Diabetes and COVID-19: Learning from past national emergencies
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Experience with the management of diabetes during past national emergencies could provide guidance on ways to mitigate risks presented by the COVID-19 pandemic, according to a review published in Diabetes Care.
“COVID-19 poses a number of serious direct and indirect risks to people with diabetes,” Jamie Hartmann-Boyce, DPhil, department lecturer and co-director of the evidence-based health care DPhil program at the University of Oxford, United Kingdom, told Healio. “These risks are not evenly distributed; people from ‘non-white’ ethic groups and from less advantaged groups bear a disproportionate share of the burden. Our health care systems need to do all they can to support people with diabetes during and after this pandemic. Lessons can be learned from previous national emergencies, where disruptions in diabetes care had profound and long-lasting consequences.”
Heightened diabetes risk during disasters
Hartmann-Boyce and colleagues wrote that evidence on the management of long-term conditions during national emergencies highlights the risks for worse outcomes among people with diabetes during the COVID-19 pandemic. Disruptions that arise due to any national emergencies can lead to increased HbA1c for those affected for up to 16 months, the researchers wrote. Some evidence suggests the effect is more pronounced for people of lower socioeconomic status or those prescribed insulin therapy, they wrote.
“A lack of access to routine health care is a leading cause of morbidity and mortality after disasters; stroke, acute myocardial infarctions and diabetes complications are all shown to increase after the immediate threat has dissipated,” the researchers wrote. “Services such as diabetes clinics may also rethink their organization to minimize risk of ongoing transmission.”
The researchers noted that the “toll of disruptions” to diabetes care is often most pronounced after the acute phase of the emergency or disaster has passed, with excess morbidity and mortality higher during the aftermath of a disaster compared with the emergency itself.
“History issues a stark warning here when considering the balance between diverting resources toward the acute COVID-19 crisis and maintaining routine care for people living with long-term conditions,” the researchers wrote.
Steps for planning and response
The researchers outlined several steps to mitigate the risks that come with managing diabetes during an emergency such as the COVID-19 pandemic, which predominantly fall under two phases: planning and response.
As part of a comprehensive planning strategy, providers should form community-based partnerships and develop culturally adapted resources for people living with diabetes, including print and web-based educational materials, with telephone support. Providers should also conduct proactive, remote reviews with their patients to go over their possible needs if health care services are disrupted, and establish a clear point of contact for patient care should a disaster occur. Before any emergency, providers can improve identification and tracking mechanisms for people living with long-term conditions, and monitor medication adherence via prescription databases.
Triage and resource allocation are key during any emergency response phase, which can include the transfer of care to allied health care providers, such as nurses and pharmacists, and communication between different agencies, the researchers wrote. Business continuity plans for pharmacies should be in place, as well as consideration of 30-day supplies from pharmacists.
For people with diabetes, any response plan should ensure access to appropriate foods and provide dedicated patient transportation or mobile clinics for patients requiring in-person care who may be affected by transport difficulties.
Continued guidance from patient support groups is also key, they wrote.
“People with diabetes are likely to be impacted by COVID-19 just as much outside the health care setting as within it, with particular concerns relating to disruptions to diet and physical activity, increased stress, and burdens on mental health and well-being,yet the literature to date focuses almost exclusively on clinical management,” the researchers wrote. “The other unspoken issue in the literature we reviewed is that of inequality. COVID-19 is not an equal-opportunity disease. The burden will disproportionally be borne by people from less-advantaged groups.”
The researchers wrote that the COVID-19 pandemic “holds a mirror to our health care systems and care of people with diabetes.”
“We need well-conducted studies; this has unfortunately been a real issue for COVID-19 research,” Hartmann-Boyce said. “Studies need to consider a wide variety of factors that contribute to risk, and evaluations are urgently needed of interventions that could be used to support people with diabetes during and after the acute phase of the pandemic.”
For more information:
Jamie Hartmann-Boyce, DPhil, can be reached at the Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, New Radcliffe House, 2nd floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG; email: jamie.hartmann-boyce@phc.ox.ac.uk; Twitter: @jhb19.
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