The imperious need for telemedicine for the care of diabetes during the COVID-19 pandemic. A comprehensive approach study.

INTRODUCTION: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. OBJECTIVE: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. METHODS: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. RESULTS: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. CONCLUSIONS: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.

INTRODUCCIÓN: Los pacientes con diabetes experimentan dificultades para mantener el control glucémico durante el confinamiento por la pandemia de COVID-19, con el riesgo de presentar complicaciones crónicas de la diabetes y COVID-19 grave. OBJETIVO: El propósito de este estudio fue evaluar la conversión de un centro de atención primaria presencial de diabetes a un servicio de telemedicina por llamada telefónica. MÉTODOS: Se realizaron consultas médicas por llamada telefónica durante la etapa inicial del confinamiento (abril a junio de 2020), para continuar el seguimiento de pacientes ingresados a un programa de atención multicomponente en diabetes. RESULTADOS: Se realizaron 1118 consultas por llamada telefónica para continuar el seguimiento de 192 pacientes con diabetes tipo 2. Participaron diferentes profesionales de distintas áreas de la salud: atención médica, educación en diabetes, nutrición, psicología y podología. CONCLUSIONES: La atención multicomponente en diabetes se transformó con éxito de un esquema de atención presencial a un servicio de telemedicina. Numerosos pacientes de atención primaria pueden ser candidatos a telemedicina. Se debe considerar un rediseño del modelo de atención que incorpore la telemedicina para mitigar la carga de morbimortalidad en enfermedades crónicas impuesta por la pandemia de COVID-19, pero también para la era pos-COVID-19.

Effect in self-care behavior and difficulties in coping with diabetes during the COVID-19 pandemic

In this study, difficulties in coping with diabetes were evaluated during the coronavirus disease 2019 (COVID-19) lock-down. Similarly, the change in diabetes self-care activities was evaluated in patients with a recent assessment before COVID-19 lockdown in Mexico City. In 212 patients with type 2 diabetes (T2D) and regular primary care, a designed questionnaire was used to evaluate the presence/absence of difficulties in self-care related to diet, physical activity/exercise, glucose monitoring, treatment adherence, getting pharmacological treatment, and confinement adherence. The Summary of Diabetes Self-Care Activities tool was used to compare the frequency of self-care behaviors in the past 7 days. Self-reported difficulties in coping with T2D were documented and included difficulties in self-care behaviors related to diet (41.6%), physical activity/exercise (40.5%), glucose monitoring (23.7%), getting pharmacological treatment (22.9%), pharmacological treatment adherence (19%), and home-confinement adherence (11.7%). In the group of patients with a recent previous-lockdown evaluation, global self-care behavior decreased from 5.15±0.9 to 4.49 ± 1.02 days/week, p 0.001. Diabetes self-care was a predictor for the presence of difficulties in coping with diabetes. Patients with T2D reported difficulties in coping with T2D and decreased diabetes self-care activities during the COVID-19 lockdown in Mexico City. Health-care policies must be designed and implemented to attenuate diabetes disease burden caused by this ongoing and future health-contingencies. En el presente estudio se evaluaron las dificultades para hacer frente a la diabetes por los pacientes durante el confinamiento por COVID-19. Así mismo, se evaluó el cambio en las actividades de autocuidado de diabetes en pacientes con evaluación reciente antes del confinamiento por COVID-19 en la Ciudad de México. En 212 pacientes con diabetes tipo 2 (DT2), se utilizó un cuestionario diseñado para evaluar la presencia/ausencia de dificultades para el autocuidado. La herramienta Summary of Diabetes Self-Care Activities (SDCA) se utilizó para comparar las actividades de autocuidado, reportado en días a la semana. Las dificultades reportadas por los pacientes incluyeron las relacionadas con: alimentación (41.6%), actividad física/ejercicio (40.5%), monitoreo de glucosa (23.7%), acceso al tratamiento farmacológico (22.9%), adherencia al tratamiento farmacológico (19%) y adherencia al confinamiento (11.7%). En el grupo de pacientes con una evaluación reciente previa al confinamiento, la actividad global de autocuidado disminuyó de 5,15±0,9 a 4,49±1,02 días/semana, valorp 0,001. El autocuidado en diabetes fue predictor de la presencia de dificultades para hacer frente a la diabetes. Los pacientes informaron dificultades para afrontar la diabetes y disminuyeron las actividades de auto-cuidado durante el confinamiento por COVID-19. Políticas de atención médica deben diseñarse e implementarse para atenuar la carga de la enfermedad causado por esta y futuras contingencias en salud.