Challenges in Women with Diabetes During the COVID-19 Pandemic

Social networks as a protective factor for worsened self-perceived health status related to self-perceived changes in loneliness and health conditions in adults aged 50+ during the COVID-19 outbreak

The coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, leading millions of people to change their lifestyles, especially older individuals who are the most at-risk population. Social isolation, the main preventive action to slow the pandemic's spread, reduced and drastically limited social connections, increasing older individuals' loneliness and stress, and worsening their health. We examined the connection between self-perceived changes in loneliness, the existence and type of social contact (face-to-face/electronic), and health conditions on self-perceived changes in health status during the outbreak, analyzing 51,778 individuals aged 50 plus from the Survey of Health, Ageing and Retirement in Europe (SHARE) database Wave 8 beta (June-August 2020). We found that the odds for worsened self-perceived health status were 249% higher among individuals who reported increased loneliness compared to the non-increase group and were lower in individuals with face-to-face contact (31%) or electronic contact (54%) during the outbreak. In addition, the odds for worsened self-perceived health status were higher for individuals with hypertension (17%), cancer (19%), chronic lung disease (25%), heart problems (27%), and other illnesses (32%). Based on the results obtained, electronic contact has shown a stronger connection as a protective factor for worsened self-perceived health since the outbreak compared to face-to-face interactions. Thus, adopting a policy that encourages the usage of electronic communications could reduce the burden on the healthcare system, particularly during pandemics, while improving patient health outcomes and minimizing pandemic-related health risks. This approach is especially important for older individuals, for whom any departure from home can cause an additional risk of exposure to the virus.

Adherence to physical exercise recommendations among type 2 diabetes patients during the COVID-19 pandemic

Background

In the era of the COVID-19 pandemic, nonadherence to the recommended physical exercise for diabetic patients is a difficult issue. Regular physical exercise is critical for reducing further complications of diabetes mellitus and the COVID-19 pandemic. The purpose of this study was to determine the predictors of type 2 adult diabetes patients’ exercise recommendations during the COVID-19 pandemic.

Methods

An institution-based cross-sectional study was conducted among 576 diabetes mellitus patients from August 1, 2020, to September 28, 2020. A systematic random sampling technique was used to select the study participants. An interviewer-administered questionnaire was used to collect the data. Frequency tables and percentages were used to explain the study variables. A binary logistic regression was used to investigate the relationship between the dependent and independent variables.

Result

A total of 576 diabetes mellitus patients participated in the study, with a response rate of 99.3%. The overall prevalence of exercise adherence was 26.4%, whereas 73.6% were non-adherents to exercise recommendations. Rural residency (AOR = 1.95, 95% CI: 1.16–3.27) and COVID-19 related knowledge (AOR = 9.95, 95% CI: 41.14–5.24) were both strongly associated with exercise recommendations.

Conclusion

In this study, only one-fourth of patients had exercised adherence during the era of the COVID-19 pandemic. Knowledge about COVID-19 was one of the factors that was strongly associated with adherence to exercise recommendations for diabetes patients. During the COVID-19 pandemic, encouraging home-based exercises can improve adherence to exercise recommendations.

Effect of pandemic on Quality of life in Diabetics (QOLID) assessment: Data from a teaching hospital in Bhubaneswar, Odisha, India

Background:

Quality of life in Diabetics (QOLID) questionnaire is a validated tool to assess the quality of life affected by diagnosed diabetic patients and has 8 sub domains, which are essential factors that have proven effect on the management. In a state of art Diabetic clinic in Bhubaneswar city, the tool was used to add more quality to diabetic management.

Methods:

The ongoing assessment through the months of 2020 (study period being from December 2019 to August 2020), offered an opportunity to assess the effect of the pandemic on QOLID scores and review some nascent or strong factors which may be affecting chronic disease management.

Results:

Complete data could be collected from 599 subjects, 343 from pre pandemic and 256 from pandemic period. The overall scores which were on 100, did not show any significant difference for pre covid and the Covid period, interestingly nearly 1.93 points better in Covid period (69.69±11.10 vs71.62±8.49; p=0.396). Mild difference in overall scores of 4.82 points is seen in females in Covid period; and as seen in age group data maximum gain in sub domains, more for females is seen in the emotional and mental health. Though women reporting to the clinic in both periods are usually in 1:2 ratios, as against men; but QOLID scores in both men and women in Covid period was 71 to 80 points. After the univariate analysis for significant factors, it was that Covid (1.50; 1.08 - 2.07) ; compliance to medications (2.27; 1.48 - 3.50) and reporting of all diabetic complications especially that of eye and depression are coming out to be strong associative factors to affect QOLID scores. Interestingly, rising education has a protective effect on QOLID scores that was significant as higher awareness and better job or earning opportunities may be a contributor for higher QOLID scores for the well educated.

Conclusion:

This brings out a strong emphasis on QOL assessments to be made an inbuilt part of Diabetic management at all centers to maximize treatment outcomes

Diabetes Management Delivery and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus during the First Wave of the 2020 COVID-19 Pandemic: A Single-Reference Center Report

OBJECTIVES

The COVID-19 pandemic has forced a rapid adaptation of healthcare services to secure care for many patient groups. This includes women with gestational diabetes mellitus (GDM). We evaluated the impacts of the first COVID-19 wave on parameters such as the GDM treatment, glycemic control, and pregnancy outcomes.

METHODS

In this retrospective study from a reference diabetes center (Krakow, Poland), we compared patient data from two different time periods: the first wave of the COVID-19 pandemic (March 2020-June 2020) and the preceding five months (October 2019-February 2020). Data was collected from the medical records and telephone surveys.

RESULTS

We included 155 consecutive women (group N1 = 73 and group N2 = 82 from the COVID-19 pandemic period and non-COVID-19 period, respectively). During the COVID-19 pandemic, almost half of all GDM women (N1 = 36, 49.3%) used telemedicine as a method of contacting their diabetic specialists while this tool was not utilized in the earlier period. Moreover, these patients reported difficulties in performing blood glucose self-control more often (N1 = 20, 27.4%, vs N2 = 7, 8.5%; p ≤ 0.01) and spent less time on diabetes education than the control group on average (N1 = 39, 53.4%, vs N2 = 9, 9.8% below 2 hours of training; p ≤ 0.01). Most analyzed glycemic parameters and pregnancy outcomes were similar. Differences were found with respect to the incidence of prolonged labor (N1 = 12, 16.4%, vs N2 = 3, 3.7%; p ≤ 0.01) and preeclampsia (N1 = 0 vs N2 = 7, 8.5%; p = 0.01).

CONCLUSION

In this single-center observational study, the first wave of the COVID-19 pandemic did not seem to have a negative impact on pregnancy outcomes in GDM women, despite the difficulties in diabetes management delivery.

Clinical practice recommendations for the detection and management of hyperglycemia in pregnancy from South Asia, Africa and Mexico during COVID-19 pandemic

The human coronavirus disease 2019 (COVID-19) pandemic has affected overall healthcare delivery, including prenatal, antenatal and postnatal care. Hyperglycemia in pregnancy (HIP) is the most common medical condition encountered during pregnancy. There is little guidance for primary care physicians for providing delivery of optimal perinatal care while minimizing the risk of COVID-19 infection in pregnant women. This review aims to describe pragmatic modifications in the screening, detection and management of HIP during the COVID- 19 pandemic. In this review, articles published up to June 2021 were searched on multiple databases, including PubMed, Medline, EMBASE and ScienceDirect. Direct online searches were conducted to identify national and international guidelines. Search criteria included terms to extract articles describing HIP with and/or without COVID-19 between 1^st March 2020 and 15^th June 2021. Fasting plasma glucose, glycosylated hemoglobin (HbA1c) and random plasma glucose could be alternative screening strategies for gestational diabetes mellitus screening (at 24–28 weeks of gestation), instead of the traditional 2 h oral glucose tolerance test. The use of telemedicine for the management of HIP is recommended. Hospital visits should be scheduled to coincide with obstetric and ultrasound visits. COVID-19 infected pregnant women with HIP need enhanced maternal and fetal vigilance, optimal diabetes care and psychological support in addition to supportive measures. This article presents pragmatic options and approaches for primary care physicians, diabetes care providers and obstetricians for GDM screening, diagnosis and management during the pandemic, to be used in conjunction with routine antenatal care.