A case series of diabetic ketoacidosis associated with SGLT2 inhibitors

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are increasingly initiated as treatment for type 2 diabetes due to favourable cardiorenal characteristics. However, studies have identified an increased risk of diabetic ketoacidosis (DKA). We carried out a retrospective, case-based study at East and North Herts NHS Trust between February 2018 and December 2020. Fifteen cases of SGLT2i associated DKA were identified in people with presumed type 2 diabetes;33.3% were classed as euglycaemic DKA with a blood glucose of <11mmol/L. All cases were associated with a significant precipitating factor including diarrhoea, vomiting, reduced oral intake and sepsis. One case was related to COVID-19. Two people were subsequently found to have raised islet autoantibodies suggesting type 1 diabetes or latent autoimmune diabetes in adults. It is important that awareness of SGLT2i associated DKA is raised among users and health care practitioners, including the recognition of euglycaemic DKA. Sick day rules should be emphasised and reiterated at clinical encounters. Non-specialists in primary care, oncology and in perioperative settings should be empowered to advocate for temporary withdrawal and there should be readier access to blood ketone monitoring when required. When SGLT2i associated DKA occurs, due consideration should be given to evaluate the diabetes classification and investigate the circumstances of the event. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.

Influencing factors of negative conversion time of nucleic acid detection in 228 patients infected with Omicron variant of SARS-CoV-2 in Shanghai

Objective: To analyze and compare the effects of different clinical characteristics on the negative conversion time of nucleic acid detection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection, and to provide a scientific basis for the isolation and treatment of coronavirus disease 2019 (COVID-19). Methods: The epidemiological and clinical data of 228 mild SARS-CoV-2 Omicron variant infected patients diagnosed in Shanghai were retrospectively collected from April 27, 2022 to June 8, 2022 in Wujiaochang designated Hospital, Yangpu District, Shanghai. The negative conversion time of nucleic acid detection was used as the outcome variable, and the patients were divided into A (18 days) and B (>18 days). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the negative conversion time of nucleic acid detection. Results: The mean nucleic acid conversion time of 228 patients was (18.7+or-12.1) d, with the median time of 18 (2-46) d. Among them, 120 patients in group A had an average nucleic acid conversion time of (13.2+or-2.0) d, and 108 cases in group B had an average nucleic acid conversion time of (20.8+or-1.3) d. Univariate analysis showed that there were no statistically significant differences in the effects of hypertension, coronary heart disease, diabetes, hypokalemia, malignant tumors, neuropsychiatric diseases, chronic digestive diseases on the negative nucleic acid conversion time (P > 0.05);however, there were significant differences in the effects of combined cerebrovascular disease, leukopenia, chronic respiratory system diseases and vaccination on the negative nucleic acid conversion time (P < 0.05). Further multivariate logistic regression analysis revealed that the combination of chronic respiratory diseases and non-vaccination were significant risk factors for prolongation of negative nucleic acid conversion time (P < 0.05). Conclusions: The results of this study show that gender, age and whether hypertension, coronary heart disease, diabetes mellitus, hypokalemia, malignant tumor, neuropsychiatric disease and chronic digestive disease have no significant effect on the nucleic acid conversion time, whereas chronic respiratory disease and no vaccination are significantly correlated with the prolongation of nucleic acid conversion time in SARS-CoV-2 Omicron-infected patients.

Current Healthcare Policy and Environmental Status of Digital Health Medical Devices in South Korea

Objectives: COVID 19 and increasing unmet needs of health technology had accelerated an adoption of digital health globally and the major categories are mobile-health, health information technology, telemedicine. Digital health interventions have various benefit on clinical efficacy, quality of care and reducing healthcare costs. The objective of the study is to identify new reimbursement policy trend of digital health medical devices in South Korea. Method(s): Official announcements published in national bodies and supplementary secondary research were used to capture policies, frameworks and currently approved products since 2019. Result(s): With policy development, several digital health devices and AI software have been introduced as non-reimbursement by utilizing new Health Technology Assessment (nHTA) pathway including grace period of nHTA and innovative medical devices integrated assessment pathway. AI based cardiac arrest risk management software (DeepCARS) and electroceutical device for major depressive disorders (MINDD STIM) have been approved as non-reimbursement use for about 3 years. Two digital therapeutics for insomnia and AI software for diagnosis of cerebral infarction were approved as the first innovative medical devices under new integrated assessment system, and they could be treated in the market. In addition, there is remote patient monitoring (RPM) reimbursement service fee. Continuous glucose monitoring devices have been reimbursed for type 1 diabetes patients by the National Health Insurance Service (NHIS) since January 2019. Homecare RPM service for peritoneal dialysis patients with cloud platform (Sharesource) has been reimbursed since December 2019, and long-term continuous ECG monitoring service fee for wearable ECG monitoring devices (ATpatch, MEMO) became reimbursement since January 2022. Conclusion(s): Although Korean government has been developed guidelines for digital health actively, only few products had been reimbursed. To introduce new technologies for improved patient centric treatment, novel value-based assessment and new pricing guideline of digital health medical devices are quite required.Copyright © 2023

Impact on glycaemic outcomes of transitioning from in-person to virtual FreeStyle Libre onboarding during the Covid-19 pandemic

Background and aims: Onboarding of the FreeStyle Libre, an intermittently scanned continuous glucose monitoring (isCGM) device, was pre-dominantly conducted in-person prior to the Covid-19 pandemic. However, onboarding rapidly become virtual due to enforced social distancing restrictions. This audit aimed to determine if onboarding method impacted on glycaemic outcomes and engagement statistics in people living with diabetes (pwD). Method(s): PwD who started FreeStyle Libre between January 2019 and March 2022, had their mode of onboarding recorded and had >=70% data were identified and included within the audit. Glycaemic indices and engagement statistics (previous 90 day averages) were obtained from LibreView (Abbott, USA) three months after the last person was onboarded, and compared using linear models, adjusting for FreeStyle Libre duration, %active (where appropriate), age and sex. Result(s): From 1007 eligible participants (in-person 44% [n = 445];virtual 56% [n = 562]), FreeStyle Libre usage duration was greater for those onboarded in-person vs. virtually (974[891,1101) vs. 420[280,564] days [p < 0.001]). There were no significant differences in glycaemic or engagement indices between in-person and virtual onboarding methods: average glucose (10[9,11]) vs. 10[9,11])mmol/l), %time very-low (<3.0mmol/l, 0[0,1]) vs. 0[0,1]%), %time low (3.0-3.8mmol/ l, 2[1,4] vs. 2[1,4]), %time in range (3.9-10.0mmol/ l, 54[+/-17] vs. 53[+/-19]%), %time high (10.1-13.9mmol/ l, 27[21,31]) vs. 26[21,31]%), %time very-high (>13.9mmol/l, 14[6,24] vs. 15[7,26]%), %active (96[90,100] vs. 94[87,99]%) or scans/day (11[8,15] vs. 10[7,14]). Conclusion(s): There were no differences in glycaemic outcomes or engagement indices between pwD between onboarding methods. Virtual onboarding using online videos for isCGM is as equally effective as face to face.

Diagnosing gestational diabetes during the Covid-19 pandemic using HbA1c rather than oral glucose tolerance test (OGTT)

The Royal College of Obstetrics and Gynaecology advocated replacing OGTT with HbA1c for gestational diabetes (GDM) screening for women with risk factors during the Covid-19 pandemic. HbA1c >=48mmol/mol/random plasma glucose (RPG) >=11.1mmol/l at booking indicated diabetes, and 41-47mmol/ mol/9-11mmol/ l prediabetes or possible GDM. Testing was repeated at 26 weeks if normal previously, with HbA1c >=39mmol/mol, fasting PG >=5.6mmol/l, or RPG >=9mmol/l diagnostic for GDM. A) At her clinic booking visit at 10 weeks gestation, 36 year-old South Asian female had HbA1c 55mmol/mol/RPG 9.5mmol/l suggesting undiagnosed type 2 diabetes. Initially managed with dietary advice and home blood glucose monitoring, metformin was added when self-monitored glucose above pregnancy targets (fasting and pre-meal <5.3mmol/l or 1 h post meal <7.8mmol/l) but insulin was required later. Metformin and insulin were stopped after delivery at 38 weeks with HbA1c 50mmol/mol three months postpartum, supporting the earlier diagnosis of type 2 diabetes. B) 32 year-old White Caucasian female was screened for GDM on booking at 11 weeks as BMI 38 kg/m2. HbA1c 44mmol/mol and RPG 6.9mmol/l confirmed GDM which was managed by dietary/lifestyle changes with glucose and pregnancy targets achieved until 28 weeks when metformin added. Normal delivery at 40 weeks with HbA1c 40mmol/mol three months postpartum triggered advice on long-term dietary/lifestyle changes and annual HbA1c checks. HbA1c was useful during the pandemic but most centres reverted to OGTT for GDM screening due to a significant fall in diagnoses using HbA1c >=39mmol/mol at 26 weeks. But, HbA1c testing was advantageous at booking to diagnose type 2 diabetes earlier.

Managing diabetes remotely: Evaluation of the uptake and efficacy of the DBm app

Objectives: Insulin optimisation requires review of glucose monitoring;Covid-19 posed challenges to this. We evaluated DBm -a remote monitoring platform utilising a glucometer and smartphone app. Method(s): Evaluation was from January to November 2021. Inclusion criteria was insulin treated diabetes with HbA1c greater than 68mmol/mol. HbA1c, demographics, frequency of CBG uploads and interactions with clinicians were collected. Result(s): 97 patients were offered DBm. 48.5% used the app. There were no statistically significant differences in gender (p = 0.05), age (p = 0.36), type of diabetes (p = 0.13) or deprivation index (p = 0.96) between users and non-users. Patients of white ethnicity were less likely to use the platform (p = 0.01). Amongst users, 70% had a reduction of HbA1c of at least 5mmol/mol over six months, with a mean reduction of 25.6mmol/mol (p = 0.01). There was no difference in age (p = 0.64), gender (p = 0.4), and type of diabetes (p = 0.23) between responders and non-responders. There was also no difference in number of call back requests generated by patients (p = 0.32) or number of CBG uploads (p = 0.899) between responders and non-responders. Conclusion(s): Uptake of the remote monitoring solution was just under 50%, with no evidence of digital exclusion, although the finding that white ethnicity patients were less likely to use the system needs further exploration. Most users had improved glucose control, but there was no association with numbers of tests or call back requests. This study demonstrates that insulin optimisation can effectively be delivered using a remote glucose monitoring system. Future work will explore patient experience and patient satisfaction.

Diabetes in Poland - public health challenges and opportunities

Introduction and objective: Diabetes, with its medical complications and societal consequences, is one the most difficult concerns for modern society. The purpose of this narrative review is to characterize the selected public health challenges and opportunities resulting from diabetes in Poland, as well as to identify public health measures that may be adopted to lower the diabetes burden in Poland. Review methods: This narrative review is based on the literature about diabetes in Poland. Scientific papers on diabetes published between 1 January 2010-31 January 2023, available in the PubMed database, were identified using a combination of the following key words: 'diabetes', 'Poland', 'public knowledge', 'management' and 'costs'. Particular attention was paid to the following diabetes-related issues: (1) current and forecast prevalence of diabetes in Poland, (2) diabetic care before and after the COVID-19 pandemic onset, (3) public knowledge of diabetes and diabetes risk factors, and (4) public health interventions to reduce the diabetes burden at the population level. Abbreviated description of the state of knowledge: A continuous growth of both the incidence and the prevalence of diabetes is predicted. Due to insufficient public awareness of diabetes risk factors and symptoms, and the health-debt caused by COVID-19 pandemic, a further rise in the number of diabetic complications is expected, as well as an increase in public spending on health care and social insurance systems. Summary: Public health interventions targeted at preventing diabetes and its complications should not be confined to reducing complications and improving diabetes care, but also include a wide range of initiatives aimed at addressing the fundamental causes of diabetes. Future study should look at the cost-effectiveness of such initiatives in order to mobilize different stakeholders and society.

Portable blood glucose meter system for self-monitoring of diabetic patients

The appearance of COVID-19 changed the lifestyle of many people as it spread rapidly around the world, causing concern to the entire health system due to the high number of infected and leading to a general confinement, changing the lifestyle and eating habits of many people causing diabetes, which is a disease caused by the high level of glucose in the blood, which can generate serious problems in the health of the person since it has no cure, this progressive disease is controlled or monitored by conventional glucometer equipment that generates pain in patients because they require blood samples to measure glucose, worse for those diabetics who must have the measurement several times a day. In view of this problem, this article will make a portable blood glucose meter system for the self-monitoring of diabetic patients and determine the blood sugar level to visualize it by means of a screen, with this system the measurement will be made without pain and will show the value of the glucose level accurately, Helping diabetic patients who perform monitoring several times a day. Through the development of l system, it was observed that it works in the best way with an efficiency of 96.97% in the measurement of glucose, when comparing with others equipment glucometers obtained a relative error of 2.99%, being an error accepted to approach the real value. © 2023 IEEE.

Digital Imaging System for the Detection of Diabetic Retinopathy

COVID-19 since its appearance caused serious problems to the health sector due to the increase in infected and deceased people by directly affecting their respiratory system, making it a primordial disease that led all countries to fight this virus, generating that other diseases go to the background such as diabetes mellitus, which is a disease caused by the neglect of people's lifestyles, that has been increasing over time and that has no cure but can be prevented by controlling your blood glucose level, this disease causes diabetic retinopathy in people that with the advance of it can cause loss of sight. In addition, to detect its stage the ophthalmologist relies on his experience, occupying a lot of time and being prone to make mistakes about the patient. In view of this problem, in this article a digital image processing system was performed for the detection of diabetic retinopathy and classified according to the characteristics obtained from the features by analyzing the fundus of the eye automatically and determining the stage in which the patient is. Through the development of this system, it was determined that it works in the best way, visualizing an efficiency of 95.78% in the detection of exudates, and an efficiency of 97.14% in the detection of hemorrhages and blood vessels, resulting in a reliable and safe system to detect diabetic retinopathy early in diabetic patients. © 2023 IEEE.

Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community-acquired pneumonia: an Egyptian multicenter prospective study

Non-invasive ventilation (NIV) might be successful if carefully selected in adult patients with cardiac dysfunction presenting with community-acquired pneumonia. The main objective of this study was to identify the early predictors of NIV failure. Adult patients with left ventricle ejection fraction (LV EF) <50% admitted to the intensive care unit (ICU) with community-acquired pneumonia and acute respiratory failure were enrolled in this multicenter prospective study after obtaining informed consents (study registrationID: ISRCTN14641518). Non-invasive ventilation failure was defined as the requirement of intubation after initiation of NIV. All patients were assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores at admission, while their Heart rate Acidosis Consciousness Oxygenation and Respiratory rate (HACOR) and lung ultrasound (LUS) scores in addition to blood lactate were assessed at NIV initiation and 12 and 24 hours later. A total of 177 patients were prospectively enrolled from February 2019 to July 2020. Of them, 53 (29.9%) had failed NIV. The mean age of the study cohort was 64.1+or- 12.6 years, with a male predominance (73.4%) and a mean LV EF of 36.4 +or- 7.8%. Almost 55.9% of the studied patients had diabetes mellitus, 45.8% had chronic systemic hypertension, 73.4% had ischemic heart disease, 20.3% had chronic kidney disease, and 9.6% had liver cirrhosis. No significant differences were observed between the NIV success and NIV failure groups regarding underlying morbidities or inflammatory markers. Patients who failed NIV were significantly older and had higher mean SOFA and APACHE II scores than those with successful NIV. We also found that NIV failure was associated with longer ICU stay (p < 0.001), higher SOFA scores at 48 hours (p < 0.001) and higher mortality (p < 0.001) compared with the NIV success group. In addition, SOFA (Odds Ratio (OR): 4.52, 95% Confidence Interval (CI): 2.59-7.88, p < 0.001), HACOR (OR: 2.01, 95% CI: 0.97-4.18, p = 0.036) and LUS (OR: 1.33, 95% CI: 1.014-1.106, p = 0.027) scores and blood lactate levels (OR: 9.35, 95% CI: 5.32-43.26, p < 0.001) were independent factors for NIV failure. High initial HACOR and SOFA scores, persistent hyperlactatemia and non-decrementing LUS score were associated with early NIV failure in patients with cardiac dysfunction presenting with community-acquired pneumonia, and could be used as clinical and paraclinical variables for early decision making regarding invasive ventilation.

Optimal continuous glucose monitoring metrics for identification of women with gestational diabetes

Aims: Continuous glucose monitoring (CGM) is widely used in pregnant women with pre-gestational diabetes, but optimal targets have not been defined in gestational diabetes. Previous work identified mild hyperglycaemia in pregnant women without gestational diabetes, but with risk factors such as obesity. We aimed to examine CGM metrics and patterns of glycaemia in women with gestational diabetes compared to healthy pregnant women with comparable risk factors. Method(s): We recruited 73 healthy women with >1 risk factor (gestational diabetes excluded using Covid-19 criteria, OGTT) and 200 women with gestational diabetes (NICE and interim-Covid- 19 criteria) from antenatal clinics at 28 weeks' gestation. A Dexcom G6 CGM device was cited on the non-dominant upper arm. Result(s): Women with gestational diabetes had significantly higher weight (mean +/- SEM 95.7 kg +/- 1.3 Vs 85.4 kg +/- 2.2) and BMI (36.0 +/- 0.5 Vs 31.3 +/- 0.7) compared to healthy pregnant women (p < 0.01). Women with gestational diabetes had significantly higher mean CGM-glucose (mean +/- SEM 5.6 +/- 0.01 Vs 5.4 +/- 0.01mmol/l;p < 0.01), significantly altered time-below- range (median(IQR);1.0% (0.2-2.9) vs 2.5% (0.7-5.5);p < 0.05) and time-in- range (95.0% (91.1-97.9) vs 94.5% (87.9-96.2);p < 0.05) but comparable time-above- range to healthy women with risk factors. Diurnal glucose profiles in women with gestational diabetes were comparable to healthy women between 14:00 and 18:00, but demonstrated significant increases in glucose at all other time points during the 24-h cycle (p < 0.01). Conclusion(s): Mean CGM glucose is the most reliable CGM metric to distinguish women with gestational diabetes from healthy pregnant women with risk factors.

Maxillofacial infections in post covid-19 era: A series of 2 cases

Everybody in the world including the health care sector has witnessed the devastating effects of COVID- 19 infection. It is an enigma to say whether COVID -19 has gone for good or not, but has definitely presented as a challenge in itself for dental professionals. Complications have escalated especially at the end of the 2nd wave, probably due to various immunosuppressant drugs that have been used for it's aggressive treatment. These cases highlights osteomyelitis of maxilla and surrounding structures in patients due raised levels of blood sugar and also due to steroidal therapy. Recent reports that have been published, show a rate of approximately 80.76% of such cases in maxilla, out of which 61.53% patients were found to be diabetic before diagnosis. These cases presents post COVID-19 osteomyelitis which is believed to be triggered by highly raised blood sugar levels in a patient who was not a known case of diabetes mellitus.

Association between Type 2 Diabetes Mellitus and Covid-19 Severity: A Literature Review

We conducted a review and evaluated the already documents reports for the relationship among diabetes and COVID-19. The review outcome shows that the COVID-19 severity seems to be greater among patients with diabetes as comorbidity. So, strict glycemic control is imperative in patients infected with COVID-19. Thus, world-wide diabetes burden and COVID-19 pandemic must be deliberated as diabetes increases the COVID-19 severity. Established on this, it is precise significant to follow specific treatment protocols and clinical management in COVID-19 patients affected with diabetes to prevent morbidity and mortality.Copyright © 2023 The Authors.

The intersection of technology, ethnicity, deprivation, and the covid-19 pandemic: Lessons from the National Diabetes Audit

Introduction: The aim was to investigate access to and the effect of intermittency scanned flash glucose monitoring (isCGM) on glycaemic control during the Covid-19 pandemic. Method(s): Data from the National Diabetes Audit from 2019 to 2021 was stratified into those who were already using isCGM on 1st April 2020 (A), those who started isCGM on or after 1st April 2020 (B), and those who did not receive isCGM (C). Logistic regression investigated the independent effects of ethnicity and deprivation on access to isCGM after adjustment for baseline covariates (age, gender, BMI, duration of diabetes, and baseline HbA1c). Ethnicity was categorized as White, Asian, Black, Mixed, and not reported. The Index of Multiple Deprivation (IMD) was divided into quintiles. Result(s): 251,620 people were identified with type 1 diabetes;88,910 (35%) had isCGM prescribed at 1st April 2020. The mean follow-up post-isCGM initiation was six months. Mean HbA1c at baseline was 67.4mmol/mol in (A), 73.6mmol/mol in (B) and 69.7mmol/mol in (C). Mean HbA1c at follow-up was 64.9mmol/mol (A) (p < 0.001), 65.5mmol/mol (p < 0.001) (B). After adjustment for age, sex, duration of diagnosis, baseline HbA1c, and BMI people with White ethnicity (OR = 1.79 p < 0.001) or in the least deprived quintile (OR = 1.54, p < 0.001) were more likely to be initiated on isCGM as compared to the black and most deprived groups. Conclusion(s): Initiating isCGM during the Covid-19 pandemic was associated with improved glycaemic control. Ethnic and socioeconomic disparities in access to isCGM were observed even during the pandemic. Ongoing work is investigating the effect of isCGM on diabetes-related hospital admissions during the pandemic.

Death risk among COVID-19 patients with diabetes mellitus

Deaths from COVID-19 are increasing in patients with comorbidities. One of the most common comorbidities is diabetes mellitus. The researchers wanted to see how having diabetes affected the mortality rate of COVID-19 participants. This investigation is a case control observational analytical study. Different types of people, called "cases", and "controls", complete the research sample. Each group had 68 responders, for a grand total of 136. Medical records from COVID-19 patients treated at Airlangga University Hospital, Surabaya, between March 2020 and September 2021 serve as the study's secondary data source. The purpose of this study's data analysis is to calculate an odds ratio. Patients with COVID-19 with concomitant diabetes mellitus had an increased risk of death, and this risk increased with age, gender, and COVID-19 symptoms. In contrast, education, occupation, and laboratory results were not significantly related to mortality among COVID-19 individuals with concomitant diabetes mellitus (GDA status). The results of this study show that COVID-19 patients with concomitant diabetes mellitus are at a higher risk of death if they are over the age of 65, if they are male, and if they have severe symptoms.

My diabetes My Way: Intelligent delivery of diabetes education and support for self-management

Background: My Diabetes My Way (MDMW) is NHS Scotland's interactive website, offering education, structured eLearning and online records access for people living with diabetes. We aimed to analyse user activity during the last 12 months. Method(s): Data were collected during the period from November 2021 to October 2022. Registration and user audit logs were analysed, observing activity across all website content and features. Result(s): An average of 62,853 pages were accessed on the public website each month. Significant activity increases were observed in December 2021 (n = 81,237). There were increased views in September 2022 (n = 76,502) and October (n = 73,039) The top five pages accessed were;Coronavirus: advice for people living with diabetes (n = 12,478), FreeStyle Libre (n = 4325), Emergency advice (n = 1576), Blood pressure-reducing your risks of complications (n = 1559) and Blood glucose monitoring and HbA1c targets (n = 1485). eLearning: During this period, 382 individuals completed one of 11 QISMET-accredited structured eLearning courses. eLearning course usage increased in relation to patient awareness activity. Social Media: There are currently 3919 Facebook and 3600 Twitter followers. Records Access: 67,655 patients had registered to access their data and 35,157 had actively accessed their records by the end of October 2022. Patient feedback remains highly positive. Conclusion(s): MDMW is a consistent and reliable resource for people with diabetes and their families to access at any time online. User statistics continue to rise, while latest development plans include the addition of new Patient Reported Outcome Measures, risk prediction features, and enhanced sharing of data with the healthcare team.

Association between Covid-19 and Diabetes Mellitus

Aim: To determine the association between Covid-19 and diabetes mellitus. Study Design: Retrospective study. Place and Duration of Study: Department of Medicine & Respiratory Physiology, Independent Medical College Faisalabad from 1st July 2022 to 31st December 2022. Methodology: Fifty five patients received at outdoor patient department of Independent University Hospital with confirmed diagnosis for Covid-19 through naso-pharyngeal reverse transcription polymerase chain reaction (RT-PCR) and aged 13-65 years were included. The complete medical files of each confirmed Covid-19 case was completely studied in relevance to diabetes mellitus association and compared with normal matched controls that only visited the OPD against the suspicion of the disease and underwent complete biochemical profiling. The baseline levels of HbA1C and glucose monitoring in each patient and control was done and compared. Result(s): The mean age of the CoVid-19 cases was 39.5+/-5.3 years while of controls as 25.65+/-4.3 years. There was an obvious significant variance in the odds ratio of Covid-19 patients and those of controls in reference to diabetes mellitus. A significant increase was observed in Odds Ratio of Covid-19 cases within the age group of 51-65 years. The Elixhauser Comorbidity Index (ECI) categories also presented, ECI >5 to be higher in Covid-19 cases than controls. Conclusion(s): There is a higher risk of diabetes new onset in Covid-19 confirmed cases as compared to matched controls.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Type 1 diabetes patient experiences and management practices during the COVID-19 pandemic in rural Uganda.

Background: The COVID-19 pandemic has impacted various aspects of the lives of persons with chronic diseases, including type 1 diabetes (T1D). However, the diabetes care experiences and practices adopted by persons living with T1D after the declaration of the COVID-19 pandemic in Uganda have not been well documented. Objectives: We investigated diabetes management practices and experiences of persons with T1D during the COVID-19 pandemic lockdown in a rural district of southwestern Uganda. Methods: Using interactive sequential explanatory mixed methods, we conducted a cross-sectional study of persons with T1D aged 18-25 years, their caregivers and health workers. Quantitative data was exclusively collected from patients with T1D using Kobo Toolbox™ and analysed with SPSS™ version 26; qualitative interviews were used to elicit responses from purposively selected patients with T1D, plus caregivers and health workers that were analysed using a thematic framework approach. Results: The study enrolled 51 (24 males) patients with T1D; diabetes duration (mean ± SD) 6.6 ± 5 years. Access to insulin syringes significantly worsened in 19.6% of participants (p = 0.03). Insulin injection frequency (p = 0.01), blood glucose monitoring (p = 0.001) and meal frequency (p = 0.0001) significantly decreased. Qualitative interviews highlighted COVID-19 restriction measures had reduced household income, frequency of clinic visits, and access to food, diabetes support and social services. Conclusions: Experiences and practices were consistent with decisions to prioritise survival, even with known risks around metabolic control. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01222-4.

Longitudinal study of the flash glucose monitoring system in type 1 diabetics: An mHealth ally in times of COVID-19.

AIMS AND OBJECTIVES: The aim of this study was to assess the effect of the FreeStyle Libre device implantation in adult type 1 diabetics in a Health Area of Castilla La Mancha (Spain) during the COVID-19 pandemic. BACKGROUND: FreeStyle Libre is a so-called mHealth device that supports health care. During COVID-1 confinement, diabetic patients could have improved their glycaemic monitoring thanks to these devices, although health care in these patients may have been limited due to confinement. METHODS: A 12-month longitudinal study in which a total of 206 type I diabetics participated, belonging to a single health area. Sociodemographic and analytical data and the Self Care Inventory Revised questionnaire (SCI-R) were collected. STROBE checklist was followed. RESULTS: The analysis showed differences related to the use of the sensor. After the study period, patients obtained better levels of basal glucose, glycosylated haemoglobin, creatinine, cholesterol, triglycerides and LDL. In addition, a significant increase in the total score of the SCI-R questionnaire was observed after the use of the monitor (MD -7.77; 95% CI -10.43, -8.29). The same occurred with different SCI-R items such as diet (MD -2.995; 95% CI -3.24, -2.57), glucose determination (MD -3.21; 95% CI -3.52, -2.91), medication administration (MD -2.58; 95% CI -2.53, -1.96) and hypoglycaemic episodes (MD -1.07; 95% CI -1.21, -0.93). In the analysis by groups, worse values of glycosylated haemoglobin and adherence to treatment (p < .05) were observed in overweight/obese subjects versus those with normal weight after one year of study. CONCLUSION: The use of flash monitoring is related to better adherence to most of the recommended habits in diabetes. Nevertheless, there seems to be no relationship with an improvement in physical exercise and preventive aspects of diabetes. A good nursing intervention to support physical exercise and the use of mHealth devices could improve the control of diabetic patients. RELEVANCE TO CLINICAL PRACTICE: The use of this mHealth device has shown positive results and reduced complications. Despite less contact with healthcare facilities due to the pandemic, type 1 diabetic patients have improved their blood results and adherence after using the device for one year. Nursing staff should focus on promoting physical activity and routine disease care in type 1 diabetics.

Hypoglycemia Induced by Zinc Supplementation for COVID-19 Prophylaxis: A Case Series.

There has been significant research and therapeutic activity within the healthcare sector in response to the coronavirus disease 2019 (COVID-19). In the United States, a complementary and alternative medicine (CAM) treatment regimen for improving patients' immune systems against COVID-19 prophylaxis includes excess zinc, vitamin C, and vitamin D supplementation administered over a seven-day period. Despite the fact that zinc and other mineral supplements are becoming increasingly popular in Western culture, clinical research on CAM remains limited. This case series examines three patients treated with a surplus of zinc tablets for COVID-19 prophylaxis who presented with moderate-to-severe hypoglycemia. Varying amounts of glucose were administered to these patients to offset their low blood sugar levels. Medical staff noted a positive Whipple's triad in two of the patients but observed no other abnormalities in the laboratory values. All three patients were instructed to cease zinc tablet intake upon discharge. Our findings raise awareness of the potential dangers associated with mineral supplements and serve as a warning for those seeking CAM treatment options.