Current 2 - Diabetes and COVID-19: Optimizing Care and Support for People with Diabetes During a Pandemic

Summary

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 comorbidities or those who are not meeting treatment goals; whereas, 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

Sources

¹Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020;368:m1198. doi.org/10.1136/bmj.m1198.

²Bode B, Garrett V, Messler J, et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J Diabetes Sci Technol. 2020;14(4):813-821. doi:10.1177/1932296820924469.

³Saulnier 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. 2017;32(5):568-579. doi:10.1017/S1049023X17006574.

⁴Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: exacerbation of disparities and long-term consequences. Diabetes Care. 2009;32(9):1632-1638. doi:10.2337/dc09-0670.

⁵Hartmann-Boyce J, Morris E, Goyder C, et al. Diabetes and COVID-19: risks, management, and learnings from other national disasters. Diabetes Care. 2020;43(8):1695-1703. doi:10.2337/dc20-1192.

⁶NHS London Clinical Networks. Outpatient appointment prioritisation for specialist diabetes departments during the coronavirus pandemic. https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2020/04/4.-Covid-19-Diabetes-Outpatient-Appointment- Prioritisation-Crib-Sheet-27032020.pdf. Published March 26, 2020. Accessed August 08, 2020.