COVID-19 pandemic consequences in people with diabetes may include more than physical findings. Optimal care should include support for indirect risks and disruptions in routine care during a pandemic.
People with diabetes may be at higher risk of both contracting COVID-19 and more severe illness burden once diagnosed, including higher mortality.1,2 Indirect risks, such as food insecurity, stress, disruption of health care services, and changes to diet and activity, may contribute to worse diabetes outcomes and have been demonstrated in large-scale disasters.3,4
While evidence regarding the impact of COVID-19 in people with diabetes continues to emerge as the pandemic unfolds, an August 2020 article in Diabetes Care5 provides a basis for providing educational and institutional support to people with diabetes and other patients with chronic illness. The article highlights strategies for optimizing care for people with diabetes during national emergencies (see Figure 1). National Health Service recommendations for care of people with diabetes state that routine appointments where diabetes is stable and well-managed could be temporarily deferred. Virtual visits via telephone or video could be used for patients with co-morbidities or those who are not meeting treatment goals, while efforts should be made to prioritize face-to-face visits in certain clinical situations, such as:
New diagnosis of Type 1 Diabetes (T1D) Urgent insulin start where symptomatic HbA1c >10%, or in cases where physical examination is essential (e.g., foot ulcer, infection)6
- Jordan R, Adab P, Cheng K. Covid-19: risk factors for severe disease and death. BMJ [Internet]. 2020 [cited 2020 Aug 10]; 368:m1198. Available from: https://doi.org/10.1136/bmj.m1198 DOI: 10.1136/bmj.m1091
- Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J Diabetes Sci Technol [Internet]. 2020 [cited 2020 Aug 10]; 14(4): 813–821. Available from: https://journals.sagepub.com/doi/10.1177/1932296820924469 DOI: 10.1177/1932296820924469
- Saulnier DD, Ribacke KB, von Schreeb J. No calm after the storm: a systematic review of human health following flood and storm disasters. Prehosp Disaster Med [Internet]. 2017 [cited 2020 Aug 10];32(5):568–579. Available from: https://pubmed.ncbi.nlm.nih.gov/28606191/ DOI: 10.1017/S1049023X17006574
- Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: exacerbation of disparities and long-term consequences. Diabetes Care [Internet] 2009 [cited 2020 Aug 10];32(9):1632–1638. Available from: https://care.diabetesjournals.org/content/32/9/1632 DOI: 10.2337/dc09-0670
- Hartmann-Boyce J, Morris E, Goyder C, Kinton J, Perring J, Nunan D, et al. Diabetes and COVID-19: risks, management, and learnings from other national disasters. Diabetes Care [Internet]. 2020 [cited 2020 Aug 10]; 43(8): 1695-1703. Available from: https://care.diabetesjournals.org/content/43/8/1695.figures-only DOI: 10.2337/dc20-1192
- London Clinical Networks [Internet]. London (EN): National Health Service England London; 2020. Outpatient appointment prioritisation for specialist diabetes departments during the coronavirus pandemic. [Cited 2020 Aug 08]; [1 screen]. Available from: https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2020/04/4.-Covid-19-Diabetes-Outpatient-Appointment- Prioritisation-Crib-Sheet-27032020.pdf
