ABSTRACT
Background: The lockdown due to the COVID-pandemic in April 2020 led to the suspension of face-to-face diabetes care and education. In this period, management of diabetes emergency was a challenge because it needed rapid recognition, diagnosis and treatment. Despite adverse situations, many DAFNE graduates had chosen to fast during Ramadan. This was supported virtually to DAFNE graduates through intermittently scanned continuous glucose monitoring (isCGM) . Aims: This study aimed to compare the isCGM glucose metrics of people with T1D who fasted during Ramadan. Methods: Baseline and fasting period isCGM data were collected. The primary outcome measures HbA1c, time in range [ (TIR) 3.9- mmol/L], time below range [ (TBR) <3.9 mmol/L], coefficient of variation (CV) , and self-reported adverse events. Results: A total of 35 people with T1D fasted with a median of 20 days. Mean HbA1c was 7.5 (0.93) % and 7.4 (0.91) % before and after fasting periods, respectively. No significant change in TIR (pre 61.1 ± 17.9% vs. during 61.9 ± 14.9%) and TAR (pre 32.1 ± 19.0% vs. during 33.1 ± 15.6%) were found. However, TBR (pre 6.8 ± 5.4% vs. during 5.0 ± 4.6%) was significantly decreased (p= 0.045) . The CV (-2.3%) and low glucose events (-5.0) also decreased during the fasting period (p≤ 0.010) . No episodes of severe hypoglycemia, DKA, or hospitalization occurred during the fasting period. Conclusions: DAFNE graduates can fast safely without the fear of hypoglycemia, and safe metrics of glycemia using diabetes self-management skills, including disaster situations like the COVID-pandemic.
ABSTRACT
OBJECTIVE: To build a clinical risk score to aid risk stratification among hospitalised COVID-19 patients. METHODS: The score was built using data of 417 consecutive COVID-19 in patients from Kuwait. Risk factors for COVID-19 mortality were identified by multivariate logistic regressions and assigned weighted points proportional to their beta coefficient values. A final score was obtained for each patient and tested against death to calculate an Receiver-operating characteristic curve. Youden's index was used to determine the cut-off value for death prediction risk. The score was internally validated using another COVID-19 Kuwaiti-patient cohort of 923 patients. External validation was carried out using 178 patients from the Italian CoViDiab cohort. RESULTS: Deceased COVID-19 patients more likely showed glucose levels of 7.0-11.1 mmol/L (34.4%, p < 0.0001) or >11.1 mmol/L (44.3%, p < 0.0001), and comorbidities such as diabetes and hypertension compared to those who survived (39.3% vs. 20.4% [p = 0.0027] and 45.9% vs. 26.6% [p = 0.0036], respectively). The risk factors for in-hospital mortality in the final model were gender, nationality, asthma, and glucose categories (<5.0, 5.5-6.9, 7.0-11.1, or 11.1 > mmol/L). A score of ≥5.5 points predicted death with 75% sensitivity and 86.3% specificity (area under the curve (AUC) 0.901). Internal validation resulted in an AUC of 0.826, and external validation showed an AUC of 0.687. CONCLUSION: This clinical risk score was built with easy-to-collect data and had good probability of predicting in-hospital death among COVID-19 patients.