Journal club diabetes and covid-19 – an international view€¦ · Journal club In this issue of...
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Journal club In this issue of Update, Dr Florence Johnson, Improving Care Manager (London region) for Diabetes UK, summarises a recent review article on diabetes and Covid-19, how countries with significant outbreaks have responded to the pandemic, and suggestions to safeguard those with diabetes ince the Covid-19 pandemic swept the globe, research has identified that people with diabetes are at higher risk of severe illness from the virus. The authors in the article 1 discussed here performed a rapid review of literature on diabetes and Covid-19 up to June 2020. So, what did they find? People with diabetes are more susceptible to infection generally, but the evidence is still inconclusive as to whether they are more susceptible to Covid-19. We do know, however, that risk factors for more severe Covid-19 infection include increased age, being male, hypertension and cardiovascular comorbidities, as well as possible other factors, such as high BMI, ethnicity, type of diabetes – risk may be higher in type 1 compared with type 2 – and certain medications. Research also suggests that those with a high HbA1c may have worse outcomes and that uncontrolled hyperglycaemia may increase hospital length of stay and mortality risk. Other indirect factors may also disadvantage this population. Changes in access to healthcare services, medication and food have previously been shown to have adverse effects on diabetes outcomes in studies of other national emergencies, and changes to diet and exercise have affected many across the globe during the pandemic. A survey performed in the United States found that a third of participants’ diets were less healthy, and half of them exercised less than before the pandemic. A healthy diet and physical activity are paramount to self- management of diabetes, and data does not yet exist on disruptions to self-management and possible diabetes-related complications arising from the pandemic. The authors studied some of the worst affected countries hit by Covid-19 – China, France, Italy, the UK and the US. Common across all five was the marked reduction in face-to-face clinical interactions, replaced by remote telephone or video appointments with healthcare professionals. All five countries had Covid-19-specific information and resources produced for people with diabetes in formats such as apps, webinars and webpages. For example, China promoted lectures given by health professionals through Baidu Health, their equivalent of Google, and through WeChat, described as China’s ‘app for everything’. Considerations, however, still need to be made for those that cannot access technology and, therefore, online information. Issues faced by people with diabetes in different countries are also discussed. For instance, in the US, where many patients lost insurance coverage, there was a reported 10% drop in the collection of diabetes prescriptions. The review article compiles guidance for healthcare services for people with diabetes during the Covid-19 pandemic, which includes recommendations for inpatient care, acute diabetes care, routine care, foot services, pregnancy services, blood tests and eye screening. It has been shown that following national emergencies, the biggest disruption to diabetes care and potentially excess morbidity and mortality comes after the acute phase, so getting diabetes care right is now as important as ever. The authors have reported how international experiences to date, and to some extent literature from previous national emergencies, can inform future decisions. But there is a noticeable lack of literature studying non-clinical factors, like mental health and wellbeing, stress, reduced physical activity and changes in diet. Further studies are needed to investigate these factors on people with diabetes during times of crises, and the learnings shared by health services from different countries, to prepare for potential future waves of Covid-19. 1 Hartmann-Boyce J et al. Diabetes and Covid-19: Risks, Management, and Learnings From Other National Disasters (2020). Diabetes Care https://doi. org/10.2337/dc20-1192 S 42 Update Autumn 2020 diabetes and covid-19 – an international view 41-45_MD-JC-SA3.indd 42 41-45_MD-JC-SA3.indd 42 25/08/2020 16:04 25/08/2020 16:04
Transcript of Journal club diabetes and covid-19 – an international view€¦ · Journal club In this issue of...
Journal club
In this issue of Update,Dr Florence Johnson, Improving Care Manager (London region) for Diabetes UK, summarises a recent review article on diabetes and Covid-19, how countries with significant outbreaks have responded to the pandemic, and suggestions to safeguard those with diabetes
ince the Covid-19 pandemic swept the globe, research has identified that people with diabetes are at
higher risk of severe illness from the virus. The authors in the article1 discussed here performed a rapid review of literature on diabetes and Covid-19 up to June 2020. So, what did they find?
People with diabetes are more susceptible to infection generally, but the evidence is still inconclusive as to whether they are more susceptible to Covid-19. We do know, however, that risk factors for more severe Covid-19 infection include increased age, being male, hypertension and cardiovascular comorbidities, as well as possible other factors, such as high BMI, ethnicity, type of diabetes – risk may be higher in type 1 compared with type 2 – and certain medications. Research also suggests that those with a high HbA1c may have worse outcomes and that uncontrolled
hyperglycaemia may increase hospital length of stay and mortality risk.
Other indirect factors may also disadvantage this population. Changes in access to healthcare services, medication and food have previously been shown to have adverse effects on diabetes outcomes in studies of other national emergencies, and changes to diet and exercise have affected many across the globe during the pandemic. A survey performed in the United States found that a third of participants’ diets were less healthy, and half of them exercised less than before the pandemic. A healthy diet and physical activity are paramount to self-management of diabetes, and data does not yet exist on disruptions to self-management and possible diabetes-related complications arising from the pandemic.
The authors studied some of the worst affected countries hit by Covid-19 – China, France, Italy, the UK and the US. Common across all five was the marked reduction in face-to-face clinical interactions, replaced by remote telephone or video appointments with healthcare professionals. All five countries had Covid-19-specific information and resources produced for people with diabetes in formats such as apps, webinars and webpages. For example, China promoted lectures given by health professionals through Baidu Health, their equivalent of Google, and through WeChat, described as China’s ‘app for everything’.
Considerations, however, still need to be made for those that cannot access technology and, therefore, online information. Issues faced by people with diabetes in different countries are also
discussed. For instance, in the US, where many patients lost insurance coverage, there was a reported 10% drop in the collection of diabetes prescriptions.
The review article compiles guidance for healthcare services for people with diabetes during the Covid-19 pandemic, which includes recommendations for inpatient care, acute diabetes care, routine care, foot services, pregnancy services, blood tests and eye screening. It has been shown that following national emergencies, the biggest disruption to diabetes care and potentially excess morbidity and mortality comes after the acute phase, so getting diabetes care right is now as important as ever.
The authors have reported how international experiences to date, and to some extent literature from previous national emergencies, can inform future decisions. But there is a noticeable lack of literature studying non-clinical factors, like mental health and wellbeing, stress, reduced physical activity and changes in diet. Further studies are needed to investigate these factors on people with diabetes during times of crises, and the learnings shared by health services from different countries, to prepare for potential future waves of Covid-19.
1 Hartmann-Boyce J et al. Diabetes and Covid-19: Risks, Management, and Learnings From Other National Disasters (2020). Diabetes Care https://doi.org/10.2337/dc20-1192
S
42 Update Autumn 2020
diabetes and covid-19 –an international view
41-45_MD-JC-SA3.indd 4241-45_MD-JC-SA3.indd 42 25/08/2020 16:0425/08/2020 16:04
