Abstract
The COVID-19 pandemic is a major international emergency leading to unprecedented medical, economic and societal challenges. Countries around the globe are facing challenges with diabetes care and are similarly adapting care delivery, with local cultural nuances. People with diabetes suffer disproportionately from acute COVID-19 with higher rates of serious complications and death. In-patient services need specialist support to appropriately manage glycaemia in people with known and undiagnosed diabetes presenting with COVID-19. Due to the restrictions imposed by the pandemic, people with diabetes may suffer longer-term harm caused by inadequate clinical support and less frequent monitoring of their condition and diabetes-related complications. Outpatient management need to be reorganised to maintain remote advice and support services, focusing on proactive care for the highest risk, and using telehealth and digital services for consultations, self-management and remote monitoring, where appropriate. Stratification of patients for face-to-face or remote follow-up should be based on a balanced risk assessment. Public health and national organisations have generally responded rapidly with guidance on care management, but the pandemic has created a tension around prioritisation of communicable vs non-communicable disease. Resulting challenges in clinical decision-making are compounded by a reduced clinical workforce. For many years, increasing diabetes mellitus incidence has been mirrored by rising preventable morbidity and mortality due to complications, yet innovation in service delivery has been slow. While the current focus is on limiting the terrible harm caused by the pandemic, it is possible that a positive lasting legacy of COVID-19 might include accelerated innovation in chronic disease management.
Highlights
Among 7162 US cases reported by the CDC (28 March), the percentage of COVID-19 patients with at least one underlying health condition (e.g diabetes) was nearly three-fold higher among those requiring [1] intensive care unit admission (78%) and [2] hospitalisation (71%) compared to people not hospitalised (27%) [3, 4]
Pregnancy, foot services, and management of newly diagnosed people with Type 1 diabetes may need to continue at full capacity, as per national guidance [13]
While some IT-integrated risk assessment tools are available (e.g. Eclipse; https://www.prescribingservices. org), they have not been adapted for risk assessment around routine care delivery during COVID-19, which is generally being done intuitively
Summary
Among 7162 US cases reported by the CDC (28 March), the percentage of COVID-19 patients with at least one underlying health condition (e.g diabetes) was nearly three-fold higher among those requiring [1] intensive care unit admission (78%) and [2] hospitalisation (71%) compared to people not hospitalised (27%) [3, 4]. Acute care for individual people with diabetes and COVID-19 Acute illness suspected or confirmed to be due to COVID19 may require modification of current guidelines, for safe use by staff unfamiliar with diabetes management, to prevent hypoglycaemia and severe hyperglycaemia [10].
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