were not consistent following sensitivity analysis. Conclusion: The findings of the systematic review and meta-analysis have demonstrated that COVID-19 lockdown resulted in a significant increase (p < 0.05) in the levels of glycated haemoglobin, fasting glucose and body mass index in patients with type 2 diabetes. In contrast, the effect of the lockdown on lipid parameters, including total cholesterol, triglycerides, LDL and HDL cholesterol was not consistent.
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Affiliation(s)
- Omorogieva Ojo
- School of Health Sciences, Faculty of Education, Health and Human Sciences, Avery Hill Campus, University of Greenwich, Avery Hill Road, London SE9 2UG, UK;
- Correspondence:
| | - Xiao-Hua Wang
- The School of Nursing, Soochow University, Suzhou 215006, China; (X.-H.W.); (Q.-Q.F.)
| | - Osarhumwese Osaretin Ojo
- Smoking Cessation Department, University Hospital, South London and Maudsley NHS Foundation Trust, Lewisham High Street, London SE13 6LH, UK;
| | - Edith Orjih
- Diabetes and Endocrine Department, Darent Valley Hospital, Dartford & Gravesham NHS Trust, Dartford DA2 8DA, UK;
| | - Nivedita Pavithran
- Department of Clinical Nutrition, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi 682041, India;
| | - Amanda Rodrigues Amorim Adegboye
- Centre for Healthcare Research, School of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK;
| | - Qian-Qian Feng
- The School of Nursing, Soochow University, Suzhou 215006, China; (X.-H.W.); (Q.-Q.F.)
| | - Paul McCrone
- School of Health Sciences, Faculty of Education, Health and Human Sciences, Avery Hill Campus, University of Greenwich, Avery Hill Road, London SE9 2UG, UK;
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20
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Bosi E, Gregori G, Cruciani C, Irace C, Pozzilli P, Buzzetti R. The use of flash glucose monitoring significantly improves glycemic control in type 2 diabetes managed with basal bolus insulin therapy compared to self-monitoring of blood glucose: A prospective observational cohort study. Diabetes Res Clin Pract 2022; 183:109172. [PMID: 34883185 DOI: 10.1016/j.diabres.2021.109172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022]
Abstract
AIM This prospective, observational cohort study aimed to measure HbA1c change over 3-6 months in type 2 diabetes managed with basal-bolus insulin and FreeStyle Libre® Flash Glucose Monitoring System (FSL) use compared to self-monitored blood glucose (SMBG). METHODS Sixteen Italian hospitals enrolled patients with type 2 diabetes (n = 322, [109 FSL, 213 SMBG users]) using basal-bolus insulin therapy for ≥ 1 year, HbA1c 8.0-12.0% (64-108 mmol/mol), new to FSL use (<3 months) or continuing with SMBG (controls). Eligible FSL and SMBG users were matched (1:2 ratio) for baseline HbA1c (within ± 0.5%, recorded ≤ 3 months previously), study site and baseline data collection date. RESULTS Overall, baseline HbA1c was 8.9 ± 0.8% (74 ± 9 mmol/mol), age 67.2 ± 10.0 years, BMI 30.5 ± 6.5 kg/m2 and insulin use duration 8.6 ± 6.6 years (mean ± SD), 56.2% were males. After 3-6 months, 234 complete cases (83 FSL, 151 SMBG users) demonstrated significantly reduced HbA1c for FSL use compared to SMBG (0.3% ± 0.12 [3 mmol/mol ± 1.3, (mean ± SE)], p = 0.0112). The difference remained statistically significant after adjusting for confounders. CONCLUSIONS HbA1c significantly improved in basal-bolus treated type 2 diabetes after flash glucose monitoring use for 3-6 months compared to SMBG.
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Affiliation(s)
- E Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital and San Raffaele Vita Salute University, Milan, Italy.
| | - G Gregori
- ASL Toscana Nord Ovest (ATNO), SS Diabetologia Massa Carrara, Carrara, Italy.
| | - C Cruciani
- USL Umbria2 URP Terni, Diabetology Terni, Narni, Amelia, Orvieto, Terni, Italy.
| | - C Irace
- University Magna Graecia Catanzaro, Department of Health Science, Catanzaro, Italy.
| | - P Pozzilli
- Campus Bio-Medico University of Rome, Endocrinology and Diabetes, Rome, Italy.
| | - R Buzzetti
- Dept. of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Di Fusco SA, Spinelli A, Castello L, Mocini E, Gulizia MM, Oliva F, Gabrielli D, Imperoli G, Colivicchi F. Impact of Working from Home on Cardiovascular Health: An Emerging Issue with the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211882. [PMID: 34831636 PMCID: PMC8621324 DOI: 10.3390/ijerph182211882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/18/2022]
Abstract
Mandatory working from home is one of the consequences of the COVID-19 pandemic for a large number of workers. Transition to working from home may significantly impact lifestyle, psychosocial status, and the overall health of workers. This review summarizes available data about the effects of lockdown measures, particularly working from home, on cardiovascular risk factors including sedentary lifestyle, unhealthy diet pattern, psychological distress, smoking, alcohol misuse, and cardiometabolic parameters. Finally, we suggest countermeasures that can attenuate the negative health impact of working from home. Indeed, timely and tailored interventions implemented by companies in cooperation with the health care system could allow workers to benefit more from some of the advantages associated with working from home.
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Affiliation(s)
- Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Martinotti Street 20, 00135 Rome, Italy; (A.S.); (L.C.); (F.C.)
- Correspondence: ; Tel.: +39-06-33061
| | - Antonella Spinelli
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Martinotti Street 20, 00135 Rome, Italy; (A.S.); (L.C.); (F.C.)
| | - Lorenzo Castello
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Martinotti Street 20, 00135 Rome, Italy; (A.S.); (L.C.); (F.C.)
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy;
| | - Michele Massimo Gulizia
- Cardiology Division, Garibaldi-Nesima Hospital, 95122 Catania, Italy;
- ANMCO Heart Care Foundation, 50121 Florence, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milano, Italy;
| | - Domenico Gabrielli
- Cardiology/CCU Unit, Cardiovascular Department, San Camillo Hospital, 00152 Rome, Italy;
| | - Giuseppe Imperoli
- Medicine Unit, Emergency Department, San Filippo Neri Hospital, 00135 Rome, Italy;
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Martinotti Street 20, 00135 Rome, Italy; (A.S.); (L.C.); (F.C.)
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22
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Garofolo M, Aragona M, Rodia C, Falcetta P, Bertolotto A, Campi F, Del Prato S, Penno G. Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies. Diabetes Res Clin Pract 2021; 180:109066. [PMID: 34563586 PMCID: PMC8458100 DOI: 10.1016/j.diabres.2021.109066] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023]
Abstract
AIMS To assess the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes. METHODS We conducted a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021, using "diabetes", "lockdown", and "glucose" as key search terms. Time in range (TIR) was the main outcome; other metrics were time above range (TAR), time below range (TBR), mean blood glucose (MBG) and its variability (%CV), estimated HbA1c (eA1c) or glucose management indicator (GMI). RESULTS Seventeen studies for a total of 3,441 individuals with type 1 diabetes were included in the analysis. In the lockdown period, TIR 70-180 mg/dl increased by 3.05% (95% CI 1.67-4.43%; p < 0.0001) while TAR (>180 mg/dL and > 250 mg/dL) declined by 3.39% (-5.14 to -1.63%) and 1.96% (-2.51 to -1.42%), respectively (p < 0.0001 for both). Both TBR < 70 and <54 mg/dL remained unchanged. MBG slightly decreased by 5.40 mg/dL (-7.29 to -3.51 mg/dL; p < 0.0001) along with a reduction in %CV. Pooled eA1c and GMI decreased by 0.18% (-0.24 to -0.11%; p < 0.0001) and a similar reduction was observed when GMI alone was considered (0.15%, -0.23 to -0.07%; p < 0.0001). Sensor use was only slightly but not significantly reduced during lockdown. CONCLUSIONS This meta-analysis shows that well-controlled people with type 1 diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters.
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Affiliation(s)
- Monia Garofolo
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Michele Aragona
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cosimo Rodia
- Section of Endocrinology, ASL Brindisi, DSS-1, Brindisi, Italy
| | - Pierpaolo Falcetta
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandra Bertolotto
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Fabrizio Campi
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Stefano Del Prato
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Giuseppe Penno
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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