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.

The factors associated with increased risk of hospitalisation in people with diabetes following SARS-CoV- 2 infection: A national replication study

Aim: People with type 1 or type 2 diabetes have a higher hospital admission rate following Covid-19 infection. This study aims to determine the degree to which the results of a previous study in Greater Manchester (GM) could be replicated in national-level data for England. Method(s): We focussed on the univariable regression analysis, which shows the association between admission and Covid-19 infection in people with diabetes. Modelling was conducted using logistic regression on data from the Covid-IMPACT database. Odds ratios were compared descriptively with the previous study. Result(s): In people with type 2 diabetes, factors associated with an increased risk of hospitalisation similar to the previous study were: older age, male sex, higher social deprivation, higher body mass index (BMI), higher cholesterol, lower eGFR, taking an ACE-inhibitor/ ARB, not taking metformin, and having asthma or hypertension. Patients with COPD, and those taking aspirin or clopidogrel also had increased risk, but the national data showed a greater risk (GM COPD odds ratio 1.89 [1.63-2.19] vs national 2.34 [2.28-2.40] / aspirin 1.49 [1.34-1.66] vs 1.66 [1.63-1.70] / clopidogrel 1.71 [1.47-1.98] vs 1.99 [1.94-2.04]). Similar results were observed in patients with type 1 diabetes. However, due to the increase in sample size, many factors which were previously not statistically significant have become significant, such as in type 2 diabetes BMI, low HDL-cholesterol. Conclusion(s): We have successfully replicated the methods, results and conclusions of our previous study in relation to factors associated with increased risk of hospital admission in diabetes individuals. Regional databases are suitable for large cohort studies, and in this instance produced similar results to a national database, validating our previous findings.

Telehealth and its impact on the management of type 2 diabetes

The recent Covid-19 pandemic has created many challenges and barriers in healthcare, which includes the treatment and management of patients with type 2 diabetes (Robson & Hosseinzadeh, 2021). The purpose of this Evidence-Based Project (EBP) project is to evaluate the effectiveness of type 2 diabetes management through telehealth and answers the following PICOT question: In patients with diabetes type 2 who have difficulties with medical visit compliance (P), will the telehealth platform (I), compared to patient's previous visit HbA1c (C) improve the Hemoglobin A1c (HbA1c) diagnostic marker (O) over a 12-week period(T)? An extensive literature search of five databases was performed, citation chasing, and a hand search yielded fourteen pieces of evidence ranging from level I to VI (Melnyk & Fineout-Overholt, 2019). The pieces of evidence selected for this project support the evidence that telehealth implementation is as effective as the "usual care" or in-person visits to treat type 2 diabetes. The John Hopkins Nursing Evidence-Based Practice (JHNEBP) model was selected. Patients with a HbA1c of greater than 6.7% have been asked to schedule two six-week telehealth visits. During the live video visit, a review of medications, and diabetes self-management education (DSME) will be conducted. Participants will be provided with education to promote lifestyle modifications. The visits will be conducted through an Electronic Medical Record (EMR) system that is Health Insurance Portability and Accountability Act (HIPAA) compliant. A paired t-Test will be used with the data collected from the pre-and post-HbA1c. Improve the management of type 2 diabetes with the incorporation of telemedicine in primary care. Research supports the need to further expand the use of telehealth in primary care, to improve patient outcomes and decrease co-morbidities related to type 2 diabetes.

Developing an aid for virtual clinics for education and identification of lipohypertrophy during the Covid-19 pandemic: Diabetesclinic@ home

Aims/objectives: To develop an app to support virtual diabetes clinics to help people with diabetes to check themselves for lipos and to discuss what they found during the virtual consultation. Method(s): Collaborative project between clinical teams and medical illustrators in Swansea Bay University Health Board, academics in Swansea University and Eli Lilly under a Collaborative Working Agreement. The teams worked together to develop the content, animations, and a learning technologist developed progressive web app (PWA). The app was tested by diabetes patient groups in Wales, as well as HCP groups, Welsh Academy for Nurses in Diabetes (WAND) and Diabetes Specialist Nurses (DSN) forum prior to launch in June 2021. Result(s): Between 28th June 2021 and 11th November 2022 the app had 827 unique users and 124 returning users. Users came from 15 different countries including UK, Australia, USA, Germany, Brazil and Saudi Arabia. The proportion of UK users were 480 (60%) England, 265 (34%) Wales, and 19 (2%) Scotland. A total of 41 users completed the feedback form;of those 11 (27%) did not know about lipos prior to using the app, 11 (27%) found a lipo using the app, 14 (34%) said they made changes to injection technique after using the app and 37 (90%) said their knowledge of lipos increased following using the app. Conclusion(s): A PWA can help to aid virtual clinics an provide education for people with diabetes. The diabetesclinic@ home app improved knowledge and detection of lipos and improved injection technique.

Trends of the medical status of adult patients with diabetes mellitus in the Samara region for 2018-2020.

According to domestic and foreign studies, diabetes mellitus (DM) is a significant risk factor for infection with the SARS-CoV-2 vi-rus, a severe course of the disease, and an adverse outcome. Trend analysis of epidemiological and clinical characteristics of DM patients living in the Samara region in the initial period of the spread of the new coronavirus infection can help to assess the effectiveness of medical care for DM patients in a challenging epidemiological setting and to determine the directions for its improvement. Objective. To assess the trends in the prevalence, incidence, and mortality of DM patients living in the Samara region and to iden-tify the changes in the structure of vascular complications and the status of glycemic control from 2018 to 2020. Material and methods. The study of the medical and epidemiological DM indicators was performed according to the design of a continuous retrospective observational study covering the period from 2018 to 2020;the object was the adult population of the Samara region. Results. The total number of DM patients in the Samara region in 2020 was 118,623 people (3.73% of the population), of which type 1 diabetes was detected in 5.2% (6118 people) and type 2 diabetes in 94.2% (111,700 people). The trends of the prevalence of type 1 DM were 186.3->192.4/100,000 population, type 2 DM 3132.5->3153.1/100,000 population;the dynamics of primary morbidity with type 1 diabetes mellitus 8.8->6.2/100,000 population, with type 2 DM 259.1->196.4/100,000 population;mortality with type 1 diabetes mellitus 3.2->4.2/100,000 population, with type 2 diabetes mellitus 120.7->174.5/100,000 population. The most common causes of death were cardiovascular diseases: 30.3% in type 1 DM, 39.7% in type 2 DM;there is a trend towards increasing in death <<from DM>> without indicating the immediate cause of death for both types of DM;<<from COVID-19>> 3.8% with type 1 DM and 3.7% with type 2 DM. The incidence of vascular complications in type 1 and type 2 DM was 31.4% and 11.5% for reti-nopathy, and 21.4 and 11.5% for nephropathy, respectively. Trends in the proportion of patients with HbA1c <7%: 28.1%->51.1% in type 1 DM, 15.7%->62.4% in type 2 DM;with HbA1c >=9.0%: 25.4%->12.1% in type 1 DM, 39.8%->7.1% in type 2 DM. Conclusion. The study demonstrates the importance of a comparative sequential assessment of the epidemiological characteristics of diabetes mellitus and the clinical status of patients living in the Samara region in challenging epidemiological settings to assess the prospects for optimizing follow-up.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Complex presentations in people with diabetes: Does HbA1c help or hinder?

HbA1c measurement is widely used for diagnosis/ management/remission of diabetes with international schemes certifying comparability. A) 75 year-old Chinese female with type 2 diabetes was admitted in April 2020 with Covid-19 and diabetic ketoacidosis. Glucose was 35mmol/l and HbA1c 150mmol/mol with previous HbA1c of 45mmol/mol on metformin and alogliptin. She was treated for ketoacidosis and once-daily Lantus introduced along with supportive management of viral illness. B) 68 year-old Afro-Caribbean with type 2 diabetes on metformin before admission, presented with new onset, jerky ballistic movements of high amplitude in right arm, 10-15 movements every 5 min. Admission glucose was >33mmol/l, ketones 1.8mmol/l and HbA1c >217mmol/ mol. Hemichorea-hemiballism, a hyperglycaemia related movement was diagnosed and insulin commenced. Glucose decreased to 8-20mmol/ l, reaching 5-15mmol/ l by time of discharge. Ballistic movements resolved when glycaemic control improved with HbA1c 169mmol/mol, 25 days after discharge. C) Several days before admission, a female with diabetes over 20 years required attention from paramedics on four occasions for hypoglycaemia. Months beforehand metformin was replaced by gliclazide due to chronic kidney disease with HbA1c 50mmol/mol, and she was transfused six weeks before admission for microcytic anaemia. Gliclazide was discontinued and her diet modified which prevented further hypoglycaemic episodes. Variant haemoglobin, beta-thalassaemia which can overestimate glycaemia;undetected by HbA1c HPLC method, invalidated HbA1c as did the blood transfusion. These cases highlight that inadequate understanding of HbA1c can lead to acute presentations of dysglycaemia. As HbA1c accuracy can be affected by multiple factors, clinical assessment and triangulation are key to the management of such patients.

Living with diabetes during Covid-19: A public engagement project bringing together lived experiences of people with type 1 and type 2 diabetes for community reflection

Aims: To bridge the gap between evidence synthesis research into the impact of the pandemic on people with diabetes (PWD) and the reality of lived experience, and give PWD space to share and reflect on their experiences. Method(s): Through a socially-distanced public engagement project, working with artists, clinicians, researchers, and PWD, we created a physical art installation and digital interactive exhibition to capture individual experiences of living through the pandemic with diabetes. PWD could submit art or written work in any form for inclusion. We evaluated public engagement by participant numbers and demographics, visitors to the digital exhibition, and written feedback. Viewers could complete an optional survey sharing thoughts about the project. Result(s): 26 people aged 16-74 years submitted to the project;58% had had type 1 diabetes, 27% had type 2 diabetes. 708 people viewed the digital exhibition (diabetescovid. art) in the first 2 months. Their responses to the exhibition included: brave, overwhelming, scary, resonating with personal experience, community giving voice, thought provoking, moving, emotional, motivating, insightful, interesting, fascinating;all respondents said they had learned from the exhibition. Summary: Our PPI representative summarised her experience of the project: "Health research is not just about the clinical, it is also about recognising, empathising with and learning from the experiences of people as demonstrated in this project. Patient involvement in research is about helping to bring about progress. It is about learning more about one's own health and well-being and also about giving something back. Above all, it is about hope.".

Did virtual consultations during Covid-19 improve diabetes transition clinic attendance compared to face to face clinic attendance

We have an established transition clinic for the patients with diabetes aged 16 to 19. Our Transition clinic covers a vast area including deprived areas such as Ellesmereport. We do have 3 monthly follow up in addition to the home visits by paedatric diabetes specialist nurses. The team involves paediatric consultants, pdsn and dietcician from adult and paedatrics departments. Virtual consultation were the main mode of consultations during covid. We used Accu Rx, Attendanywhere and telephone consultations. We compared the clinic attendance pre and post covid. We compared clinic attendance for 9 months from March 2019 to December 2019 which were pre Covid to March 2020 to December 2020 during Covid. We had 150 appointments in 2019 and 112 appointments in 2020. The DNAs were 21 during covid with virtual consultations and 28 pre Covid with face to face appointments. The DNA rates were 18.6% in 2019 as face to face review and 18.75% during covid as virtual consultations. Surprisingly, the DNA rates did not improve when the clinics were virtual as we expected. In Conclusion, the virtual consultations did not improve the attendance in this vulnerable age group. Due to vulnerability of this age group, we felt that the face to face consultations were more appropriate. All of our appointments for the diabetes transition clinics are face to face in person due to above findings.

Hospital-acquired Covid-19 infection in those with diabetes in Scotland

Aims: We wish to evaluate what proportion of hospitalised Covid-19 among those with diabetes was acquired during hospital admission. Method(s): Using the Scottish Care Information -Diabetes patient record, we linked RT-PCR test results through a study window from 01/01/2020 to 08/08/2021 to hospital discharge data. We defined nosocomial Covid-19 infection as having a first positive RT-PCR test in a window from 5 days post-admission to the admission end date. Result(s): From 127,477 people with at least one hospital admission in the study window, there were 4070 (3.2%) who tested positive with an RT-PCR test. Of those who tested positive, 1674 (41%) met the nosocomial infection definition. We found that nosocomial infection was more likely in females (OR 1.28, 95% CI 1.14, 1.47 p < 0.01). The risk also increased with each year of age (OR 1.03, 95% CI 1.02, 1.03 p < 0.01), with those over 60 being twice as likely to acquire Covid-19 in hospital than their younger counterparts. We found that diabetes type was not significantly related to hospital-acquired infection (OR 0.99, 95% CI 0.76, 1.29 p = 0.95). Conclusion(s): These results show that almost half of all hospitalisations with Covid-19 in those with diabetes were hospital-acquired. This emphasises the importance of nosocomial infection and its prevention in the impact of the pandemic on the population with diabetes.

ID: 215433 The History of Spinal Cord Stimulation to Treat Painful Diabetic Peripheral Neuropathy

Introduction: Diabetic peripheral neuropathy (DPN) is the most common neuropathic syndrome seen in patients with diabetes. Roughly 30% of the diabetes patient population1 experience painful DPN symptoms including bilateral stabbing or burning pain in addition to numbness in the feet and lower legs. Traditionally painful DPN symptoms have been treated with conventional medical management (CMM) including glycemic control, general risk factor management, as well as pharmaceutical agents. These treatment approaches are often unsuccessful in the long-term1. Spinal cord stimulation (SCS) has been demonstrated as an effective treatment for painful DPN of the lower extremities with multiple publications dating back to 1996 showing benefits of SCS for pain relief and improved Quality of Life (QoL) in DPN patients (Figure 1)2-18. Method(s): A systematic literature review of the robust body of evidence for SCS in the treatment of painful DPN was conducted. Publications were selected for inclusion by two independent reviewers using defined selection criteria. Additional relevant publications from outside the search dates were included. Result(s): SCS was first documented as an effective treatment for DPN in three single-arm studies published between 1996 and 20122,4,5, one of which was followed-up to thirty-six months18, and another to seven-years3. These studies paved the way for two RCTs published in 20146,7, one of which was followed-up to five-years in two publications8,10, and another7 was followed-up with analyses on QoL9 and an evaluation of the effects of burst SCS17. Two meta-analyses were published in 2020 and 202111,12. A post-hoc analysis of a multi-center single-arm study on high frequency (10kHz) SCS to treat DPN was published in 202013 and followed by an RCT published in 202114 with additional 1-year follow-up15,16. Collectively these studies demonstrate that SCS is an effective therapy for patients with painful DPN by reducing pain and increasing QoL for DPN patients (Figure 1). Conclusion(s): This review of a large body of evidence shows a decades-long history of the effectiveness of SCS for symptom relief in patients suffering from painful DPN. Future research on the effectiveness of new waveforms and novel methods of energy delivery to the spinal cord are needed. The study of outcomes in addition to pain relief is also needed, which may better illustrate the breadth of effects of SCS therapy on the underlying disease factors. Increasing awareness of the current evidence is essential to increasing therapy adoption by expanding payer support and influencing referring health care provider behavior. Disclosure: Eric Grigsby, MD: AE Mann Foundation: Consulting Fee: Self, Bioness Inc.: Consulting Fee: Self, Medallion Therapeutics: Consulting Fee: Self, Medtronic: Consulting Fee: Self, SPR Therapeutics: Consultant: Self, Tenex Health: Consultant: Self, Voyager Therapeutics: Consultant: Self, Xalud: Consulting Fee: Self, AE Mann Foundation: Consulting Fee: Self, Medallion Therapeutics: Consulting Fee: Self, Bioness Inc.: N/A: Self, Medallion Therapeutics: N/A: Self, SPR Therapeutics: N/A: Self, Abbott / St. Jude Medical: N/A: Self, Tenex: N/A: Self, Vertos: N/A: Self, Xalud: N/A: Self, AE Mann Foundation: Consulting Fee: Self, Bioness Inc.: Consulting Fee: Self, Medtronic, Inc.: N/A: Self, Collegium Pharmaceutical, Inc.: Trustee: Self, Flowonix Medical: Served on speakers' bureau: Self, Jazz Pharmaceuticals: Served on speakers' bureau: Self, Jazz Pharmaceuticals: Trustee: Self, Spinal Restoration, Inc.: Trustee: Self, Jazz Pharmaceuticals: N/A: Self, Alfred Mann Foundation: N/A: Self, Boston Scientific: N/A: Self, CNS Therapeutics: N/A: Self, Collegium Pharmaceutical, Inc.: N/A: Self, Flowonix Medical: N/A: Self, Jazz Pharmaceuticals: N/A: Self, Medtronic, Inc.: N/A: Self, Myoscience: N/A: Self, NeurAxon Inc.: N/A: Self, Spinal Restoration, Inc.: N/A: Self, St. Jude Medical, Inc.: N/A: Self, Abbott Laboratories: Consultant: Self, Alfred Mann Foundation: Consulting Fee: Self, Cervel Neurotech, Inc.: Consultant: Self, CNS Therapeutics: Consultant: Self, Covidien: Consultant: Self, Cumberland Pharmaceuticals, Inc.: Consultant: Self, Flowonix Medical: Consultant: Self, Jazz Pharmaceuticals: Consultant: Self, Mainstay Medical: Consultant: Self, Medtronic, Inc.: Consultant: Self, Myoscience: Consultant: Self, NeuroPhage Pharmaceuticals: Consultant: Self, Nevro Corp: Consultant: Self, Palyon: Consultant: Self, Spinal Modulation: Consultant: Self, SPR Therapeutics: Consultant: Self, St. Jude Medical, Inc.: Consultant: Self, Tenex Health, Inc.: Consultant: Self, VertiFlex Inc.: Consultant: Self, Vertos Medical, Inc.: Consultant: Self, Xalud Therapeutics, Inc.: Contracted Research: Self, Medtronic, Inc.: Served on speakers' bureau: Self, Flowonix Medical: Served on advisory board: Self, Medtronic, Inc.: N/A: Self, Jazz Pharmaceuticals: N/A: Self, Medtronic, Inc.: Ownership Interest: Own Stock, Stock Options, Future Stock Options: Self, Nevro Corp: Ownership Interest: Own Stock, Stock Options, Future Stock Options: Self, Rachel Slangen, PhD: None, Lisa Johanek, PhD: Medtronic: Salary/Employee: Self, Maddie LaRue, PHD: Medtronic: Employee:, Cecile de Vos, PhD: None, Melissa Murphy: Medtronic: Consulting Fee:, Relievant: Consulting Fee:Copyright © 2023

Physical effects of Covid-19 in patients with diabetes 1 year after hospitalisation in the UK: PHOSP-Covid study

Aim: To investigate the impact of Covid-19 on daily activity, maximal physical performance, and clinical frailty of people living with diabetes (any type) 1-year post-hospitalisation for Covid-19 in the UK. Method(s): This study is part of PHOSP-Covid, a multicentre long-term cohort study that recruited adults (>=18 years) who were discharged from one of the 83 NHS hospitals across the four UK nations following a clinical diagnosis of Covid-19 before March 31, 2021. We compared The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Incremental shuttle walk test (ISWT) distance (m), and clinical frailty (Rockwood frailty level), 5-month and 1-year after discharge in patients with and without diabetes. Result(s): Out of 2545 individuals (538 (21%) with diabetes), the proportion of individuals who classified as either 'mildly frail' or 'moderately or higher frail severity' was higher in individuals with diabetes (month 5: diabetes 9.9%, no diabetes 4.7%;month 12: diabetes 8%, no diabetes 4.9%). ISWT distance in patients with diabetes were significantly lower at both follow-ups but this measure improved from 5-months to 1-year (290 [95% CI: 190-440] vs 370 [250-560] for diabetes and 340 [210-450] vs 420 [270-590] for those without, both p < 0.01). At both time points, people with diabetes reported higher levels of fatigue (36 [24-44] vs 39 [25-46] at 5-month (p = 0.03);37 [26-45] vs 40 [28-47] at 1-year visit (p < 0.01)). Conclusion(s): One year after hospitalisation long Covid is more observed in people with diabetes.

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.

Assessment of the Relationship between COVID-19 infection and Glucose Levels in Related to ABO Group Among Diabetes Patients in Iraq

COV-19 has been quickly spreading in the world, producing lung inflammation and abrupt, even deadly, pulmonary collapse, COV-19were much higher in diabetic patients than in non-diabetic pa-tients. Diabetes is one of the primary causes of illness and death, and its prevalence is projected to increase rapidly over the next several decades. This investigation sought to determine how COVID-19 influenced the levels of glucose in the blood of patients diagnosed with type 1 and type 2 diabetes (DM), as well as whether or not the levels of glucose returned to normal following a recovery period of one month. Addi-tionally, there was a connection between ABO blood type and the severity of COV-19. The current study was to how COV-19 affected ABO group distribution and blood glucose levels in people who suffer from type 1 and 2 diabetes (DM). Study design: This study included ninety (90) patient divided into three groups: diabetes patient group (30) sample (control), 30 sample of DM with COV-19group and 30 sample recovery from Covid 19 after period one month of recovery, determination of the above mentioned blood groups was performed using manual method, and glucose levels measured of DM by diabetes device. The study demonstrated a relation between blood type ABO and COV-19, with type B blood being the most influenced by COV-19 in patients with type 2 diabetes, whereas there were no significant variations between blood types in those who suffer from type 1 diabetes. In type 1, 2 diabetic patients, no significant differences in blood glucose levels were found between diabetic patients with COV-19 and the recovery group from COV-19. The study displayed that the severity of COV-19 disease associated with B blood type in patients who suffer from type 2 diabetes and Cov-19 has no direct impact on blood glucose levels.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.

COVID-19 among Hospitalized Patients with Diabetes in Karachi: A Single Centre Study

Aim: To evaluate the clinical characteristics, severity, and outcomes of local COVID-19 patients with diabetes. Study Design: Case series Place and duration of study: Orthopedic Medical Institute Hospital, Karachi from 1st September 2020 to 28th February 2021. Method(s): One hundred and forty seven COVID-19 positive patients with diabetes and pre-diabetes were enrolled. The patients' demographic and clinical information specific to COVID-19 and diabetes was collected and analyzed. Result(s): The mean age of 64.03+/-11.56 years. The ischemic heart disease (39.9%) and hypertension (74.3%) were the two most prevalent comorbid conditions. The overall mortality rate of 20.3%. Between patients with diabetes receiving steroids and those receiving no steroids, the mean fasting (FBG) and random blood glucose (RBG) were relatively elevated. Glycemic control had no discernible impact on the severity, results, or length of the COVID-19 hospital stay (p>0.05). Conclusion(s): No significant effect of diabetes millitus control on COVID severity and outcomes, but the altered blood glucose levels suggest a need to define specific targeted intervention for COVID-19 patients with comorbidities, specifically diabetes mellitus.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Characteristics of Type 2 Diabetes Patients That Used Virtual Care Since COVID-19 Pandemic: Evidence from a Large Commercial Healthcare Claims Database in the US

Objectives: The use of virtual care has accelerated since the emergence of COVID-19 pandemic. This study aims to analyze the differences in patient characteristics between new and existing type 2 diabetes mellitus (T2DM) patients that utilized virtual care. Method(s): Adult patients (age318 years) with T2DM who had a virtual care (phone or video) visit between April 1, 2020 and March 31, 2022 from the OptumLabs Data Warehouse were identified. The date of the first virtual visit was defined as the index date. Patients were required to be continuously insured at least 1 year prior to their index date (baseline) and at least 90 days of follow-up coverage. T2DM patients were categorized as newly diagnosed and as existing T2DM patients based on whether a diabetes diagnosis was observed in the baseline or not. Result(s): A total of 1,864,203 unique T2DM patients were eligible, with18.5% identified as newly diagnosed and 81.5% as existing T2DM patients. On average, newly diagnosed T2DM patients were younger than existing T2DM patients. Majority (54.5%) of newly diagnosed T2DM patients were commercially insured compared to only 38.6% existing T2DM patients. Among the existing T2DM patients, 61.2% were White, 17.9% Non-Hispanic Black, 12.7% Hispanic and 8.2% others. Of this population, 12.7 % had a household income >= $125,000, 13.3% had at least a Bachelor's degree, and 80.3% reside in a metropolitan area. For the newly diagnosed T2DM cohort, 59.7% were White, 15.3% Non-Hispanic Black, 13.4% Hispanic, and 11.6% others. More of the newly diagnosed T2DM cohort had higher household income, higher education, and resided in a metropolitan area compared to patients with existing T2DM. Conclusion(s): T2DM patients that used virtual care were heterogenous in terms of their baseline characteristics. This underscores the emerging trend that virtual care can potentially play a complementary role in managing patients with diabetes.Copyright © 2023

Comparison of HbA1c measurement in remotely prepared capillary versus standard venous blood samples

Background The COVID-19 pandemic has disrupted routine HbA1c testing. This has led to difficulties in monitoring glycaemic control and identifying people with suboptimal glycaemia. Delayed diagnosis of diabetes and suboptimal glycaemic control over extended periods can increase the risk of developing long-term complications of diabetes. The self-collection of capillary blood remotely (at home) for routine HbA1c testing can facilitate monitoring of glycaemic control whilst supporting virtual consultations. The aimof this study was to assess the clinical performance and user acceptance of capillary blood samples prepared remotely using the MiniCollect capillary blood collection device as an alternative to standard venous blood collection for HbA1c analysis. Methods Adult men and women with any type of diabetes were recruited. Following informed written consent, eligible participants provided a venous blood sample at their routine clinic appointment and subsequently prepared a capillary blood sample remotely. Participants also completed a bespoke usability questionnaire. Results Of 84 participants recruited, 62 capillary samples returned to the laboratory, with 41 having a paired venous sample for HbA1c analysis. HbA1c results using both collection methods demonstrated good agreement;Passing-Bablok Regression analysis, y=0 + 1x;R=0.986, Bland-Altman Difference Plot providing a mean difference of 0.3 mmol/mol. Conclusions Over half of participants found the MiniCollect device easy to use. The majority were in favour of the remote capillary blood collection service and would use it if routinely available. The remote self-collection of capillary blood for HbA1c is a convenient alternative for people with diabetes living and working in rural or urban settings ensuring optimal continuance of care.

The Survival Probability of Covid-19 Patients with Type 2 Diabetes Mellitus during Pandemic at Al Ihsan Hospital, West Java Province, Indonesia

BACKGROUND: The high prevalence of diabetes mellitus (DM) in the population causes DM to become one of the most common comorbidities of coronavirus disease 2019 (COVID-19). Patients with diabetes have a higher risk of experiencing serious complications from COVID-19 and even death. AIM: This study was aimed to determine the difference in survival probability of COVID-19 patients, based on their DM status and to determine the association between type 2 DM and COVID-19 mortality at Al Ihsan Hospital, West Java Province, Indonesia. METHOD(S): The population of this retrospective cohort study were COVID-19 patients, aged >=18 years and were treated at Al Ihsan Hospital, from March 2020 to December 31, 2021. Differences in survival probability were obtained from survival analysis with Kaplan-Meier. Cox Proportional Hazard regression was used to determine the association between type 2 DM and COVID-19 mortality. RESULT(S): Totally, 308 confirmed positive COVID-19 patients were recruited in this study. During the 21 days of observation, survival probability of COVID-19 patients with type 2 DM was significantly lower than those without type 2 DM (71.24% vs. 84.13% respectively, with p = 0.0056). There was a statistically significant association between type 2 DM and COVID-19 mortality after controlling for age, cough symptoms, acute respiratory distress syndrome, vaccination, chronic kidney disease, ventilator use, antiviral therapy, and the percentage of bed occupation rate COVID-19 isolation at admission. The adjusted hazard ratio showing association between type 2 DM and COVID-19 mortality in the final model of multivariate analysis was 2.68 (95% CI 1.24-5.73). CONCLUSION(S): The survival probability of COVID-19 patients with type 2 DM was significantly lower than those without type 2 DM. COVID-19 patients with DM in Al Ihsan Hospital were almost 3 times more likely to be fatal as compared COVID-19 patients without DM.Copyright © 2023 Oka Septiriani, Mondastri Korib Sudaryo, Syahrizal Syarif, Citra Citra.

Glycemic Control Improvement amongst Patients with Diabetes Mellitus during a COVID-19 Lockdown in Jordan

Aims: The purpose of this study is to evaluate the effects of lockdown measures by the Jordanian government to contain the spread of the novel corona virus (COVID-19) on glycemic control of patients with diabetes mellitus. Method(s): This cross-sectional study was conducted in Jordan University Hospital. A total of 264 patients with type 2 or type 1 diabetes mellitus were sampled. The authors evaluated the extent of glycemic control reached by patients with type 2 or type 1 diabetes mellitus by measuring change in glycosylated hemoglobin (A1C) values, in addition to the number of hypoglycemic episodes experienced by patients during lockdown. The authors conducted a questionnaire via telephone interviews to record information about drug adherence and availability, diet, physical activity, and telephone consultations. A paired sample t-test was used to compare values before and after lockdown. Result(s): A significant reduction in HbA1C values was found during lockdown (p=0.038), with only 33.6% of patients experiencing one or more hypoglycemic episodes;both factors suggest controlled blood glucose levels. Medication adherence was found to be the main reason for improvement, with 74.8% of our population being strongly adherent to their medications. Conclusion(s): In Jordanian patients with diabetes mellitus, glycemic control was significantly improved during COVID-19 lockdown and this was found to be associated with strong medication adherence.Copyright © 2023 University of Jordan,Deanship of Scientific Research. All rights reserved.