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1.
Diabetes Obes Metab ; 2022 May 31.
Article in English | MEDLINE | ID: covidwho-1868638

ABSTRACT

BACKGROUND AND AIMS: We report normative glucose metrics for time in ranges ( % TIR 3.9-10 mmol/L, %TBR <3.9 mmol/L and %TAR >10 mmol/L) for UK adult FreeStyle Libre (FSL) users within 4 defined age-groups and observed changes during the COVID-19 pandemic on these over time. METHODS: Data was extracted from 8,914 LibreView de-identified user accounts from adult users aged 18+ with ≥5 days of sensor readings in each month from January to June 2020. Age-group categories were based on self-reported age on LibreView accounts (18-25, 26-49, 50-64, 65+ yrs). RESULTS: In January, prior to the COVID-19 pandemic, the 65+ age group had the highest %TIR (57.9%) while the 18-25 age group had the lowest (51.2%) (p<0.001). Within each age group, TIR increased during the analysed months, by between 1.7% (26-49 yrs old) and 3.1% (65+ yrs) (p<0.001 in all cases). %TBR was significantly reduced only in the 26-49 yr age group, whereas %TAR was reduced by between 1.5% (26-49 yrs old) to 3.0% (65+ yrs) (p<0.001 in both cases). The proportion of adults achieving both >70% TIR and <4% TBR targets increased from 11.7% to 15.9% for those 65+ years (p<0.001) and from 6.0% to 9.1% for 18-25 (p<0.05). Mean daily glucose-sensor scan rates were at least 12 per day and remained stable across the analysis period. CONCLUSIONS: Our data show the baseline glucose metrics for FSL users in the UK across different age groups under usual care. During lockdown in the UK, the proportion of adults achieving TIR consensus targets increased among FSL users. This article is protected by copyright. All rights reserved.

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-311486

ABSTRACT

Background: A key first step in optimising COVID-19 patient outcomes during future case-surges, is to learn from the experience within individual hospitals during the early stages of the pandemic. The aim of this study was to investigate the extent of variation in COVID-19 outcomes between National Health Service (NHS) hospital trusts and regions in England using data from March-July 2020.Methods: This was a retrospective observational study using the Hospital Episode Statistics administrative dataset. Patients aged ≥ 18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1st and July 31st, 2020 were included. In-hospital mortality was the primary outcome of interest. In secondary analysis, 30 days emergency hospital readmission, length of stay and mortality within 30 days of discharge were also investigated. Logistic regression was used to adjust for covariates.Findings: There were 86,356 patients with a confirmed diagnosis of COVID-19 included in the study, of whom 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death. After adjusting for covariates, the extent of the variation in mortality rates between hospital trusts and regions was relatively modest. Trusts with a larger baseline number of beds had better outcomes than those with a smaller number of beds.Interpretation: There is little evidence of clustering of deaths within hospital trusts. There may be opportunities to learn from the experience of individual trusts to help prepare for future hospital management of COVID-19 patients during future case-surges.Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Declaration of Interests: The authors declare that there is no conflict of interest.Ethics Approval Statement: Consent from individuals involved in this study was not required. The analysis and presentation of data follows current NHS Digital guidance for the use of HES data for research purposes and is anonymised to the level required by ISB1523 Anonymisation Standard for Publishing Health and Social Care Data.

3.
BMJ Open Diabetes Res Care ; 9(2)2021 11.
Article in English | MEDLINE | ID: covidwho-1518143

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has reduced the accessibility to hemoglobin A1c (HbA1c) tests required for virtual diabetes clinics. The aim was to develop and validate a user-friendly postal system for remote HbA1c monitoring. RESEARCH DESIGN AND METHODS: Validation: A total of 123 capillary blood samples from people with diabetes (PWD) needing face-to-face consultations along with healthy volunteers were measured on a point-of-care (POC) Siemens DCA Vantage Analyzer. Another sample of 5-10 drops was simultaneously collected in a K2EDTA tube (BD Microtainer) and stored for up to 12 days at room temperature for subsequent retesting. Feasibility: During October to December 2020, a total of 286 postal HbA1c kits were sent to PWD prior to their virtual consultation. These contained sample collection guidance, the necessary equipment and a feedback form. As per Packing Instruction 650 regulations, these were posted back to the diabetes center for HbA1c testing on the POC analyzer. RESULTS: There was a strong correlation between the first and the stored sample (R2=0.978). There was a small clinically insignificant negative bias -1.53 mmol/mol (2 SD = 3.10 mmol/mol). Bland-Altman plots showed 93% of results within 2 SD. Of the 87% of returned kits, only one sample failed to be analyzed. 94% of PWD who provided feedback were happy to use the postal HbA1c system again. CONCLUSIONS: A robust user-friendly postal HbA1c system has been created and successfully integrated into clinical practice using the existing POC equipment at the diabetes center. It provides accurate HbA1c results and is an invaluable tool for remote monitoring of HbA1c in PWD-both during and after the pandemic.


Subject(s)
COVID-19 , Pandemics , Feasibility Studies , Glycated Hemoglobin A/analysis , Humans , SARS-CoV-2
4.
BMJ Open ; 11(7): e050713, 2021 07 14.
Article in English | MEDLINE | ID: covidwho-1311169

ABSTRACT

INTRODUCTION: Optimising glycaemic control in type 1 diabetes (T1D) remains challenging. Flash glucose monitoring with FreeStyle Libre 2 (FSL2) is a novel alternative to the current standard of care self-monitoring of blood glucose (SMBG). No randomised controlled trials to date have explored the potential benefits of FSL2 in T1D. We aim to assess the impact of FSL2 in people with suboptimal glycaemic control T1D in comparison with SMBG. METHODS: This open-label, multicentre, randomised (via stochastic minimisation), parallel design study conducted at eight UK secondary and primary care centres will aim to recruit 180 people age ≥16 years with T1D for >1 year and glycated haemoglobin (HbA1c) 7.5%-11%. Eligible participants will be randomised to 24 weeks of FSL2 (intervention) or SMBG (control) periods, after 2-week of blinded sensor wear. Participants will be assessed virtually or in-person owing to the COVID-19 pandemic. HbA1c will be measured at baseline, 12 and 24 weeks (primary outcome). Participants will be contacted at 4 and 12 weeks for glucose optimisation. Control participants will wear a blinded sensor during the last 2 weeks. Psychosocial outcomes will be measured at baseline and 24 weeks. Secondary outcomes include sensor-based metrics, insulin doses, adverse events and self-report psychosocial measures. Utility, acceptability, expectations and experience of using FSL2 will be explored. Data on health service resource utilisation will be collected. ANALYSIS: Efficacy analyses will follow intention-to-treat principle. Outcomes will be analysed using analysis of covariance, adjusted for the baseline value of the corresponding outcome, minimisation factors and other known prognostic factors. Both within-trial and life-time economic evaluations, informed by modelling from the perspective of the National Health Service setting, will be performed. ETHICS: The study was approved by Greater Manchester West Research Ethics Committee (reference 19/NW/0081). Informed consent will be sought from all participants. TRIAL REGISTRATION NUMBER: NCT03815006. PROTOCOL VERSION: 4.0 dated 29 June 2020.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adolescent , Blood Glucose , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemic Agents , Multicenter Studies as Topic , Pandemics , Randomized Controlled Trials as Topic , SARS-CoV-2 , State Medicine , United Kingdom
6.
Diabet Med ; 38(2): e14458, 2021 02.
Article in English | MEDLINE | ID: covidwho-1214788

ABSTRACT

Dapagliflozin (SGLT-2 inhibitor) and sotagliflozin (SGLT1/2 inhibitor) are two of the drugs of SGLT inhibitor class which have been recommended by the National Institute for Health and Care Excellence (NICE) in people with type 1 diabetes with BMI ≥27 kg/m2 . Dapagliflozin is licensed in the UK for use in the NHS while sotagliflozin may be available in future. These and possibly other SGLT inhibitors may be increasingly used in people with type 1 diabetes as new licences are obtained. These drugs have the potential to improve glycaemic control in people with type 1 diabetes with the added benefit of weight loss, better control of blood pressure and more time in optimal glucose range. However, SGLT inhibitors are associated with a higher incidence of diabetic ketoacidosis without significant hyperglycaemia. The present ABCD/Diabetes UK joint updated position statement is to guide people with type 1 diabetes and clinicians using these drugs help mitigate this risk and other potential complications. Particularly, caution needs to be exercised in people who are at risk of diabetic ketoacidosis due to low calorie diets, illnesses, injuries, starvation, excessive exercise, excessive alcohol consumption and reduced insulin administration among other precipitating factors for diabetic ketoacidosis.


Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Diabetic Ketoacidosis/epidemiology , Overweight/metabolism , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Benzhydryl Compounds/therapeutic use , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/metabolism , Drug Therapy, Combination , Glucosides/therapeutic use , Glycosides/therapeutic use , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Overweight/complications , Practice Guidelines as Topic , United Kingdom
7.
EClinicalMedicine ; 35: 100859, 2021 May.
Article in English | MEDLINE | ID: covidwho-1202394

ABSTRACT

BACKGROUND: A key first step in optimising COVID-19 patient outcomes during future case-surges is to learn from the experience within individual hospitals during the early stages of the pandemic. The aim of this study was to investigate the extent of variation in COVID-19 outcomes between National Health Service (NHS) hospital trusts and regions in England using data from March-July 2020. METHODS: This was a retrospective observational study using the Hospital Episode Statistics administrative dataset. Patients aged ≥ 18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1st and July 31st, 2020 were included. In-hospital mortality was the primary outcome of interest. In secondary analysis, critical care admission, length of stay and mortality within 30 days of discharge were also investigated. Multilevel logistic regression was used to adjust for covariates. FINDINGS: There were 86,356 patients with a confirmed diagnosis of COVID-19 included in the study, of whom 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death. After adjusting for covariates, the extent of the variation in-hospital mortality rates between hospital trusts and regions was relatively modest. Trusts with the largest baseline number of beds and a greater proportion of patients admitted to critical care had the lowest in-hospital mortality rates. INTERPRETATION: There is little evidence of clustering of deaths within hospital trusts. There may be opportunities to learn from the experience of individual trusts to help prepare hospitals for future case-surges.

8.
Diabet Med ; 38(1): e14442, 2021 01.
Article in English | MEDLINE | ID: covidwho-991281

ABSTRACT

AIMS: Inpatient care for people with diabetes can and must be improved. The COVID-19 pandemic has impacted the way care is delivered across the UK. Diabetes UK needed to understand how inpatient care for people with diabetes has been affected and to identify opportunities, areas of concerns and recommendations for the future. METHODS: We interviewed 28 healthcare professionals and hospital teams from across the UK to find out about their experiences of delivering inpatient diabetes care during the first peak of the COVID-19 pandemic. RESULTS: We found that disruption to inpatient diabetes services created positive environments and opportunities for new ways of working, but in the minority, impacted on the quality of care clinicians felt they were able to deliver. CONCLUSIONS: It is important that these positive ways of working be maintained and as a result of these experiences we have outlined urgent recommendations for the challenging winter months ahead.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/therapy , Health Personnel , Inpatients , Patient Care/methods , SARS-CoV-2 , COVID-19/prevention & control , Diabetes Mellitus/epidemiology , Humans , Pandemics , Patient Care/trends , Quality of Health Care/trends , United Kingdom/epidemiology
10.
Eur J Endocrinol ; 183(2): G67-G77, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-665892

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.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Therapies, Investigational/trends , COVID-19 , Coronavirus Infections/diagnosis , Diabetes Mellitus/diagnosis , Endocrinology/methods , Endocrinology/trends , Humans , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Telemedicine/methods , Telemedicine/trends , Therapies, Investigational/methods , United Kingdom/epidemiology
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