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1.
Lancet ; 398(10313): 1837-1850, 2021 11 13.
Article in English | MEDLINE | ID: covidwho-1510434

ABSTRACT

Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.


Subject(s)
Developing Countries , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/pathology , Diabetes Mellitus, Type 1/therapy , Global Burden of Disease/trends , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Adolescent , Child , Child, Preschool , Disease Management , History, 20th Century , History, 21st Century , Humans , Hypoglycemic Agents/economics , Hypoglycemic Agents/history , Insulin/economics , Insulin/history , Life Expectancy , Universal Health Insurance
2.
J Clin Invest ; 131(11)2021 06 01.
Article in English | MEDLINE | ID: covidwho-1448082

ABSTRACT

First administered to a human subject as a tuberculosis (TB) vaccine on July 18, 1921, Bacillus Calmette-Guérin (BCG) has a long history of use for the prevention of TB and later the immunotherapy of bladder cancer. For TB prevention, BCG is given to infants born globally across over 180 countries and has been in use since the late 1920s. With about 352 million BCG doses procured annually and tens of billions of doses having been administered over the past century, it is estimated to be the most widely used vaccine in human history. While its roles for TB prevention and bladder cancer immunotherapy are widely appreciated, over the past century, BCG has been also studied for nontraditional purposes, which include (a) prevention of viral infections and nontuberculous mycobacterial infections, (b) cancer immunotherapy aside from bladder cancer, and (c) immunologic diseases, including multiple sclerosis, type 1 diabetes, and atopic diseases. The basis for these heterologous effects lies in the ability of BCG to alter immunologic set points via heterologous T cell immunity, as well as epigenetic and metabolomic changes in innate immune cells, a process called "trained immunity." In this Review, we provide an overview of what is known regarding the trained immunity mechanism of heterologous protection, and we describe the current knowledge base for these nontraditional uses of BCG.


Subject(s)
Diabetes Mellitus, Type 1/therapy , Immunity, Cellular , Multiple Sclerosis/therapy , Mycobacterium bovis/immunology , T-Lymphocytes/immunology , Urinary Bladder Neoplasms/therapy , Virus Diseases/therapy , Animals , Diabetes Mellitus, Type 1/history , Diabetes Mellitus, Type 1/immunology , Diabetes Mellitus, Type 1/pathology , History, 20th Century , History, 21st Century , Humans , Multiple Sclerosis/history , Multiple Sclerosis/immunology , Multiple Sclerosis/pathology , Mycobacterium Infections, Nontuberculous/history , Mycobacterium Infections, Nontuberculous/immunology , Mycobacterium Infections, Nontuberculous/pathology , Mycobacterium Infections, Nontuberculous/prevention & control , Tuberculosis/history , Tuberculosis/immunology , Tuberculosis/prevention & control , Urinary Bladder Neoplasms/history , Urinary Bladder Neoplasms/immunology , Urinary Bladder Neoplasms/pathology , Virus Diseases/history , Virus Diseases/immunology , Virus Diseases/pathology
3.
Pediatr Clin North Am ; 68(5): 1093-1101, 2021 10.
Article in English | MEDLINE | ID: covidwho-1428327

ABSTRACT

This article summarizes clinical observations and management strategies in pediatric type 1 diabetes (T1D) during the coronavirus disease 2019 (COVID-19) pandemic. Despite initial fears that children with diabetes would, similar to adults with diabetes, be at risk for severe COVID-19, most pediatric patients with a history of T1D who developed COVID-19 had mild disease or were asymptomatic similar to their peers without diabetes. The article also summarizes the use of telemedicine to provide ongoing care for pediatric patients with T1D during the COVID-19 pandemic. Finally, the article highlights important lessons learned about management of pediatric diabetes during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , Telemedicine/methods , Child , Comorbidity , Humans
4.
Diabetes Technol Ther ; 23(9): 642-651, 2021 09.
Article in English | MEDLINE | ID: covidwho-1387686

ABSTRACT

Background: We describe the utilization of telemedicine visits (video or telephone) across the type 1 diabetes (T1D) Exchange Quality Improvement Collaborative (T1DX-QI) during the COVID-19 pandemic. Metrics, site-level survey results, and examples of interventions conducted to support telemedicine in T1D are shown. Materials and Methods: Thirteen clinics (11 pediatric, 2 adult) provided monthly telemedicine metrics between December 2019 and August 2020 and 21 clinics completed a survey about their telemedicine practices. Results: The proportion of telemedicine visits in T1DX-QI before the pandemic was <1%, rising to an average of 95.2% in April 2020 (range 52.3%-99.5%). Three sites initially used mostly telephone visits before converting to video visits. By August 2020, the proportion of telemedicine visits decreased to an average of 45% across T1DX-QI (range 10%-86.6%). The majority of clinics (62%) performed both video and telephone visits; Zoom was the most popular video platform used. Over 95% of clinics reported using CareLink™, Clarity®, Glooko™, and/or t:connect® to view device data, with only one center reporting automated data upload into the electronic medical record. The majority of centers had multidisciplinary teams participating in the video visits. All sites reported reimbursement for video visits, and 95% of sites reported coverage for telephone visits early on in the pandemic. Conclusions: There was rapid adoption of telemedicine in T1DX-QI during the COVID-19 pandemic. Future insurance reimbursement for telemedicine visits and the ideal ratio of telemedicine to in-person visits in T1D care remain to be determined.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Telemedicine , Adult , Child , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Humans , Pandemics
5.
Front Endocrinol (Lausanne) ; 12: 703905, 2021.
Article in English | MEDLINE | ID: covidwho-1376692

ABSTRACT

Importance: There is no consensus on the impact of the 2020 COVID-19 pandemic lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) in the US. Aim: To determine the impact of the pandemic lockdown of March 15th through July 6th, 2020 on glycemic control after controlling for confounders. Subjects and Methods: An observational study of 110 subjects of mean age 14.8 ± 4.9 years(y), [male 15.4 ± 4.0y, (n=57); female 14.1 ± 3.8y, (n=53), p=0.07] with T1D of 6.31 ± 4.3y (95% CI 1.0-19.7y). Data were collected at 1-4 months before the lockdown and 1-4 months following the lifting of the lockdown at their first post-lockdown clinic visit. Results: There was no significant change in A1c between the pre- and post-pandemic lockdown periods, 0.18 ± 1.2%, (95% CI -0.05 to 0.41), p=0.13. There were equally no significant differences in A1c between the male and female subjects, -0.16 ± 1.2 vs -0.19 ± 1.2%, p=0.8; insulin pump users and non-pump users, -0.25 ± 1.0 vs -0.12 ± 1.4%, p=0.5; and pubertal vs prepubertal subjects, 0.18 ± 1.3 vs -0.11 ± 0.3%, p=0.6. The significant predictors of decrease in A1c were pre-lockdown A1c (p<0.0001) and the use of CGM (p=0.019). The CGM users had significant reductions in point-of-care A1c (0.4 ± 0.6%, p=0.0012), the CGM-estimated A1c (p=0.0076), mean glucose concentration (p=0.022), a significant increase in sensor usage (p=0.012), with no change in total daily dose of insulin (TDDI). The non-CGM users had significantly increased TDDI (p<0.0001) but no change in HbA1c, 0.06 ± 1.8%, p=0.86. Conclusions: There was no change in glycemic control during the pandemic lockdown of 2020 in US children.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/blood , Glycemic Control , Quarantine , Adolescent , Age Factors , Blood Glucose/metabolism , Blood Glucose Self-Monitoring/instrumentation , Blood Glucose Self-Monitoring/methods , COVID-19/prevention & control , Child , Communicable Disease Control/organization & administration , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Female , Glycated Hemoglobin A/metabolism , Glycemic Control/instrumentation , Glycemic Control/methods , History, 21st Century , Humans , Insulin/administration & dosage , Insulin Infusion Systems , Male , Pandemics , Quarantine/organization & administration , Retrospective Studies , United States/epidemiology
6.
BMJ Open Diabetes Res Care ; 9(1)2021 08.
Article in English | MEDLINE | ID: covidwho-1360558

ABSTRACT

INTRODUCTION: Achieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type 1 diabetes are impacted by hypoglycemia in areas of life that are important to their overall QoL. RESEARCH DESIGN AND METHODS: Participants responded to a web-based qualitative survey involving a novel 'Wheel of Life' activity. Responses were analyzed using reflexive thematic analysis. RESULTS: The final sample included 219 adults with type 1 diabetes from Denmark, Germany, the Netherlands, and the UK. They had a mean±SD age of 39±13 years and diabetes duration of 20±14 years. Participants identified eight areas of life important to their overall QoL, including relationships and social life, work and studies, leisure and physical activity, everyday life, sleep, sex life, physical health, and mental health. Participants reported emotional, behavioral, cognitive, and social impacts of hypoglycemia within domains. Across domains, participants described interruptions, limited participation in activities, exhaustion, fear of hypoglycemia, compensatory strategies to prevent hypoglycemia, and reduced spontaneity. CONCLUSIONS: The findings emphasize the profound impact of hypoglycemia on QoL and diabetes self-care behaviors. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask individuals how hypoglycemia affects important areas of their lives to better understand the personal impact and develop tailored management plans.


Subject(s)
Diabetes Mellitus, Type 1 , Hypoglycemia , Adult , Blood Glucose , Diabetes Mellitus, Type 1/therapy , Humans , Hypoglycemia/epidemiology , Middle Aged , Quality of Life , Surveys and Questionnaires
7.
Nutr Metab Cardiovasc Dis ; 31(9): 2605-2611, 2021 08 26.
Article in English | MEDLINE | ID: covidwho-1343328

ABSTRACT

BACKGROUND AND AIMS: To analyze lifestyle habits and weight evolution during the COVID-19 pandemic-associated lockdown, in diabetes and overweight/obesity patients (body mass index (BMI) [25-29.9] and ≥30 kg/m2, respectively). METHODS AND RESULTS: We collected information on participants' characteristics and behavior regarding lifestyle before and during the lockdown, through the CoviDIAB web application, which is available freely for people with diabetes in France. We stratified the cohort according to BMI (≥25 kg/m2vs < 25 kg/m2) and examined the determinants of weight loss (WL), WL > 1 kg vs no-WL) in participants with a BMI ≥25 kg/m2, in both univariate and multivariate analyses. Of the 5280 participants (mean age, 52.5 years; men, 49%; diabetes, 100% by design), 69.5% were overweight or obese (mean BMI, 28.6 kg/m2 (6.1)). During the lockdown, patients often quit or decreased smoking; overweight/obese participants increased alcohol consumption less frequently as compared with normal BMI patients. In addition, overweight/obese patients were more likely to improve other healthy behaviors on a larger scale than patients with normal BMI: increased intake of fruits and vegetables, reduction of snacks intake, and reduction of total dietary intake. WL was observed in 18.9% of people with a BMI ≥25 kg/m2, whereas 28.6% of them gained weight. Lifestyle favorable changes characterized patients with WL. CONCLUSIONS: A significant proportion of overweight/obese patients with diabetes seized the opportunity of lockdown to improve their lifestyle and to lose weight. Identifying those people may help clinicians to personalize practical advice in the case of a recurrent lockdown.


Subject(s)
COVID-19/prevention & control , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/therapy , Healthy Lifestyle , Obesity/therapy , Risk Reduction Behavior , Weight Loss , Adult , Aged , Body Mass Index , COVID-19/epidemiology , COVID-19/transmission , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diet, Healthy , Exercise , Female , France/epidemiology , Habits , Health Behavior , Health Knowledge, Attitudes, Practice , Health Surveys , Humans , Male , Middle Aged , Nutritive Value , Obesity/diagnosis , Obesity/epidemiology , Prevalence , Risk Assessment , Risk Factors , Smoking Cessation , Time Factors , Weight Gain
8.
BMJ Open Diabetes Res Care ; 9(1)2021 07.
Article in English | MEDLINE | ID: covidwho-1304224

ABSTRACT

INTRODUCTION: Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs' abilities to manage patients with T1D. RESEARCH DESIGN AND METHODS: Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences. RESULTS: In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01). CONCLUSIONS: The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.


Subject(s)
Diabetes Mellitus, Type 1 , Community Health Services , Diabetes Mellitus, Type 1/therapy , Health Personnel , Humans , Primary Health Care , Surveys and Questionnaires
12.
Diabetologia ; 64(8): 1717-1724, 2021 08.
Article in English | MEDLINE | ID: covidwho-1219907

ABSTRACT

AIMS/HYPOTHESIS: The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. METHODS: A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. RESULTS: Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55-74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. CONCLUSIONS/INTERPRETATION: In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. IN PEOPLE WITH TYPE 1 DIABETES AND COVID-19 ADMITTED TO HOSPITAL IN THE UK, BMI AND ONE OR MORE MICROVASCULAR COMPLICATIONS HAD A POSITIVE ASSOCIATION AND LOW SERUM CREATINE LEVELS HAD A NEGATIVE ASSOCIATION WITH DEATH/ADMISSION TO INTENSIVE CARE UNIT AFTER ADJUSTING FOR AGE.


Subject(s)
COVID-19/epidemiology , COVID-19/pathology , Diabetes Mellitus, Type 1/epidemiology , Patient Admission/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/therapy , Female , Hospitals/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index , United Kingdom/epidemiology
13.
Front Immunol ; 12: 653974, 2021.
Article in English | MEDLINE | ID: covidwho-1202332

ABSTRACT

This study discusses substantive advances in T cell proliferation analysis, with the aim to provoke a re-evaluation of the generally-held view that Ki-67 is a reliable proliferation marker per se, and to offer a more sensitive and effective method for T cell cycle analysis, with informative examples in mouse and human settings. We summarize recent experimental work from our labs showing that, by Ki-67/DNA dual staining and refined flow cytometric methods, we were able to identify T cells in the S-G2/M phases of the cell-cycle in the peripheral blood (collectively termed "T Double S" for T cells in S-phase in Sanguine: in short "TDS" cells). Without our refinement, such cells may be excluded from conventional lymphocyte analyses. Specifically, we analyzed clonal expansion of antigen-specific CD8 T cells in vaccinated mice, and demonstrated the potential of TDS cells to reflect immune dynamics in human blood samples from healthy donors, and patients with type 1 diabetes, infectious mononucleosis, and COVID-19. The Ki-67/DNA dual staining, or TDS assay, provides a reliable approach by which human peripheral blood can be used to reflect the dynamics of human lymphocytes, rather than providing mere steady-state phenotypic snapshots. The method does not require highly sophisticated "-omics" capabilities, so it should be widely-applicable to health care in diverse settings. Furthermore, our results argue that the TDS assay can provide a window on immune dynamics in extra-lymphoid tissues, a long-sought potential of peripheral blood monitoring, for example in relation to organ-specific autoimmune diseases and infections, and cancer immunotherapy.


Subject(s)
CD8-Positive T-Lymphocytes/immunology , COVID-19/immunology , Cell Cycle/immunology , Diabetes Mellitus, Type 1/immunology , Ki-67 Antigen/immunology , Neoplasms/immunology , SARS-CoV-2/immunology , Animals , CD8-Positive T-Lymphocytes/pathology , COVID-19/pathology , COVID-19/prevention & control , COVID-19 Vaccines/immunology , COVID-19 Vaccines/therapeutic use , Diabetes Mellitus, Type 1/pathology , Diabetes Mellitus, Type 1/therapy , Humans , Mice , Neoplasms/pathology , Neoplasms/therapy
15.
Front Endocrinol (Lausanne) ; 12: 669302, 2021.
Article in English | MEDLINE | ID: covidwho-1191679

ABSTRACT

Background: Overburdened healthcare systems during the coronavirus disease (COVID-19) pandemic led to suboptimal chronic disease management, including that of pediatric type 1 diabetes mellitus (T1DM). The pandemic also caused delayed detection of new-onset diabetes in children; this increased the risk and severity of diabetic ketoacidosis (DKA). We therefore investigated the frequency of new-onset pediatric T1DM and DKA in Saudi Arabia during the COVID-19 pandemic and compared it to the same period in 2019. Methods: We conducted a multicenter retrospective cohort study, including patients aged 1-14 years admitted with new-onset T1DM or DKA during the COVID-19 pandemic (March-June 2020) and the same period in 2019. We assessed factors including age, sex, anthropometric measures, nationality, duration of diabetes, diabetes management, HbA1c levels, glycemic control, cause of admission, blood gas levels, etiology of DKA, DKA complications, length of hospital stay, and COVID-19 test status. Result: During the lockdown, 106 children, compared with 154 in 2019, were admitted to 6 pediatric diabetes centers. Among the admissions, DKA was higher in 2020 than in 2019 (83% vs. 73%; P=0.05; risk ratio=1.15; 95% confidence interval, 1.04-1.26), after adjusting for age and sex. DKA frequency among new-onset T1DM and HbA1c levels at diagnosis were higher in 2020 than in 2019 (26% vs. 13.4% [P=<0.001] and 12.1 ± 0.2 vs. 10.8 ± 0.25 [P<0.001], respectively). Females and older patients had a higher risk of DKA. Conclusion: The lockdown implemented in Saudi Arabia has significantly impacted children with T1DM and led to an increased DKA frequency, including children with new-onset T1DM, potentially owing to delayed presentation.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1/epidemiology , Diabetic Ketoacidosis/epidemiology , Pandemics , Quarantine/statistics & numerical data , Age Factors , Anthropometry , Blood Gas Analysis , Child , Cohort Studies , Diabetes Mellitus, Type 1/therapy , Diabetic Ketoacidosis/therapy , Disease Management , Female , Glycated Hemoglobin A , Glycemic Control , Humans , Length of Stay , Male , Saudi Arabia/epidemiology , Sex Factors
16.
Diabetes Care ; 44(6): 1447-1450, 2021 06.
Article in English | MEDLINE | ID: covidwho-1183788

ABSTRACT

OBJECTIVE: We compared the uptake of telemedicine for diabetes care across multiple demographic groups during the coronavirus disease 2019 pandemic to understand the impact of telemedicine adoption on access to care. RESEARCH DESIGN AND METHODS: The study analyzed demographic information of patients with type 1 diabetes seen between 1 January 2018 and 30 June 2020 at a single center. We compared the odds of completing a visit via telemedicine across multiple demographic characteristics. RESULTS: Among 28,977 patient visits, the odds of completing a visit via telemedicine were lower among non-English-speaking (1.7% vs. 2.7%; adjusted odds ratio [aOR] 0.45, 95% CI 0.26-0.79) and Medicaid-insured (32.0% vs. 35.9%; aOR 0.83, 95% CI 0.72-0.95) pediatric patients. No clinically significant differences were observed for other demographic factors. CONCLUSIONS: Rapid transition to telemedicine did not significantly impact access to diabetes care for most demographic groups. However, disparities in access to care for historically marginalized groups merit close attention to ensure that use of telemedicine does not exacerbate these inequities.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Telemedicine , Child , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Health Services Accessibility , Humans , Pandemics , SARS-CoV-2 , United States
17.
J Diabetes Sci Technol ; 15(5): 986-992, 2021 09.
Article in English | MEDLINE | ID: covidwho-1133531

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. METHODS: We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. RESULTS: Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P < .001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P = .02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P = .001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. CONCLUSIONS: Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Diabetes Mellitus/therapy , Healthcare Disparities , Telemedicine , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , California/epidemiology , Child , Child, Preschool , Communicable Disease Control/methods , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , Diabetes Mellitus/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Endocrinology/methods , Endocrinology/organization & administration , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Infant , Male , Middle Aged , Pandemics , Primary Health Care/organization & administration , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Quarantine , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Young Adult
18.
Diabetes Res Clin Pract ; 170: 108502, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1074700

ABSTRACT

Monitoring of glucose levels is essential to effective diabetes management. Over the past 100 years, there have been numerous innovations in glucose monitoring methods. The most recent advances have centered on continuous glucose monitoring (CGM) technologies. Numerous studies have demonstrated that use of continuous glucose monitoring confers significant glycemic benefits on individuals with type 1 diabetes (T1DM) and type 2 diabetes (T2DM). Ongoing improvements in accuracy and convenience of CGM devices have prompted increasing adoption of this technology. The development of standardized metrics for assessing CGM data has greatly improved and streamlined analysis and interpretation, enabling clinicians and patients to make more informed therapy modifications. However, many clinicians many be unfamiliar with current CGM and how use of these devices may help individuals with T1DM and T2DM achieve their glycemic targets. The purpose of this review is to present an overview of current CGM systems and provide guidance to clinicians for initiating and utilizing CGM in their practice settings.


Subject(s)
Blood Glucose Self-Monitoring/methods , Blood Glucose/analysis , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/therapy , Technology/methods , Humans , Longitudinal Studies
19.
Diabetes Metab Syndr ; 15(1): 243-247, 2021.
Article in English | MEDLINE | ID: covidwho-1065022

ABSTRACT

BACKGROUND AND AIMS: In Colombia, the government established mandatory isolation after the first case of COVID-19 was reported. As a diabetes care center specialized in technology, we developed a virtual training program for patients with type 1 diabetes (T1D) who were upgrading to hybrid closed loop (HCL) system. The aim of this study is to describe the efficacy and safety outcomes of the virtual training program. METHOD: ology: A prospective observational cohort study was performed, including patients with diagnosis of T1D previously treated with multiple doses of insulin (MDI) or sensor augmented pump therapy (SAP) who were updating to HCL system, from March to July 2020. Virtual training and follow-up were done through the Zoom video conferencing application and Medtronic Carelink System version 3.1 software. CGM data were analyzed to compare the time in range (TIR), time below range (TBR) and glycemic variability, during the first two weeks corresponding to manual mode with the final two weeks of follow-up in automatic mode. RESULTS: 91 patients were included. Mean TIR achieved with manual mode was 77.3 ± 11.3, increasing to 81.6% ± 7.6 (p < 0.001) after two weeks of auto mode use. A significant reduction in TBR <70 mg/dL (2,7% ± 2,28 vs 1,83% ± 1,67, p < 0,001) and in glycemic variability (% coefficient of variation 32.4 vs 29.7, p < 0.001) was evident, independently of baseline therapy. CONCLUSION: HCL systems allows T1D patients to improve TIR, TBR and glycemic variability independently of previous treatment. Virtual training can be used during situations that limit the access of patients to follow-up centers.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Insulin Infusion Systems , Patient Education as Topic/methods , Telemedicine/methods , Adolescent , Adult , Aged , Blood Glucose Self-Monitoring/methods , COVID-19/prevention & control , Cohort Studies , Colombia/epidemiology , Female , Follow-Up Studies , Humans , Hypoglycemic Agents/administration & dosage , Male , Middle Aged , Prospective Studies , Young Adult
20.
Endocrinol Diabetes Metab ; 4(1): e00180, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064345

ABSTRACT

Introduction: The COVID-19 pandemic has forced rapid reconsideration as to the way in which health care is delivered. One potential means to provide care while avoiding unnecessary person-to-person contact is to offer remote services (telemedicine). This study aimed to (1) gather real-time information on the use and perception of telemedicine in people living with type 1 diabetes and (2) assess the challenges, such as restricted access to health care and/or medical supplies. Methods: An anonymous questionnaire was widely distributed between 24 March and 5 May 2020 using an open-access web-based platform. Data were analysed descriptively, and results were stratified according to age, sex and HbA1c. Results: There were 7477 survey responses from individuals in 89 countries. Globally, 30% reported that the pandemic had affected their healthcare access due to cancelled physical appointments with their healthcare providers. Thirty-two per cent reported no fundamental change in their medical follow-up during this period, with 9% stating that no personal contact was established with their doctors over the duration of the study. Twenty-eight per cent received remote care through telephone (72%) or video-calls (28%). Of these, 86% found remote appointments useful and 75% plan to have remote appointments in the future. Glucose control, indicated by HbA1c, was positively associated with positive perception of telemedicine. In males, 45% of respondents with an HbA1c > 9% rated telemedicine not useful compared to those with lower HbA1c, while 20% of females with an HbA1c > 9% rated it not useful (χ2 = 14.2, P = .0016). Conclusion: Remote appointments have largely been perceived as positive in people with type 1 diabetes with the majority (75%) stating that they would consider remote appointments beyond the pandemic. Age and level of education do not appear to influence perception of telemedicine, whereas poor glucose control, particularly in males, seems to negatively affect perception.


Subject(s)
Attitude to Health , COVID-19 , Diabetes Mellitus, Type 1/therapy , Telemedicine , Adolescent , Adult , Aged , Diabetes Mellitus, Type 1/metabolism , Disease Management , Educational Status , Female , Glycated Hemoglobin A/metabolism , Humans , Male , Middle Aged , SARS-CoV-2 , Sex Factors , Surveys and Questionnaires , Young Adult
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