Abstract
BackgroundThe COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes. To examine psychosocial well-being and diabetes outcomes in individuals with type 1 diabetes during the COVID-19 pandemic, and investigate how these factors vary in different countries.MethodsBetween April and June 2020 we employed a cross national comparative research study in the United States (US), Brazil, and Iran to collect data from 1788 adults with type 1 diabetes using web-based survey. Study participants answered questions relevant to diabetes distress, diabetes burnout, depressive symptoms, COVID-19 related changes, and socio-demographic characteristics. They also reported their last Hemoglobin A1c (HbA1c) and daily Time-in-Range (TiR) blood glucose. We analyzed data using comparative tests (Chi-square, Kruskal–Wallis and McNemar test), logistic and linear regression adjusted for fixed effects.ResultsThere were significant changes prior and during the pandemic regarding access to diabetes care, diabetes supplies and medications, healthy food and safe places to exercise in all countries (p < 0.05). Participants in Iran experienced higher levels of diabetes distress (57.1%), diabetes burnout (50%), and depressive symptoms (60.9%), followed by Brazil and US (p < 0.0001). US participants reported better glycemic control (HbA1c = 6.97%, T1R = 69.64%) compared to Brazil (HbA1c = 7.94%, T1R = 51.95%) and Iran (HbA1c = 7.47%, T1R = 51.53%) (p < 0.0001). There were also significant relationships between psychosocial well-being, diabetes outcomes, socio-demographic data, and COVID-19 related challenges in overall sample (p < 0.05).ConclusionsRegardless of differences among US, Brazil, and Iran, our findings revealed that different countries may experience similar challenges related to the COVID-19 pandemic which can impact negatively diabetes outcomes and psychosocial well-being in individuals with type 1 diabetes. Countries need to consider modifiable variables associated with poor diabetes outcomes and sub optimal psychosocial well-being and target vulnerable population using significant socio-demographic variables.
Highlights
The COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes
This study highlights significance differences in access to diabetes care, medications and supplies, healthy food and safe places to exercise during the COVID-19 pandemic regardless the country of origin
Diabetes burnout, and depressive symptoms are common in individuals with diabetes [19,20,21], and are associated with difficulties in diabetes self-management, and sub-optimal glycemic control regardless of the pandemic [21,22,23]. Given this unique pandemic scenario and the lack of scientific evidence, the current study aims to 1: compare psychosocial well-being and glycemic control among adults with type 1 diabetes experiencing the COVID-19 pandemic in United States (US), Brazil, and Iran, and 2: examine which COVID-19 related changes and sociodemographic characteristics are related to psychosocial well-being and glycemic outcome in these countries
Summary
The COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes. The COVID-19 pandemic is a global public health emergency, which presents profound and wide-ranging negative impacts on vulnerable communities, including individuals living with diabetes [4]. Disruption to routine diabetes care, social isolation, and quarantine is associated with higher levels of stress, fear of becoming infected, and concerns related to availability of appropriate care in individuals with type 1 diabetes [13, 14]. This can contribute to worsening diabetes management, resulting in long-term diabetes complications and suboptimal diabetes outcomes [10]. The immediate research goals should be screening psychosocial well-being across vulnerable and high risk groups, including individuals with diabetes [18]
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