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García-Lara RA, Suleiman-Martos S, Dominguez-Vías G, Romero-Béjar JL, Garcia-Morales V, Gómez-Urquiza JL, Suleiman-Martos N. Impact effects of COVID-19 pandemic on chronic disease patients: A longitudinal prospective study. J Clin Nurs 2024; 33:2226-2236. [PMID: 38476057 DOI: 10.1111/jocn.17104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/11/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
AIMS To assess the effects of COVID-19 pandemic on clinical variables as part of the routine clinical monitoring of patients with chronic diseases in primary care. DESIGN A prospective longitudinal study was conducted in primary care centres of the Andalusian Health Service. METHODS Data were recorded before the pandemic (T1), during the declaration of the state of emergency (T2) and in the transition phase (T3). The Barthel index and the Short Portable Mental Status Questionnaire (SPMSQ) were used to analyse functional and cognitive changes at the three time points. HbA1c, systolic and diastolic blood pressure, heart rate, BMI and lipid levels were assessed as clinical variables. Descriptive statistics and non-parametric chi-square test were used for analysis. STROBE checklist was used for the preparation of this paper. RESULTS A total fo148 patients with chronic conditions were included in the analysis. Data analysis revealed in T2 only significant reductions in BMI, total levels of cholesterol and HDL during the onset of the pandemic. Barthel Index, SPMSQ, blood pressure and triglycerides and LDL levels worsened in T2, and the negative effects were maintained in T3. Compared to pre-pandemic values, HbA1c levels improved in T3, but HDL levels worsened. CONCLUSIONS COVID-19 has drastically disrupted several functional, cognitive and biological variables. These results may be useful in identifying clinical parameters that deserve closer attention in the case of a new health crisis. Further studies are needed to assess the potential impacts of each specific chronic condition. IMPACT Cognitive and functional status, blood pressure and triglycerides and LDL levels worsen in short term, maintaining the negative effects in medium-term.
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Affiliation(s)
- Rubén A García-Lara
- Íllora Health Center, Granada-Metropolitan Health District, Andalusian Health Service, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Spain
| | | | - Germán Dominguez-Vías
- Physiology Department, Ceuta Faculty of Health Sciences, University of Granada, Ceuta, Spain
| | | | - Victoria Garcia-Morales
- Biomedicine, Biotechnology and Public Health Department, Physiology Area, Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | | | - Nora Suleiman-Martos
- Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
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Hammersen J, Tittel SR, Khodaverdi S, Reschke F, Flury M, Menzel U, Mönkemöller K, Meissner T, Karges B, Holl RW. Metabolic control during the first two years of the COVID-19 pandemic in pediatric patients with type 1 diabetes: results from the German DPV initiative. Acta Diabetol 2023; 60:757-766. [PMID: 36871116 PMCID: PMC9985474 DOI: 10.1007/s00592-023-02050-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/04/2023] [Indexed: 03/06/2023]
Abstract
AIM To assess effects of the SARS-CoV2 pandemic on metabolic control in youth with type 1 diabetes (T1D) in Germany in a population-based analysis. METHODS Data from 33,372 pediatric T1D patients from the Diabetes Prospective Follow-up (DPV) registry, with face-to-face visits or telemedicine contacts in the years 2019-2021, were available. Datasets from eight time periods between March 15, 2020, and December 31, 2021, according to SARS-CoV2 incidence waves, were compared to those from five control time periods. Parameters of metabolic control were assessed with adjustment for sex, age, diabetes duration, and repeated measurements. Laboratory-measured HbA1c values and those estimated from CGM were aggregated into a combined glucose indicator (CGI). RESULTS There was no clinically relevant difference in metabolic control between pandemic and control time periods with adjusted CGI values ranging from 7.61% [7.60-7.63] (mean [95% confidence interval (CI)]) in the third quarter of 2019 to 7.83% [7.82-7.85] in the time period from January 1 to March 15 2020, in the other control periods, and during the pandemic, CGI values lay between these values. BMI-SDS rose during the pandemic from 0.29 [0.28-0.30] (mean [95% CI]) in the third quarter of 2019 to 0.40 [0.39-0.41] during the fourth wave. Adjusted insulin dose rose during the pandemic. Event rates for hypoglycemic coma and diabetic ketoacidosis remained unchanged. CONCLUSIONS We found no clinically relevant change of glycemic control or incidence of acute diabetes complications during the pandemic. The observed BMI increase may represent an important health risk for youth with T1D.
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Affiliation(s)
- Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany.
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Semik Khodaverdi
- Clinic for Children and Adolescent Medicine, Clinical Centre Hanau, Hanau, Germany
| | - Felix Reschke
- Diabetes Center for Children and Adolescents, Children's Hospital Auf Der Bult, Hannover, Germany
| | - Monika Flury
- Children's Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Ulrike Menzel
- Department of Paediatric Endocrinology, AKK Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Strasse, Cologne, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital, Duesseldorf, Germany
| | - Beate Karges
- Division of Endocrinology and Diabetology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Pediatrics, Bethlehem Hospital Stolberg, Stolberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Meyerowitz-Katz G, Ferdousi S, Maberly G, Astell-Burt T. Diabetes during the COVID-19 pandemic: are people getting access to the right level of care? BMC Health Serv Res 2023; 23:167. [PMID: 36797704 PMCID: PMC9933792 DOI: 10.1186/s12913-023-09168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Avoidance of health services, in particular hospital and community services, is problematic for people with diabetes. Evidence has demonstrated that such missed attendances are associated with worse health, faster declines in functioning, and higher rates of mortality long-term. This paper investigated the impact of the pandemic on healthcare access across community and hospital care, including Virtual Care (VC) using several large datasets of General Practice (GP) and hospital services in western Sydney. METHODS A retrospective cohort study using a time-series database of 173,805 HbA1c tests done at Blacktown and Mt Druitt hospitals and 1.8 million recorded consultations at GP clinics in the region was undertaken. RESULTS The average rate of diabetes in Emergency Department fell from 17.8% pre-pandemic to 11% after January 2020 (p < 0.001). This rate varied substantially over time, and correlated well with large outbreaks of COVID-19 in the state. Conversely, attendances of people with diabetes to GP clinics, especially using VC services, increased substantially over the pandemic period. DISCUSSION/CONCLUSION During the pandemic there was a substantial avoidance of hospital care by patients with diabetes. However, this may have been replaced by VC offered in the community for those with less severe diseases.
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Affiliation(s)
- Gideon Meyerowitz-Katz
- Western Sydney Local Health District, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia. .,Population Wellbeing and Environment Research Lab, School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia.
| | - Shahana Ferdousi
- Wentwest, Western Sydney Primary Health Network, Campbelltown, NSW Australia
| | - Glen Maberly
- grid.460687.b0000 0004 0572 7882Western Sydney Local Health District, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW 2148 Australia ,grid.1013.30000 0004 1936 834XBoden Initiative, Charles Perkins Centre, University of Sydney, Camperdown, NSW Australia
| | - Thomas Astell-Burt
- grid.1007.60000 0004 0486 528XPopulation Wellbeing and Environment Research Lab, School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW Australia
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von Sengbusch S, Schneidewind J, Bokelmann J, Scheffler N, Bertram B, Frielitz FS, Hiort O, Lange K. Monthly video consultation for children and adolescents with type 1 diabetes mellitus during the COVID-19 pandemic. Diabetes Res Clin Pract 2022; 193:110135. [PMID: 36374788 PMCID: PMC9616483 DOI: 10.1016/j.diabres.2022.110135] [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: 08/18/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
AIMS To explore the impact of primarily telemedical care for children and adolescents with type 1 diabetes by monthly video consultations on metabolic control and parents' treatment satisfaction and disease-specific burden during the COVID-19 pandemic. METHODS In this 12-month multicenter observational follow-up VIDIKI 2.0 study, 100 participants (3-18 years) received monthly video consultations, which partially replaced quarterly outpatient clinic appointments during the pandemic. The children's metabolic parameters as well as the parents' treatment satisfaction and diabetes specific burden were assessed at study entry and 12 months later. RESULTS During the study, 912 video consultations took place (mean 0.84 ± 0.23 / patient/month). The children's HbA1c remained stable, while mean sensor glucose level and glucose management indicator decreased. Simultaneously, parents' treatment satisfaction significantly increased, and their diabetes-specific burden and distress decreased. CONCLUSIONS Primarily telemedical care of children and adolescents with type 1 diabetes during the COVID-19 pandemic via monthly video consultations resulted in a significant improvement in parents' treatment satisfaction and their diabetes-specific burden and distress. It was associated with a slight improvement in mean sensor glucose and glucose management indicator, while HbA1c remained stable. Thus, video consultations offer great potential to enhance standard care for children and adolescents with diabetes.
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Affiliation(s)
- Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig- Holstein, Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Julia Schneidewind
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig- Holstein, Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Jessica Bokelmann
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Nadine Scheffler
- Department of Pediatrics, General Hospital Itzehoe, Robert-Koch-Straße 2, 25524 Itzehoe, Germany.
| | - Bettina Bertram
- Department of Pediatrics, General Hospital Kiel, Chemnitzstraße 33, 24116 Kiel, Germany.
| | - Fabian-Simon Frielitz
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig- Holstein, Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Karin Lange
- Hannover Medical School, Medical Psychology, Carl-Neuberg Straße 1, 30625 Hannover, Germany.
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Al-Qahtani MH, Bukhamseen FM, Al-Qassab AT, Yousef AA, Awary BH, Albuali WH, Alkhalifa ZM, Yousef HA. The Impact of COVID-19 Lockdown on the Incidence of Type 1 DM and the Glycemic Control of Diabetic Children: Findings from a Teaching Hospital, Saudi Arabia. Rev Diabet Stud 2022; 18:152-156. [PMID: 36309774 PMCID: PMC9652708 DOI: 10.1900/rds.2022.18.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE: We evaluated glycemic control among T1DM pediatric patients attending the endocrinology pediatrics clinics at King Fahd Hospital of the University (KFHU) prior to and during COVID-19 restraining regulations. In addition, we assessed the trends and variations in the incidence of T1DM during 2017-2021, including the COVID-19 years by identifying newly diagnosed patients presenting to pediatrics emergency department (ED) in KFHU. METHODS: To estimate the effect of COVID-19 on the incidence of T1DM, we identified newly diagnosed cases of T1DM among pediatric patients attending the ED during the years 2017- 2021. The participants' data were collected through electronic medical records. Information collected included patient age, sex, and HbA1c readings. Three HbA1c readings of interest that were defined and collected are pre-COVID reading, in-COVID reading, and post-COVID reading. RESULTS: The difference of female participants' readings was statistically non-significant (Z= -0.416, p = 0.678), with a pre- and post-COVID median of 10.70 (Q1= 9.00, Q3= 12.15), and 10.50 (Q1= 8.80, Q3= 12.35), respectively. In contrast, the difference was statistically significant among male participants (Z= -2.334, p = 0.02), with a pre- and post-COVID median of 10.20 (Q1= 8.70, Q3= 11.80), and 10.65 (Q1= 9.00, Q3= 12.70), respectively. There was a statistically significant increase in HbA1c of persons > 11 years old (Z= -2.471, p= 0.013), with a pre- and post-COVID median of 10.40 (Q1= 9.00, Q3= 12.10), and 10.90 (Q1= 9.00, Q3= 12.60), respectively. Conversely, persons ≤ 11 years old showed no statistically significant change in HbA1c (Z= -.457, p= 0.648), with a pre- and post-COVID median of 10.45 (Q1= 8.70, Q3= 11.85), and 10.20 (Q1= 8.40, Q3= 12.075), respectively. Disregarding any influence of time, the effect of sex showed no statistically significant difference in HbA1c between males and females [F (1,125) = 0.008, p = 0.930]. Meanwhile, the age effect on HbA1c, regardless of time influence, was statistically significant [F (1,125) = 4.993, p = 0.027]. There was no statistically significant interaction between time and sex on HbA1c levels [F (1.74, 217) = 0.096, p = 0.883] and between age and time [F (3.92,289.57) = 1.693, p = 0.190]. CONCLUSIONS: The number of visits to healthcare facilities dropped significantly during the COVID-19 pandemic, but the rate of newly diagnosed T1DM increased. There was a variable effect on HbA1c levels of those patients, which suggests that each demographic group in the population might have been affected differently by the pandemic. Future research should determine factors associated with better glycemic control and measures to sustain these changes the pandemic might have created.
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Affiliation(s)
- Mohammad Hussain Al-Qahtani
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia,,Address correspondence to: Mohammad Hussain Al-Qahtani, e-mail:
| | | | | | - Abdullah Abdulsalam Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bassam Hassan Awary
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Hamad Albuali
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Haneen Abdulsalam Yousef
- Department of Family Medicine, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam, Saudi Arabia
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Hammersen J, Reschke F, Tittel SR, Pappa A, Dost A, Köstner K, Rosenbauer J, Kapellen TM, Rohrer TR, Holl RW. Metabolic control during the SARS-CoV-2 lockdown in a large German cohort of pediatric patients with type 1 diabetes: Results from the DPV initiative. Pediatr Diabetes 2022; 23:351-361. [PMID: 35084805 DOI: 10.1111/pedi.13319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess if metabolic control worsened during the SARS-CoV2 lockdown in spring 2020 in youth with type 1 diabetes (T1D) in Germany. METHODS Data from 19,729 pediatric T1D patients from the diabetes prospective follow-up (DPV) registry were available. Data sets from four time-periods between January 1 and June 30, 2020, were compared with data from the whole year 2019 in the same patient; differences were adjusted for seasonality, increasing age, and longer diabetes duration. HbA1c values from laboratory measurements and estimates derived from continuous glucose monitoring (CGM) were aggregated into a combined glucose indicator (CGI), expressed in analogy to HbA1c. RESULTS Based on regression models adjusted for differences of sex, age, diabetes duration, and migratory background between the four time-periods, CGI values in 2020 were slightly higher than in 2019, for example, by 0.044% (0.042-0.046) (median [95% CI]) in the second lockdown month, time-period 3. Insulin dose and BMI-SDS were also marginally higher. In 2020, there were fewer hospitalizations (e.g., incidence risk ratio in time-period 3 compared with 2019: 0.52 [95% CI: 0.46-0.58]). In a subgroup of patients reporting CGM data in both years, metrics in 2020 improved: time in target increased, and mean sensor glucose fell, for example, by 2.8% (2.7-2.9), and by 4.4 mg/dl (4.3-4.6) in time-period 3. CONCLUSION Before, during, and after the lockdown in spring 2020, metabolic control in youth with T1D in Germany did not differ significantly from the preceding year. Further effects of the ongoing pandemic on pediatric T1D patients need to be evaluated.
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Affiliation(s)
- Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Felix Reschke
- Diabetes Center for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Angeliki Pappa
- Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
| | - Axel Dost
- Department of Pediatrics, University Hospital Jena, Jena, Germany
| | - Katharina Köstner
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Thomas M Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.,Median Children's Hospital "Am Nicolausholz", Bad Kösen, Germany
| | - Tilman R Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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