A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India

Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania

BACKGROUND

The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services.

OBJECTIVES

We investigated the pandemic's impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania.

METHODS

A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February-April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access.

RESULTS

We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05-2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22-0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33-0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14-2.88]; p = 0.011).

CONCLUSIONS

COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.

Managing Type 2 Diabetes During the COVID-19 Pandemic: Scoping Review and Qualitative Study Using Systematic Literature Review and Reddit

BACKGROUND

The COVID-19 pandemic impacted how people accessed health services and likely how they managed chronic conditions such as type 2 diabetes (T2D). Social media forums present a source of qualitative data to understand how adaptation might have occurred from the perspective of the patient.

OBJECTIVE

Our objective is to understand how the care-seeking behaviors and attitudes of people living with T2D were impacted during the early part of the pandemic by conducting a scoping literature review. A secondary objective is to compare the findings of the scoping review to those presented on a popular social media platform Reddit.

METHODS

A scoping review was conducted in 2021. Inclusion criteria were population with T2D, studies are patient-centered, and study objectives are centered around health behaviors, disease management, or mental health outcomes during the COVID-19 pandemic. Exclusion criteria were populations with other noncommunicable diseases, examining COVID-19 as a comorbidity to T2D, clinical treatments for COVID-19 among people living with T2D, genetic expressions of COVID-19 among people living with T2D, gray literature, or studies not published in English. Bias was mitigated by reviewing uncertainties with other authors. Data extracted from the studies were classified into thematic categories. These categories reflect the findings of this study as per our objective. Data from the Reddit forums related to T2D from March 2020 to early March 2021 were downloaded, and support vector machines were used to classify if a post was published in the context of the pandemic. Latent Dirichlet allocation topic modeling was performed to gather topics of discussion specific to the COVID-19 pandemic.

RESULTS

A total of 26 studies conducted between February and September 2020, consisting of 13,673 participants, were included in this scoping literature review. The studies were qualitative and relied mostly on qualitative data from surveys or questionnaires. Themes found from the literature review were "poorer glycemic control," "increased consumption of unhealthy foods," "decreased physical activity," "inability to access medical appointments," and "increased stress and anxiety." Findings from latent Dirichlet allocation topic modeling of Reddit forums were "Coping With Poor Mental Health," "Accessing Doctor & Medications and Controlling Blood Glucose," "Changing Food Habits During Pandemic," "Impact of Stress on Blood Glucose Levels," "Changing Status of Employment & Insurance," and "Risk of COVID Complications."

CONCLUSIONS

Topics of discussion gauged from the Reddit forums provide a holistic perspective of the impact of the pandemic on people living with T2D, which were found to be comparable to the findings of the literature review. The study was limited by only having 1 reviewer for the literature review, but biases were mitigated by consulting authors when there were uncertainties. Qualitative analysis of Reddit forms can supplement traditional qualitative studies of the behaviors of people living with T2D.

Exploring Disease Management Experiences of Individuals with Type 2 Diabetes During the COVID-19 Pandemic: A Qualitative Study

The aim of this study was to investigate the impact of COVID-19 infection on disease management among individuals with type 2 diabetes and to explore their perspectives on COVID-19. This descriptive qualitative study included patients with diabetes, with a sample of 15 patients meeting the study criteria. The data were analyzed using code groups, which were then further categorized into main themes and subthemes. The main themes were: initial contact with the SARS-CoV-2 that is associated with COVID-19 illness changes in diabetes self-management behaviors; attempt at maintaining diabetes selfmanagement behaviors; and problems with accessing diabetes care. The study findings revealed several significant insights. Individuals with diabetes exhibited a fear of contracting SARS-CoV-2, which led to reduced levels of exercise and difficulties in managing blood sugar levels and insulin adjustments. Moreover, due to anxiety about COVID-19 infection, they postponed health check-ups, resulting in experiencing diabetes-related complications.

The Implications of the Pandemic with Covid-19 in the Glycemic Control of People with Type 2 Diabetes

Introduction

The COVID-19 lockdown influenced the glycemic control and other metabolic parameters in people with type 1 and 2 diabetes mellitus.

Objective

To study the effects of COVID-19 lockdown on glycemic control in people with type 2 diabetes mellitus (T2DM).

Material and Methods

Our study group included 120 Romanian people with T2DM from both urban and rural areas. We employed a structured questionnaire with multiple-choice to collect data about DM management during lockdown, the interaction with their diabetologist, the access to treatment, and what other factors influenced their DM management during the lockdown.

Results

We did not observe an increase of numbers of hyper or hypoglycemia during the restriction period in people with T2DM. The number of glycemic imbalances was higher in people treated with insulin than those with oral antidiabetics (OAD) (p=0.003, X2=8.91). Regarding the causes of imbalances, we did not obtain a significant difference during the restriction period, neither between patients following treatment with insulin nor with OAD. On the contrary, we observed that only 26.7% of people with T2DM managed to maintain their weight or lost weight vs 73.3% patients who gained several extra kg (p<0.001, X2=52.26).

Conclusion

The findings of this study have demonstrated that in people with T2DM, the COVID-19 lockdown determines better glycemic control among patients treated with OAD compared to those treated with insulin therapy. Anxiety, stress, and emotions were the main reasons that led to the increase in glycemic values of these patients. Also, most patients have gained weight either due to lack of physical activity or due to stress.

The effect of COVID-19 pandemic on diabetes care indices in Southern Iran: an interrupted time series analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) requires a continues bulk of cares. It is very probable COVID-19 pandemic is affected its healthcare coverage.

METHODS

The interrupted time series analysis is used to model the trend of diabetes healthcare indices, such as the health worker visits, physician visits, body mass index (MBI), fasting blood sugar (FBS), and hemoglobin A1c (HbA1c), before and after the start of COVID-19 pandemic. The reference of data was the totals of all T2DM patients living in Fars Province, Southern Iran, areas covered by Shiraz University of Medical Science (SUMS), from 2019 to 2020.

RESULTS

A significant decrease for visits by the health workers, and physicians was observed by starting COVID-19 pandemic (β2 = -0.808, P < 0.001, β2 = -0.560, P < 0.001); Nevertheless, the coverage of these services statistically increased by next months (β3 = 0.112, P < 0.001, β3 = 0.053, P < 0.001). A same pattern was observed for the number of BMI, FBS and HbA1c assessments, and number of refer to hospital emergency wards (β3 = 0.105, P < 0.001; β3 = 0.076, P < 0.001; β3 = 0.022, P < 0.001; β3 = 0.106, P < 0.001). The proportion of T2DM patients with HbA1C < 7%, and controlled hypertension during study period was statistically unchanged.

CONCLUSIONS

When the COVID-19 pandemic was announced, T2DM healthcare coverage drastically decreased, but it quickly began to rebound. The health monitoring system could not have any noticeable effects on diabetes outcomes.

Impact of lockdown during COVID-19 on glycaemic control in children with type 1 diabetes mellitus following at diabetes clinic, Omdurman, Sudan

Corona Virus Disease-2019 (COVID-19) is a novel pandemic disease. There have been many challenges for diabetic patients, which might have resulted in an increased risk of complications and significant lifestyle changes, including physical inactivity and psychological distress. This study evaluated the effects of lockdown on paediatric patients with type 1 diabetic mellitus (T1DM) in terms of acute metabolic complications and psychological deterioration. A questionnaire-based cross-sectional study was conducted between November 2020 and February 2021 at Mohammed Alamin Hamid Diabetic Clinic, Omdurman, Sudan. Data was collected from direct interviews with patients and their caregivers. Out of 208 children with T1DM aged from 1-18 years, 48.1% had persistent hyperglycaemia, and 20.6% had hypoglycaemia. Insulin doses were missed in 20.2% of them, glucose monitoring was not done in 28.8%, and 20.6% reported decreased physical activity during the lockdown. Mean HbA1c levels were the same in pre and post-lockdown periods. There was an insignificant relationship between physical activity, dietary changes, and glycaemic control (p values = 0.519 and 0.146, respectively). On the other hand, there was a significant weak positive correlation between psychological and behavioural disorders such as aggression, anxiety, isolation, and glycaemic control (p-value = 0.032, 0.002, and <0.0001; r = 0.115, 0.135, and 0.169, respectively). The negative impact of the COVID-19 lockdown found on blood glucose measures and psychological status may correlate with glucose monitoring equipment shortage, lifestyle changes, and mood deterioration.

Diabetes Prevention and Measures to Ensuring a Healthy Lifestyle during COVID-19 Pandemic and after

The incidence of diabetes mellitus (DM) is increasing exponentially globally, with 90% of the confirmed cases being type 2 DM. The global incidence of DM is expected to increase by 48% during 2017-2045. The coronavirus disease 2019 (COVID-19) pandemic continues to have a massive impact on human health, causing sudden lifestyle changes through quarantine measures, such as lockdown, social distancing, various curfews, and isolation at home. This in turn might increase the risk of developing numerous chronic diseases, such as DM, obesity, and cardiovascular diseases, which increase the severity of COVID-19. To this end, we performed a comprehensive review to determine viable measures for the prevention of DM and its subsequent upsurge globally. Additionally, we have determined strategies that should be adopted globally to ensure a healthy lifestyle during the COVID-19 pandemic and later.

Vitamin D deficiency in patients with diabetes and its correlation with water fluoride levels

Chronic exposure to fluoride through drinking water has been linked to insulin resistance and resulting type 2 diabetes mellitus (T2DM). Here, we aim to study the impact of water fluoride levels on blood glucose and vitamin D levels. A hospital-based study was conducted on diabetic patients (n = 303) at All India Institute of Medical Sciences (AIIMS), Raebareli outstation patient department (OPD). The relationship between vitamin D or fasting blood glucose levels (BGLs) with water fluoride levels was estimated through Spearman's rank correlation. We found a significant negative correlation between water fluoride and vitamin D levels [r_s = -0.777, p-value < 0.001] and a positive correlation between water fluoride and fasting BGLs [r_s = 0.178, p-value <0.05]. The participants residing in fluoride-endemic areas (F > 1.5 mg/L) had higher odds of severe vitamin D deficiency (odds ratio: 5.07, 95% CI: 1.9-13.2, p-value = 0.0009). The results demonstrate that vitamin D deficiency and fasting BGLs are significantly associated with water fluoride levels. This study signifies the role of fluoride toxicity in poor glycemic control and derived vitamin D deficiency. Vitamin D supplementation and the application of standard household water purification devices are recommended to tackle vitamin D deficiency in fluoride-endemic areas.

Retrospective study on the impact of COVID-19 lockdown on patients with type 2 diabetes in Northern Jordan

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.

How did lockdown and social distancing policies change the eating habits of diabetic patients during the COVID-19 pandemic? A systematic review

Background

After the declaration of the COVID-19 pandemic, governments established national lockdowns and social distancing as an effective plan to control this disease. As a result of the lockdown policies, diabetic patients` access to food products, medication, and routine follow-ups is disrupted, making it difficult for them to control their disease.

Methods

International databases, including PubMed/Medline, Web of Science, and Scopus, were searched until April 2022. All observational studies included assessing the impact of lockdown and social distancing on eating habits (as primary outcome), and glycemic and anthropometric indices (as secondary outcomes) of diabetic patients during the COVID-19 pandemic. The Newcastle-Ottawa Quality Scale was used to assess the quality rating of the studies.

Results

Overall, 22 studies were included in this systematic review, the results of which varied in different communities. In most studies, consumption of grains, fruits, and vegetables was reported to increase. On the other hand, consumption of snacks and sweets was reported to increase in other surveys. During the COVID-19 lockdown, most diabetic patients preferred to cook meals at home, using less takeout, fast foods, and alcoholic drinks. Although the patients mostly improved their eating habits, the glycemic and anthropometric indices were contradictory in different studies. Studies showed that the eating habits of diabetic patients vary from country to country, even in some cases and studies done in the same country showed different results. For example, all the studies done in Japan showed an increase in the consumption of snacks and sweets, leading to weight gain in the patients. However, conflicting results in eating habits have been observed in studies conducted in India.

Conclusion

The lockdown policies have led to a beneficial change in the eating habits of diabetic patients to consume more fruits and vegetables and reduce the consumption of animal protein products and alcoholic beverages. While some diabetic patients have increased consumption of snacks and sweets, leading to a disturbance in their glycemic and anthropometric indices control. Understanding the consequences of lockdown and social distancing of the diabetic patient during the COVID-19 pandemic can help public health authorities make better recommendations to improve glycemic control.

Quality outcome of diabetes care during COVID-19 pandemic: a primary care cohort study

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.

Evaluating the effect of COVID-19 on quality measures of patients with type 2 diabetes in two family nurse practitioner-owned clinics

BACKGROUND

The COVID-19 pandemic necessitated lockdowns resulting in the disruption of access to primary care. A family nurse practitioner (NP)-owned practice shifted many visits to telehealth to provide care to all their patients including those with chronic illness . The purpose of this project was to evaluate the impact of the pandemic on selected diabetes quality measures and adherence to national diabetes guidelines in two previously well-performing NP-owned primary care clinics.

LOCAL PROBLEM

Previous quality improvement studies demonstrated high performing metrics for their patients with type 2 diabetes mellitus (DM). The evaluation of the patients with type 2 DM was necessary to assess the care being delivered in the practice.

METHODS

A retrospective record review and analysis of 179 patients older than 18 years was implemented during the early days of the pandemic. Demographic data, process, and outcome measures for diabetes care were collected and compared with previous data from 2013 to 2017 to identify gaps in care.

INTERVENTIONS

Telehealth was implemented to deliver care to patients because of the lockdown. The evaluation of these metrics during the period where telehealth was being used to provide care was warranted to evaluate the status of patients with type 2 DM.

RESULTS

Patients with type 2 DM receiving care with telehealth demonstrated worsening A1cs and other quality care measures, including fewer ophthalmology evaluations.

CONCLUSION

While access to telehealth was important for these patients with type 2 DM, the findings demonstrated that the COVID-19 pandemic had a negative impact on diabetes quality measures. While these may have also reflected the challenges of adhering to lifestyle interventions during this stressful time, telehealth alone may not be an adequate delivery mechanism for primary care for those with type 2 DM.

The impact of the COVID-19 pandemic on glycaemic control in people with diabetes: A systematic review and meta-analysis

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.

Changes in self-care behaviors of Iranian patients with type 2 diabetes using insulin pens during COVID-19 pandemic

Aims

The COVID-19 pandemic as a serious public health concern has been accompanied with changes and restrictions in everyday life. This can affect directly or indirectly health behaviors and disease management, particularly in developing countries with low resources. This study aimed to compare self-care behaviors of patients with type 2 diabetes using insulin pens before and after the COVID-19 pandemic.

Methods

This was a prospective cohort study involving 300 patients with type 2 diabetes who had been referred to a referral tertiary care diabetes clinic during 2018–2019. The Summary of Diabetes Self-Care Activities Assessment (SDSCA) questionnaire was used for the evaluation of 5 self-care activities.

Results

The mean total self-care score before and one year after the onset of the COVID-19 crisis was 37.63 (SD, 10.89) and 26.14 (SD, 10.99), respectively. Before the COVID-19 crisis, 27%, 54.3%, and 18.7% of patients had poor, moderate, and good self-care, respectively. One year after the onset of the epidemic, however, these rates were 66.3%, 29%, and 4.7%, respectively. There was a significant difference between the mean score of 5 indices of self-care behaviors before and after the COVID-19 crisis (p < 0.01).

Conclusion

Our findings suggest the deterioration of self-care behaviors amidst the COVID-19 pandemic in an Iranian population. Continuous follow-up of patients with diabetes and the design of effective educational programs for these patient can prevent or delay the long-term consequences of diabetes, especially in the context of the COVID-19 crisis.

"Pre-Ramadan" telemedicine: Effect on fasting experience and glycemic control during ramadan in people with type 1 diabetes

OBJECTIVE

People with type 1 diabetes (T1D) are advised to have a "pre-Ramadan" visit to receive the assessment and education needed to safely fast during the holy month of Ramadan. The COVID-19 lockdown has interrupted this standard of care in Muslim-majority countries where telemedicine is not well-established. Here, we examined the impact of virtual"pre-Ramadan" visits, as an alternative option to the traditional (in-person) visits, on fasting experience and glycemic control during Ramadan in people with T1D.

METHOD

151 individuals with T1D were categorized into 3 groups according to the type of"pre-Ramadan" visit that they attended in 2020: virtual (n = 50), in-person (n = 56), and no visit (n = 45). Number of days fast was broken and CGM metrics were retrospectively compared across the groups.

RESULT

Patients who had a virtual"pre-Ramadan" visit were more likely to use continuous glucose monitors (CGM) than those who had no visit (61.7% and 38.6%, respectively, p < 0.05). Attending a virtual"pre-Ramadan" visit was associated with the least number of days fast was broken compared to those who had no visit (p < 0.01) or in-person visit (p = 0.02). CGM time in range (TIR) during Ramadan was the highest in those who had virtual "Pre-Ramadan" visits compared to those who had no visit or in-person visits (59%, 44%, and 47%,respectively). After adjusting for age, gender, pre-Ramadan A1c, and CGM use, the odds of fasting most days of Ramadan were highest in the virtual group [OR (CI): 9.13 (1.43, 58.22)] followed by the in-person group [3.02 (0.54,16.68)] compared to the no visit group.

CONCLUSION

Virtual"pre-Ramadan" visits are effective alternative to in-person visits when managing people with T1D who plan to fast during Ramadan.

Analysis of Clinical Parameters, Drug Consumption and Use of Health Resources in a Southern European Population with Diabetes That Did Not Contract COVID-19: A Longitudinal Big Data Study

The lockdown measures imposed to stop the spread of the virus have affected the general population, but particularly people with chronic diseases such as diabetes. An observational real world data pre-post study of 86,615 individuals over the age of 16, having a medical history in the Aragon (Spain) Health Service and diagnosed with diabetes, without COVID-19 infection was undertaken. Clinical, pharmacological and health resource use variables were collected during the six months prior to the onset of the lockdown and during the six months after the lockdown ended. The Student's t-test was used to analyse differences in means. Our study does not show clinically relevant changes six months following the end of the strict lockdown. The consumption, by these patients, of hypoglycaemic drugs and the use of health resources continue at below pre-pandemic levels, six months later. The interruption in care for these patients and the lifestyle change resulting from the pandemic do not appear to have had a significant impact on the health of the diabetic population.

Impact of COVID-19 lockdown on diabetes management and follow-up in a broad population in Spain

BACKGROUND

To evaluate the impact of COVID-19 lockdown on glycaemic control and diabetes follow-up in a Spanish metropolitan area with a total general population of 340,000.

METHODS

A retrospective real-world study comparing HbA1c testing, an indicator of diabetes control, and mean HbA1c during different COVID-19 restriction periods in 2020 (full lockdown, post-lockdown, partial lockdown) with the same periods in 2019. HbA1c testing was analysed per study period and according to gender, age and clinical setting. Associations between HbA1c testing and different covariables were investigated using logistic regression analysis. Changes in HbA1c were evaluated by repeated measures multivariate analysis of variance (ANOVA).

RESULTS

During full lockdown, 6847 individuals, of which 56.7% were over 65 and 6.5% below 40, were tested for HbA1c compared to 14,180 in 2019 (OR 0.47, 95% CI:0.46-0.49). Reduction in HbA1c testing was greater among older individuals (OR 0.44, 95% CI:0.42-0.45). No differences were observed for post-lockdown (OR 1.01, 95% CI:0.99-1.04). During partial lockdown, 10,816 individuals had at least one HbA1c measured compared to 12,749 in 2019 (OR 0.84, 95% CI:0.82-0.87). Mean HbA1c during full lockdown was 7.26% (±1.06) compared to 7.50% (±1.14) in 2019 (p < .0001). For gender and across all age groups, HbA1c levels were lower during full lockdown. HbA1c changes were not significantly different during post-lockdown and partial lockdown.

CONCLUSIONS

COVID-19 restriction measures affected HbA1c testing. During complete lockdown, HbA1c testing decreased by half across all gender and age groups. No deleterious effect on glycaemic control was observed during lockdown and post-lockdown among those tested.

Self-care Behaviours and Technology utilised during COVID-19: Systematic Review

Background

Self-care behaviors are essential for people living with chronic conditions; however, the outbreak of the COVID-19 pandemic has imposed additional complications on their daily routines. Few studies have analyzed how self-care behaviors have changed during COVID-19 and the role of digital technology, especially among people with chronic conditions.

Objective

This study aims to review how self-care behaviors have changed for people with chronic conditions during the COVID-19 pandemic, and what technology they have adopted to manage their conditions during that period.

Methods

A systematic review was conducted using narrative synthesis. Data were extracted from PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, and Google Scholar, including articles from December 2019 onward. Eligible studies focused on adults diagnosed with chronic conditions undertaking any self-care tasks in line with the middle-range theory of self-care of chronic illness (ie, self-care maintenance, monitoring, and management). The methodological quality of the included articles was assessed with the McMaster Critical Review Forms for Quantitative or Qualitative Studies.

Results

In total, 36 primary research articles were included. Changes to self-care behaviors during COVID-19 among people with chronic conditions were organized according to the middle-range theory of self-care of chronic illness focusing on self-care maintenance (ie, medication adherence, physical activity, and diet control), self-care monitoring (ie, monitoring signs and symptoms), and self-care management (ie, consultations with health care providers). Positive self-care behaviors observed include the following: individuals trying to maintain good glycemic control during COVID-19 increased their medication adherence in 27% (10/36) of studies; and diet control improved in 50% (18/36) of studies. Negative self-care behaviors observed include the following: decline in physical activities and increased sedentariness were observed in 65% (23/36) of studies; poor diet control was observed in 57% (21/36) of studies; and self-monitoring of health status dropped in 43% (15/36) of studies. The use of technology to support self-care of chronic conditions during COVID-19 was reported in 72% (26/36) of studies. The actual use of telehealth in place of physical consultations during COVID-19 was observed in 50% (18/36) of studies, and other digital technologies (eg, social media apps, smartphone apps, web-based platforms, and web browsing) were used in 50% (18/36) of studies. Telehealth was discussed and recommended as the default technology in delivering future health care services during COVID-19 and beyond in 77% (28/36) of studies.

Conclusions

This review highlighted the necessity to rethink how models of self-care should continue to address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases. Perhaps the silver lining of COVID-19 is that adoption of digital technology (especially telehealth) among a vast cross-section of people with chronic conditions is possible. Future research should investigate effective ways to incorporate evidence-based digital health tools into these new models of self-care that address the challenges of chronic and infectious conditions.

The impact of the COVID-19 pandemic on adolescents and young adults living with type 2 diabetes

Objectives

The aim of this study was to assess the impacts of the COVID-19 pandemic on adolescents and young adults living with type 2 diabetes (T2D) involved in the national Improving Renal Complications in Adolescents with T2D through REsearch (iCARE) study.

Methods

The Environmental influences on Child Health Outcomes (ECHO) COVID-19 Questionnaire developed by the National Institutes of Health ECHO COVID-19 Task Force was administered to participants (n=85) from the iCARE study between June 2020 and October 2020. Children 12 years old (via parent report) and adolescents and young adults ≥13 years old (via self-report) participated. The questionnaire assessed the impact of the pandemic on health-care appointments, lifestyle, internet use, social connections and mental health.

Results

Participants were 17.0±3.1 (range, 12 to 27) years of age and predominantly female (61.3%). During the pandemic, 69.4% were able to attend their health-care appointments by telephone or virtual platforms, 31.7% ate more, 45.1% slept more and 29.3% spent less time on physical activities. There was an increase in internet use for both educational (42.0%) and noneducational purposes (54.9%). Participants felt less socially connected (64.6%). Participants also felt sometimes (59.2%), often (19.7%) and very often (6.7%) satisfied with their lives.

Discussion

Our study revealed that the COVID-19 pandemic has had various impacts on the daily lives of adolescents and young adults living with T2D. Future research should include longitudinal studies of the health burden of the COVID-19 pandemic on this population, with a more in-depth evaluation of mental health outcomes and clinical outcomes.

Effect of COVID-19 lockdown on lifestyle habits and self-care practices of diabetic and hypertensive patients in rural Shimla and Udaipur – Findings from the HealthRise India program

Background

COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self-care practices are not only associated with less severe COVID-19 infections but also with a high recovery rate.

Objectives

This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur.

Methods

A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year.

Results

Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID-19 pandemic. During COVID-19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001).

Conclusion

Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.

The Experiences of People with Diabetes during COVID-19 Pandemic Lockdown

Little is known about the theoretical foundation underling the response of people with diabetes managing their everyday routines during COVID-19 pandemic lockdown.

AIM

To explore the experience of people with diabetes during COVID-19 pandemic lockdown in light of the risk perception, response and behavioral change theories.

METHOD

A qualitative descriptive design was employed, and Braun and Clark's six step analysis were used for thematic analysis. Semi-structured interviews were conducted online using Zoom Videos Communication.

RESULT

Five themes were defined as follows: (1) perceived the threat and faced their fears, (2) appraised the damage, (3) identified the challenges, (4) modified their routine, and (5) identified the strengths that facilitate the efficacy of their response. There were eight sub-themes within the themes.

CONCLUSION

The results of this study may provide an opportunity for nurses to reflect on issues highlighted by the patients regarding more effective communication, knowledge and skill development for people to support self-care during national emergencies.

Glucose control in diabetes during home confinement for the first pandemic wave of COVID-19: a meta-analysis of observational studies

AIM

To assess the effect on glycaemic control of confinement due to lockdown measures, during COVID-19 pandemic, in people with type 1 (T1DM) and type 2 (T2DM) diabetes.

METHODS

Meta-analysis of observational studies reporting measures of glucose control and variability before and during and/or after periods of confinement caused by COVID-19 in 2020 and/or 2021.

RESULTS

We included 27 studies on T1DM. No significant change in Hba1c was observed after lockdown (WMD - 1.474 [- 3.26; 0.31] mmol/mol, I² = 93.9). TIR significantly increased during and after lockdown (WMD: 2.73 1.47; 4.23 %, I² = 81% and 3.73 [1.13; 5.33] %, I² = 85%, respectively).We retrieved nine studies on T2DM patients. No significant variation in HbA1c was detected (WMD - 1.257 - 3.91; 1.39 mmol/mol, I² = 98.3%). HbA1c had a more favourable trend in studies performed in Asia than in Europe (p = 0.022 between groups).

CONCLUSION

Lockdown showed no significant detrimental effect on HbA1c in either T1DM or T2DM. Conversely, home confinement led to a reduction in mean glucose and glucose variability in T1DM, although with a high heterogeneity of results.

Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia

AIM

To analyse the relation between face-to-face appointments and management of patients with type 2 diabetes mellitus (T2DM) visited in primary care practices (PCP).

METHODS

Retrospective study in 287 primary care practices (PCPs) attending>300,000 patients with T2DM. We analysed the results of 9 diabetes-related indicators of the Healthcare quality standard, comprising foot and retinopathy screening, blood pressure (BP) and glycemic control; and the incidence of T2DM. We calculated each indicator's percentage of change in 2020 with respect to the results of 2019.

RESULTS

Indicators' results were reduced in 2020 compared to 2019, highlighting the indicators of foot and retinopathy screening (-51.6% and -25.7%, respectively); the glycemic control indicator (-21.2%); the BP control indicator (-33.7%) and the incidence of T2DM (-25.6%). Conversely, the percentage of type 2 diabetes patients with HbA1c > 10% increased by 34%. PCPs with<11 weekly face-to-face appointments offered per professional had greater reductions than those PCPs with more than 40. For instance, a reduction of -60.7% vs -38.2% (p-value < 0.001) in the foot screening's indicator; -27.5% vs -12.5% (p-value < 0.001) in glycemic control and -40.2 vs -24.3% (p-value < 0.001) in BP control.

CONCLUSIONS

Reducing face-to-face visits offered may impact T2DM patients' follow-up and thus worsen their control.

Effect of Lockdown on Diabetes Care During the COVID-19 Pandemic: Result of a Telephone-Based Survey Among Patients Attending a Diabetic Clinic in Northern India

Background

The coronavirus disease 2019 (COVID-19) pandemic has aggravated the demand for diabetes care due to restrictive measures like the lockdown affecting access to healthcare services. The current study was conducted to assess the changes in medication compliance, dietary pattern, and glucose monitoring during the lockdown period as compared to the pre-lockdown period among patients living with type 2 diabetes mellitus (T2DM) attending a diabetes clinic in northern India.

Methods

This cross-sectional study was conducted between May and July 2020. Information regarding the sociodemographic and clinical profiles of the patients like age, sex, income, qualification, family history of diabetes, history of smoking and alcohol, type of treatment, co-morbidities, drug adherence for T2DM, changes in the pattern of diet, physical activity, blood glucose monitoring, and drug usage during and before the lockdown was collected through telephonic interviews using a structured tool. Descriptive analysis was performed, and the chi-square and Wilcoxon sign ranks tests were used to see the association between variables.

Results

A total of 260 patients were enrolled in the study. A higher proportion of males reported a decrease in the consumption of cereals (13.9%), eggs (56.5%), and meat and fish (92.7%) and an increase in water intake (25.8%) while a higher proportion of females reported no change in physical activity levels (77.2%) during the lockdown against pre-COVID times. There was a significant improvement in medication adherence and glycemic control during the lockdown period as compared to the pre-lockdown times.

Conclusion

More time for self-care, adequate counseling about glycemic goals, and knowledge of self-monitoring of blood glucose levels helped the majority of patients in adopting a healthy lifestyle and achieve better glycemic control during the COVID-19 lockdown.

Self-isolation negatively impacts self-management of diabetes during the coronavirus (COVID-19) pandemic

BACKGROUND/AIM

People with diabetes are at a greater risk of serious complications from Coronavirus disease (COVID-19). Self-management of diabetes is therefore of paramount importance. The purpose of this study is to compare self-management of diabetes pre-COVID-19 and during the COVID-19 pandemic.

METHODS

679 participants with diabetes completed an online structured questionnaire survey. Various exposure variables (demographics, duration, treatment and complications of diabetes, self-isolation, etc.) were analysed to examine associations with the following outcome variables: (i) fluctuation of blood glucose levels, (ii) access to diabetes medicine, (iii) access to healthy diet, (iv) physical activity. Adjusted multiple regression analysis ascertained significant associations for each outcome variable against exposure variables.

RESULTS

Multiple regression analysis showed that self-isolation was significantly associated with greater fluctuation in blood glucose levels (OR = 1.8, 95% CI = 1.2-2.6, p = 0.005), reduced access to diabetes medicine (OR = 1.9, 95% CI = 1.1-3.1, p = 0.02) and reduced access to healthy diet (OR = 3.0, 95% CI = 2.0-4.6, p < 0.001). Fluctuation in blood glucose level was also significantly associated with having at least one complication of diabetes (OR = 2.2, 95% CI = 1.2-3.9, p = 0.008) and reduced access to diabetes medicine was significantly higher in people who were on insulin (OR = 2.1, 95% CI = 1.3-3.3, p = 0.001).

CONCLUSIONS

Self-isolation was shown to impact almost all factors that influence self-management of diabetes. A targeted approach to improved access to diabetes medicine, healthy diet for people who needed to self-isolate is vital in order to ensure that they are able to self-manage their diabetes effectively.

COVID-19 pandemic: Effects of national lockdown on the state of health of patients with type 2 diabetes mellitus in a Moroccan population

BACKGROUND

The complete lockdown caused by the COVID-19 pandemic had imposed a new behavior and lifestyle especially in terms of diet, physical activity, and the management of patients with chronic diseases.

AIM

The present study aimed to analyze the impact of lockdown on the monitoring and care of type 2 diabetes mellitus (T2DM) patients in a Moroccan population from the Doukkala region.

SUBJECTS AND METHODS

We conducted a retrospective observational study including 121 T2DM patients recruited from the Diabetes Diagnosis and Treatment Center of El Jadida city. Demographic, anthropometric, and biochemical data of our T2DM patients were recorded before and after lockdown that lasted 82 days. All patients have signed an informed consent after being informed about the purely scientific aims of the study.

RESULTS

Our sample involved 84 women and 37 men with an age average of 57.31 ± 0.91 years. The effects of lockdown were more marked in women than in men: women showed a significant tendency to gain weight (from 78.13 ± 1.36 kg to 81.80 ± 1.45 kg; p-value < 0.000), that impacted the body mass index (p-value < 0.000); they also showed significant increases in HbA1c values (p-value = 0.001), significant decrease in systolic blood pressure (p-value = 0.0302) and a surprising increase in high-density lipoprotein cholesterol (p-value = 0.0132). The prevalence of metabolic syndrome in the women sample increased from 46.4% to 54.8% after the lockdown. In men, the negative effect of lockdown was observed only in HbA1c that values increased significantly from 8.66 ± 0.21% to 9.51 ± 0.25% (p-value = 0.0127).

CONCLUSION

Our results reveal that lockdown had impacted negatively the health status of T2DM patients, especially women. We suggest an urgent development of programs aiming to improve the hygiene of life and to reduce the impact of future crises on patients suffering chronic diseases such as T2DM.

A cross-sectional study on the telemedicine usage and glycemic status of diabetic patients during the COVID-19 pandemic

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic disrupts selfmanagement in diabetic patients in Indonesia. This study aimed to determine the telemedicine usage and factors contributing to glycemic control in type 2 diabetes mellitus (T2DM) patients during the pandemic. METHODS A cross-sectional study was conducted in T2DM patients aged 25–54 years. The questionnaire included general characteristics, diabetes conditions, consultation factors, and self-care management. Glycemic status was evaluated using glycated hemoglobin (HbA1c) levels, which was categorized into poor (HbA1c≥7%) and good glycemic control (HbA1c<7%). Data were analyzed using chi-square and binary logistic regression. RESULTS Of 264 patients, only 19.2% used telemedicine and 60.2% had poor glycemic control during the pandemic. Overweight or obesity (odds ratio [OR] = 5.740 [95% confidence interval [CI] = 2.554–12.899]; p<0.001), insulin injection (OR = 3.083 [95% CI = 1.238–7.677]; p = 0.016), and frequent fried food consumption (OR = 5.204 [95% CI = 1.631–16.606]; p = 0.005) were the factors contributing to poor glycemic control. The risk is lower if exercised regularly (OR = 0.036 [95% CI = 0.007–0.195]; p<0.001) and consulted with a doctor using telemedicine (OR = 0.193 [95% CI = 0.044–0.846]; p = 0.029) or in-person visits (OR = 0.065 [95% CI = 0.016–0.260]; p<0.001). CONCLUSIONS Glycemic control was not optimal during the COVID-19 pandemic. Therefore, keeping a healthy lifestyle and staying connected with a doctor are important to ensure optimal blood glucose control and reduce the risk of diabetesrelated complications.

The Impact of COVID-19 Lockdown on Diabetes Complication and Diabetes Management in People With Diabetes in Indonesia

Aims: As the country with the seventh largest number of People with Diabetes (PWD) in the world, the Coronavirus disease 2019 (COVID-19) pandemic, and the Large Social Scale Restriction (LSSR) policy taken by the Indonesian government to reduce the number of COVID-19 transmissions is estimated to interfere diabetes management and will increase the incidence of diabetes complications. This study aims to determine the difficulties of diabetes management and its impact on diabetes morbidity during the COVID-19 pandemic in Indonesia. Methods: This study is a cross-sectional study using a national scale web survey. This research was conducted in Indonesia enrolling 1124 PWD aged 18 years or older. Diabetes complications are defined as self-assessed incidence of hypoglycemia, or Diabetic Foot Ulcer (DFU), or hospital admission experienced by PWD in Indonesia during the COVID-19 pandemic. The correlation between diabetes management difficulties and diabetes-related complications was measured using a modified cox regression test. Results: Diabetes management difficulties were experienced by 69.8% of PWD in Indonesia. The difficulties include attending diabetes consultation 30.1%, access to diabetes medication 12.4%, checking blood glucose levels 9.5%, controlling diet 23.8%, and performing regular exercise 36.5%. Diabetes-related complications occurred in 24.6% of subjects. Those who had diabetes management difficulties during the COVID-19 pandemic are prone to have diabetes complications by 1.4 times greater (PR: 1.41, 95% CI: 1.09-1.83) than those who did not. Conclusion: The COVID-19 pandemic and LSSR have impact on diabetes management and diabetes-related complications as assessed by PWD in Indonesia.

Lifestyle and behavioral changes during nationwide lockdown in India-A cross-sectional analysis

INTRODUCTION

After almost two months of reporting the first case of the novel coronavirus disease (COVID-19) in the country, the nationwide lockdown in India was initiated on 24th of March 2020, to curtail the spread of the SARS-CoV-2 infection in the country. While this lockdown had been in place for almost 3 months, the people of the nation have experienced changes in their routine lives in a wide range of activities, including personal behaviours. This study was conducted to identify the impacts that the lockdown had on the lifestyle and behavioural aspects of Indians during the lockdown.

METHODS

It was a cross sectional study, conducted by online survey. Data collection was done for the period of 3 months.

RESULTS

The study found that a huge number of participants had significant changes in their diet, sleep, bowel habits and also their personal traits. Also, the lockdown had improved interpersonal relationships and helped people explore their hobbies or even acquire a new skill (about 25% of the participants). More than 90% of the participants perceived decrease in air pollution and a majority reported increase in personal hygiene (74.2%), perceived decrease in crime rates (67.3%) as benefits of lockdown.

CONCLUSIONS

It would be recommended to include variables to screen for mental health issues among the general population.

Psychological Crisis Intervention for COVID-19 Lockdown Stress in Patients With Type 1 Diabetes Mellitus: Survey Study and Qualitative Analysis

BACKGROUND

The COVID-19 pandemic has challenged the worldviews of most people. Social isolation after the COVID-19 lockdown has not only led to economic difficulties but also resulted in adverse psychological reactions. As in most countries, including Poland, this situation has been very challenging for patients with type 1 diabetes mellitus (T1DM). In Poland, a crisis intervention team for patients with T1DM was established. The goal of the team was to provide psychological support for these patients, if needed, and to present information concerning how these patients may obtain medical consultations and prescriptions.

OBJECTIVE

We aimed to analyze the psychological parameters and main emotional reactions of patients with T1DM during the COVID-19 lockdown.

METHODS

An email with information concerning the possibility of having a web-based consultation with psychologists and psychiatrists and an attached set of psychological tests was sent to all patients with T1DM who were under the care of an outpatient diabetes clinic. The consultations were performed by licensed clinical psychologists and psychologists. This study was approved by the Bioethics Committee of the Jagiellonian University in Krakow, Poland.

RESULTS

The patients who decided to use psychological support had statistically higher levels of anxiety (state P=.043; trait P=.022), stress (P=.001) than those of patients from the group who did not seek support.

CONCLUSIONS

The presented intervention team may be perceived as an example of important and successful cooperation and communication between specialists of different fields of medicine (diabetology, psychiatry, and psychology) in a crisis situation.

Physical Activity, Sedentary Behavior and Well-Being of Adults with Physical Disabilities and/or Chronic Diseases during the First Wave of the COVID-19 Pandemic: A Rapid Review

Background: People with physical disabilities and/or chronic diseases report lower levels of physical activity and well-being than the general population, which potentially is exacerbated through the COVID-19 pandemic. This study explored the international literature on physical activity, sedentary behavior and well-being in adults with physical disabilities and/or chronic diseases during the first wave of the pandemic. Method: In a rapid review, we included studies reporting on physical activity, sedentary behavior and/or well-being in adults with physical disabilities and/or chronic diseases. Four databases (Pubmed, CINAHL, PsycInfo, Embase) were searched for studies published until 30 September 2020. Results: We included twenty-nine studies involving eleven different types of disabilities or health conditions from twenty-one different countries. Twenty-six studies reported on physical activity, of which one reported an increase during the COVID-19 pandemic, four studies reported no difference, and twenty-one studies reported a decrease. Thirteen studies reported a decline in well-being. Only one study measured sedentary behavior, reporting an increase. Conclusion: Despite the variety in methods used, almost all studies reported negative impacts on physical activity and well-being in people with physical disabilities and/or chronic disease during the first wave of the pandemic. These findings highlight the importance of supporting this population, especially in times of crisis.

Impact of COVID-19 pandemic on glycemic control among outpatients with type 2 diabetes in Japan: A hospital-based survey from a country without lockdown

AIMS

Some studies have reported changes in glycemic control of patients with diabetes mellitus under lockdown. However, no previous study examined the impact of the pandemic on glycemic control in patients with diabetes in countries that did not introduce a lockdown such as Japan. This study aimed to assess changes in glycemic control during the pandemic in patients with type 2 diabetes treated at a Japanese clinic.

METHODS

We conducted a historical cohort study, using electronic medical records of patients with type 2 diabetes who visited our clinic between January 2019 and August 2020. Differences in HbA1c values before and after the outbreak of COVID-19 were the primary outcome, examined using the linear mixed model.

RESULTS

HbA1c values significantly increased from 7.45% to 7.53% after the state of emergency was introduced (n = 1,009). Furthermore, a deterioration in HbA1c values was observed in particular among women, patients aged ≥ 65 years, those with body mass index of ≥ 25 kg/m², and those that were not using insulin.

CONCLUSIONS

Glycemic control deteriorated in patients with type 2 diabetes during the pandemic even in a country without a national lockdown.

COVID-19 lockdown and lifestyles: A narrative review

Background: The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic has been controlling disease transmission. However, lockdown measures used to mitigate transmission have affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature has emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances. Methods: We comprehensively searched PubMed and the World Health Organization’s global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed. Results: Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes. Conclusions: The COVID-19 pandemic provides an opportunity to better understand the negative impact of strict lockdown measures on lifestyles. At the same time, it helps us identify and initiate positive behavioral changes, which, if consolidated, could improve chronic disease outcomes. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.

Change in glucose-lowering medication regimens in individuals with type 2 diabetes mellitus during the COVID-19 pandemic in Germany

AIM

To estimate the proportion of individuals with type 2 diabetes mellitus (T2DM) undergoing changes in glucose-lowering therapy in 2019 and 2020.

METHOD

Individuals with T2DM who had at least one consultation in one of 940 general (including diabetologist) practices in Germany between January and July 2019 (N = 79 268) and between January and July 2020 (N = 85 046) were included. Therapy changes were defined as the prescription of new glucose-lowering drugs, with or without the discontinuation of previous treatments (therapy switch and add-on therapy, respectively). The number of T2DM patients with at least one medication regimen change was calculated for the periods 1 January to 14 March in 2019 and 2020, and for the periods 15 March to 31 July in 2019 and 2020. March 2020 corresponded to the beginning of the lockdown in Germany.

RESULTS

Overall, there was a decrease in the number of patients with at least one medication regimen change in the period 15 March to 31 July 2019 compared with 15 March to 31 July 2020 (dipeptidyl peptidase-4 inhibitors: -15%; sodium-glucose co-transporter-2 inhibitors: -3%; glucagon-like peptide-1 receptor agonists: 0%; other oral glucose-lowering drugs: -6%; and insulin: -21%).

CONCLUSIONS

The coronavirus disease-2019 (COVID-2019) pandemic had a strong impact on glucose-lowering drug use in T2DM patients in Germany. More research is warranted to further investigate the treatment and management of T2DM individuals during the COVID-19 era in Germany and elsewhere.

The impact of a prolonged lockdown and use of telemedicine on glycemic control in people with type 1 diabetes during the COVID-19 outbreak in Saudi Arabia

BACKGROUND

To minimize the spread of Coronavirus Disease-2019, Saudi Arabia imposed a nationwide lockdown for over 6 weeks. We examined the impact of lockdown on glycemic control in individuals with type 1 diabetes (T1D) using continuous glucose monitoring (CGM); and assessed whether changes in glycemic control differ between those who attended a telemedicine visit during lockdown versus those who did not.

MATERIALS AND METHODS

Flash CGM data from 101 individuals with T1D were retrospectively evaluated. Participants were categorized into two groups: Attended a telemedicine visit during lockdown (n = 61) or did not attend (n = 40). Changes in CGM metrics from the last 2 weeks pre-lockdown period (Feb 25 - March 9, 2020) to the last 2 weeks of complete lockdown period (April 7-20, 2020) were examined in the two groups.

RESULTS

Those who attended a telemedicine visit during the lockdown period had a significant improvement in the following CGM metrics by the end of lockdown: Average glucose (from 180 to 159 mg/dl, p < 0.01), glycemic management indicator (from 7.7 to 7.2%, p = 0.03), time in range (from 46 to 55%, p < 0.01), and time above range (from 48 to 35%, p < 0.01) without significant changes in time below range, number of daily scans or hypoglycemic events, and other indices. In contrast, there were no significant changes in any of the CGM metrics during lockdown in those who did not attend telemedicine.

CONCLUSIONS

A six-week lockdown did not worsen, nor improve, glycemic control in individuals with T1D who did not attend a telemedicine visit. Whereas those who attended a telemedicine visit had a significant improvement in glycemic metrics; supporting the clinical effectiveness of telemedicine in diabetes care.

Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme

BACKGROUND

South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians' awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region.

METHODS

We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative.

RESULTS

Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown.

CONCLUSIONS

Our results identified important knowledge, access and uptake barriers to the prevention of COVID-19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor.

Telemedicine During the COVID-19 Pandemic: A Paradigm Shift in Non-Communicable Disease Management? - A Cross-Sectional Survey from a Quaternary-Care Center in South India

PURPOSE

This study aims to gauge the perception and adoption rates of telemedicine amongst patients with non-communicable diseases (NCD) as opposed to in-person consultations in a quaternary care center in South India.

PATIENTS AND METHODS

A web-hosted 21-item cross-sectional survey was distributed to 220 randomly selected patients with a routine appointment in one of the seven departments caring for NCDs in the study center. Descriptive analysis and inferential analyses were done. Paired samples T-test and Pearson's Chi-square test were used study associations.

RESULTS

In-person consultations decreased by 1.9±4.47 visits per year, in 2020 vs 2019. Most participants reported "fear of COVID-19" as the primary reason for this decline. Participants also reported that their consultation times had significantly decreased (OR=6.43, 95% CI=1.7-24.08, p=0.006). The decreased consultations time, difficulty in obtaining in-person appointments, along with the reduced physical examination during consultations have made participants more open to the idea of teleconsultations (OR=3.88, 95% CI=1.21-12.47, p=0.022). Eighty-five (38.63%) participants had already adopted telemedicine for their routine consultations during the pandemic. Whilst participants felt that telemedicine was an adequate surrogate for in-person consultations, a significant difficulty in obtaining medications was noted (OR=6, 95% CI=1.34-26.81, p=0.019).

CONCLUSION

In-person consultations were decreased primarily due to the perception of significant risk of COVID-19 exposure in the present scenario. Telemedicine adoption in the private sector may be sustainable throughout the pandemic and beyond, if patients are offered to continue their routine consultations with their regular doctors and ensured medicine availability. Integration of telemedicine by the public and private health sector of India into routine NCD care delivery is the need of the hour, but further studies are required to estimate the effectiveness of the systems.

COVID-19 associated with diabetes and other noncommunicable diseases led to a global health crisis

COVID-19 has gravely threatened high-risk populations, such as people with diabetes and other noncommunicable diseases, leading to disproportionate hospitalizations and deaths worldwide. It is well documented from previous outbreaks that diabetes increases the risk for poor outcomes due to SARS infection. In the present review, we bring evidence that the country and global level health crisis caused by COVID-19 could have been avoided or extremely minimized if measures to protect high-risk populations were implemented timely. In addition to general lockdowns, testing, tracing, isolation and hygiene measures, other specific interventions for diabetes and comorbidities management were shown crucial to allow the continuation of care services during the pandemic. These interventions included: teleconsultation, digital remote education andmonitoring, e-prescriptions, medicine delivery options, mobile clinics, and home point-of-care tests. In conclusion, we recommend prompt actions to protect the most vulnerable groups, valuing knowledge and experiences from previous outbreaks and lessons learned during the COVID-19 pandemic, in order to shield communities, health systems and the global economy.

Decentralized COVID-19 measures in Brazil were ineffective to protect people with diabetes

BACKGROUND AND AIMS

COVID-19 severity and mortality are elevated in individuals with diabetes. During the pandemic, interventions recommended globally for people with diabetes were to keep blood glucose on target whilst staying at home to curb the spread of the virus. In Brazil, similar measures were proposed. The aim of our observational study was to assess whether these measures achieved their objectives.

METHODS

An anonymous and untraceable survey was shared from April 22nd to May 4th. States with more than 30 respondents were included in the analysis and Fisher's exact test was performed to identify associations, with p < 0.05 considered significant.

RESULTS

Type 1 diabetes and female participants were prevalent, 60.76% and 76.12% respectively. 10 out of 26 states were included, in addition to the Federal District (1562 responses). Only in three states (Bahia, Goiás and Pernambuco) less than 50% of the respondents experienced higher glycemia or higher variability during the pandemic. Goiás state, where almost half of the respondents (49.12%) have private insurance, presented the highest percentage of individuals receiving medicines for three months (35.48%) and one of the lowest percentages of blood glucose deterioration (47.17%). In the large states of Minas Gerais, Rio de Janeiro and São Paulo, consultations and/or lab exams were postponed by 37.14%, 34.33% and 40.88%, respectively.

CONCLUSIONS

The decentralized measures implemented by states in Brazil left most people with diabetes unprotected. Many were forced to venture outside to collect or to purchase their medical supplies monthly and reported increased glycemic levels and/or variability.

Clinical considerations in patients with diabetes during times of COVID19: An update on lifestyle factors and antihyperglycemic drugs with focus on India

BACKGROUND

Diabetes is recognized as an important comorbidity in patients with COVID-19 and a large amount of literature has become available regarding this. The aim of this article is to review the literature regarding various aspects of association between diabetes and COVID-19 and to highlight clinically relevant points with focus on India.

METHODS

We searched Pubmed and Google Scholar databases for articles regarding diabetes and COVID-19 published between March 19, 2020 and August 30, 2020.

RESULTS

Diabetes and poor glycemic control are associated with increased severity and mortality in patients with COVID-19. Several clinical scenarios about hyperglycemia and COVID-19 are identified and each of these needs specific management strategies.

CONCLUSION

It is prudent to maintain good glycemic control in patients with diabetes in order to minimize the complications of COVID-19. There is a need for well conducted studies to asses the role of individual antihyperglycemic therapies in COVID-19 and also the behavior of new onset diabetes diagnosed either after COVID-19 infection or during this time.