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1.
Intern Med ; 61(1): 37-48, 2022.
Article in English | MEDLINE | ID: covidwho-1604725

ABSTRACT

Objective In this study, we investigated whether and how the COVID-19 pandemic affected glycemic control and blood pressure (BP) control in patients with diabetes mellitus (DM). Methods DM patients whose HbA1c level was measured regularly before and after the declaration of a state of emergency were included in this study. Some patients were given questionnaires about changes in their lifestyle to determine the factors affecting glycemic control and BP control. Results The median HbA1c level of the 804 patients increased significantly from 6.8% before the state of emergency to 7.1% and 7.0% during and after the state of emergency, respectively. This was in contrast to the decrease one year earlier due to seasonal variations. In the 176 patients who responded to the questionnaire, the HbA1c level also increased significantly during and after the state of emergency. The worsening of glycemic control was more pronounced in the group that had achieved HbA1c of <7% before the state of emergency than in those with higher values. Unlike the rise in HbA1c, the BP did not rise during the state of emergency but did rise significantly afterwards. There was no marked decrease in HbA1c or BP after the state of emergency, even in patients who responded that they were much more careful with their diet, ate less, or exercised more. Conclusions The COVID-19 pandemic worsened glycemic control and BP control, even in patients who perceived no marked change in their diet or exercise, suggesting that more active lifestyle guidance is necessary for good treatment of DM patients.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Diabetes Mellitus , Blood Glucose , Blood Pressure , Diabetes Mellitus/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Glycated Hemoglobin A/analysis , Glycemic Control , Humans , Japan/epidemiology , Pandemics , SARS-CoV-2
2.
Int J Environ Res Public Health ; 18(24)2021 12 15.
Article in English | MEDLINE | ID: covidwho-1572489

ABSTRACT

During the COVID-19 pandemic, the Internet has been a major source of information for people to keep updated with news and guidelines. However, concerns have been raised about the 'infodemic', which includes the overabundance of online information and the spread of misleading information. Adequate eHealth literacy skills among world citizens have therefore been emphasized as vital during the pandemic. Persons with type 2 diabetes have been at increased risk of severe outcomes of COVID-19 disease. This study aimed to explore online COVID-19 information acquisition experiences among persons with type 2 diabetes and varying eHealth literacy. Fifty-eight participants filled out the eHealth Literacy Scale (eHEALS), along with a qualitative questionnaire with free-text questions. Additionally, 10 participants were interviewed. Thematic analysis was applied to identify patterns in participants' experiences. Two domains were identified: perceived challenges with online information about COVID-19, and coping strategies to manage challenges. The perceived challenges were: being exposed to information overload, dealing with conflicting information, and being strongly emotionally affected. The related coping strategies were: protecting oneself, trusting authorities, taking command, and using common sense. These strategies often involved triangulation of the information obtained, including participants consulting their common sense, various sources, or family and friends. This paper highlights the crucial role of authorities in delivering online information, that according to health literacy principles, is easy to access, understand, and use. Furthermore, our results reinforce the importance of diabetes nurses, as well as healthcare professionals in general, in encouraging patients to share their Internet findings, promote information from reliable sources, and deliver tailored information that suits individual needs. Because our results underline the importance of social support in eHealth literacy and the assessment of online health information, the inclusion of family and friends needs to be increasingly considered in diabetes care. Due to the small homogenous sample, the results of this study cannot be generalized. However, the reader can assess the transferability to other situations and settings based on our contextual descriptions.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Health Literacy , Telemedicine , Diabetes Mellitus, Type 2/epidemiology , Humans , Internet , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
4.
Lancet Diabetes Endocrinol ; 9(10): 671-680, 2021 10.
Article in English | MEDLINE | ID: covidwho-1531932

ABSTRACT

BACKGROUND: Diabetic ketoacidosis (DKA) has been reported to be increasing in frequency during the COVID-19 pandemic. We aimed to examine the rates of DKA hospital admissions and the patient demographics associated with DKA during the pandemic compared with in prepandemic years. METHODS: Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, we extracted all emergency hospital admissions in England coded with DKA from March 1 to June 30, 2020 (first wave of the pandemic), July 1 to Oct 31, 2020 (post-first wave), and Nov 1, 2020, to Feb 28, 2021 (second wave), and compared these with DKA admissions in the equivalent periods in 2017-20. We also examined baseline characteristics, mortality, and trends in patients who were admitted with DKA. FINDINGS: There were 8553 admissions coded with DKA during the first wave, 8729 during the post-first wave, and 10 235 during the second wave. Compared with preceding years, DKA admissions were 6% (95% CI 4-9; p<0·0001) higher in the first wave of the pandemic (from n=8048), 6% (3-8; p<0·0001) higher in the post-first wave (from n=8260), and 7% (4-9; p<0·0001) higher in the second wave (from n=9610). In the first wave, DKA admissions reduced by 19% (95% CI 16-21) in those with pre-existing type 1 diabetes (from n=4965 to n=4041), increased by 41% (35-47) in those with pre-existing type 2 diabetes (from n=2010 to n=2831), and increased by 57% (48-66) in those with newly diagnosed diabetes (from n=1072 to n=1681). Compared with prepandemic, type 2 diabetes DKA admissions were similarly common in older individuals and men but were higher in those of non-White ethnicities during the first wave. The increase in newly diagnosed DKA admissions occurred across all age groups and these were significantly increased in men and people of non-White ethnicities. In the post-first wave, DKA admissions did not return to the baseline level of previous years; DKA admissions were 14% (11-17) lower in patients with type 1 diabetes (from n=5208 prepandemic to n=4491), 30% (24-36) higher in patients with type 2 diabetes (from n=2011 to n=2613), and 56% (47-66) higher in patients with newly diagnosed diabetes (from n=1041 to n=1625). During the second wave, DKA admissions were 25% (22-27) lower in patients with type 1 diabetes (from n=5769 prepandemic to n=4337), 50% (44-56) higher in patients with type 2 diabetes (from n=2608 to n=3912), and 61% (52-70) higher in patients with newly diagnosed diabetes (from n=1234 to n=1986). INTERPRETATION: Our results provide evidence for differences in the numbers and characteristics of people presenting with DKA during the COVID-19 pandemic compared with in the preceding 3 years. Greater awareness of risk factors for DKA in type 2 diabetes and vigilance for newly diagnosed diabetes presenting with DKA during the COVID-19 pandemic might help mitigate the increased impact of DKA. FUNDING: None.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/epidemiology , Emergency Service, Hospital/trends , Patient Admission/trends , Population Surveillance , Adolescent , Adult , Aged , COVID-19/prevention & control , Databases, Factual/trends , Diabetes Mellitus, Type 2/therapy , Diabetic Ketoacidosis/therapy , England/epidemiology , Female , Humans , Male , Middle Aged , Population Surveillance/methods , Time Factors , Young Adult
5.
Cardiovasc Diabetol ; 20(1): 218, 2021 11 06.
Article in English | MEDLINE | ID: covidwho-1503722

ABSTRACT

Type 2 diabetes is one of the most relevant risk factors for heart failure, the prevalence of which is increasing worldwide. The aim of the review is to highlight the current perspectives of the pathophysiology of heart failure as it pertains to type 2 diabetes. This review summarizes the proposed mechanistic bases, explaining the myocardial damage induced by diabetes-related stressors and other risk factors, i.e., cardiomyopathy in type 2 diabetes. We highlight the complex pathology of individuals with type 2 diabetes, including the relationship with chronic kidney disease, metabolic alterations, and heart failure. We also discuss the current criteria used for heart failure diagnosis and the gold standard screening tools for individuals with type 2 diabetes. Currently approved pharmacological therapies with primary use in type 2 diabetes and heart failure, and the treatment-guiding role of NT-proBNP are also presented. Finally, the influence of the presence of type 2 diabetes as well as heart failure on COVID-19 severity is briefly discussed.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Disease Management , Heart Failure/epidemiology , Mass Screening/methods , Biomarkers/blood , COVID-19/blood , COVID-19/diagnosis , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Glycated Hemoglobin A/metabolism , Heart Failure/blood , Heart Failure/diagnosis , Humans , Mass Screening/trends , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Prognosis
6.
Aging (Albany NY) ; 13(20): 23459-23470, 2021 10 28.
Article in English | MEDLINE | ID: covidwho-1498163

ABSTRACT

BACKGROUND: Since April 2021, the SARS-CoV-2 (B.1.167) Delta variant has been rampant worldwide. Recently, this variant has spread in Guangzhou, China. Our objective was to characterize the clinical features and risk factors of severe cases of the Delta variant in Guangzhou. METHODS: A total of 144 patients with the Delta variant were enrolled, and the data between the severe and non-severe groups were compared. Logistic regression methods and Cox multivariate regression analysis were used to investigate the risk factors of severe cases. RESULTS: The severity of the Delta variant was 11.1%. Each 1-year increase in age (OR, 1.089; 95% CI, 1.035-1.147; P = 0.001) and each 1-µmol/L increase in total bilirubin (OR, 1.198; 95% CI, 1.021-1.406; P = 0.039) were risk factors for severe cases. Moreover, the risk of progression to severe cases increased 13.444-fold and 3.922-fold when the age was greater than 58.5 years (HR, 13.444; 95% CI, 2.989-60.480; P = 0.001) or the total bilirubin level was greater than 7.23 µmol/L (HR, 3.922; 95% CI, 1.260-12.207; P = 0.018), respectively. CONCLUSION: Older age and elevated total bilirubin were independent risk factors for severe cases of the Delta variant in Guangzhou, especially if the age was greater than 58.5 years or the total bilirubin level was greater than 7.23 µmol/L.


Subject(s)
COVID-19/therapy , SARS-CoV-2/isolation & purification , Adult , COVID-19/diagnosis , COVID-19/mortality , COVID-19/prevention & control , COVID-19 Vaccines , Cardiovascular Diseases/epidemiology , China/epidemiology , Comorbidity , Cough/etiology , Diabetes Mellitus, Type 2/epidemiology , Female , Fever/etiology , Hospital Mortality , Humans , Hypertension/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2/genetics , Severity of Illness Index
7.
Endocrinol Metab (Seoul) ; 36(5): 1142-1146, 2021 10.
Article in English | MEDLINE | ID: covidwho-1485221

ABSTRACT

It has been suggested that the coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on glycemic control in patients with type 2 diabetes mellitus (T2DM). However, no study has examined yearly trends in glycated hemoglobin (HbA1c) levels after the start of the COVID-19 outbreak. Here, we performed a retrospective analysis of HbA1c concentrations during the early period of the COVID-19 outbreak (COVID-19 cohort) and then compared the yearly trend in the mean HbA1c level, along with fluctuations in HbA1c levels, with those during previous years (non-COVID-19 cohorts). We observed that the mean HbA1c level in patients with T2DM increased during the first 6 months of the COVID-19 outbreak. After 6 months, HbA1c levels in the COVID-19 cohort returned to levels seen in the non-COVID-19 cohorts. The data suggest that vulnerable patients with T2DM should be monitored closely during the early period of a pandemic to ensure they receive appropriate care.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/blood , Glycated Hemoglobin A/analysis , Glycemic Control/trends , Adult , Blood Glucose/analysis , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , Diabetes Mellitus, Type 2/epidemiology , Disease Outbreaks/statistics & numerical data , Female , Humans , Male , Retrospective Studies , SARS-CoV-2/genetics , Time Factors
8.
Front Endocrinol (Lausanne) ; 12: 731974, 2021.
Article in English | MEDLINE | ID: covidwho-1485049

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing a worldwide epidemic. It spreads very fast and hits people of all ages, especially patients with underlying diseases such as diabetes. In this review, we focus on the influences of diabetes on the outcome of SARS-CoV-2 infection and the involved mechanisms including lung dysfunction, immune disorder, abnormal expression of angiotensin-converting enzyme 2 (ACE2), overactivation of mechanistic target of rapamycin (mTOR) signaling pathway, and increased furin level. On the other hand, SARS-CoV-2 may trigger the development of diabetes. It causes the damage of pancreatic ß cells, which is probably mediated by ACE2 protein in the islets. Furthermore, SARS-CoV-2 may aggravate insulin resistance through attacking other metabolic organs. Of note, certain anti-diabetic drugs (OADs), such as peroxisome proliferator-activated receptor γ (PPARγ) activator and glucagon-like peptide 1 receptor (GLP-1R) agonist, have been shown to upregulate ACE2 in animal models, which may increase the risk of SARS-CoV-2 infection. However, Metformin, as a first-line medicine for the treatment of type 2 diabetes mellitus (T2DM), may be a potential drug benefiting diabetic patients with SARS-CoV-2 infection, probably via a suppression of mTOR signaling together with its anti-inflammatory and anti-fibrosis function in lung. Remarkably, another kind of OADs, dipeptidyl Peptidase 4 (DPP4) inhibitor, may also exert beneficial effects in this respect, probably via a prevention of SARS-CoV-2 binding to cells. Thus, it is of significant to identify appropriate OADs for the treatment of diabetes in the context of SARS-CoV-2 infections.


Subject(s)
COVID-19/epidemiology , COVID-19/metabolism , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/metabolism , Angiotensin-Converting Enzyme 2/antagonists & inhibitors , Angiotensin-Converting Enzyme 2/metabolism , Animals , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/pharmacology , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Humans , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/therapeutic use , Lung/drug effects , Lung/metabolism , T-Lymphocytes/drug effects , T-Lymphocytes/metabolism , TOR Serine-Threonine Kinases/antagonists & inhibitors , TOR Serine-Threonine Kinases/metabolism
9.
PLoS One ; 16(10): e0258914, 2021.
Article in English | MEDLINE | ID: covidwho-1480460

ABSTRACT

BACKGROUND: Risk factors of severe COVID-19 have mainly been investigated in the hospital setting. We investigated pre-defined risk factors for testing positive for SARS-CoV-2 infection and cardiovascular or pulmonary complications in the outpatient setting. METHODS: The present cohort study makes use of ambulatory claims data of statutory health insurance physicians in Bavaria, Germany, with polymerase chain reaction (PCR) test confirmed or excluded SARS-CoV-2 infection in first three quarters of 2020. Statistical modelling and machine learning were used for effect estimation and for hypothesis testing of risk factors, and for prognostic modelling of cardiovascular or pulmonary complications. RESULTS: A cohort of 99 811 participants with PCR test was identified. In a fully adjusted multivariable regression model, dementia (odds ratio (OR) = 1.36), type 2 diabetes (OR = 1.14) and obesity (OR = 1.08) were identified as significantly associated with a positive PCR test result. Significant risk factors for cardiovascular or pulmonary complications were coronary heart disease (CHD) (OR = 2.58), hypertension (OR = 1.65), tobacco consumption (OR = 1.56), chronic obstructive pulmonary disease (COPD) (OR = 1.53), previous pneumonia (OR = 1.53), chronic kidney disease (CKD) (OR = 1.25) and type 2 diabetes (OR = 1.23). Three simple decision rules derived from prognostic modelling based on age, hypertension, CKD, COPD and CHD were able to identify high risk patients with a sensitivity of 74.8% and a specificity of 80.0%. CONCLUSIONS: The decision rules achieved a high prognostic accuracy non-inferior to complex machine learning methods. They might help to identify patients at risk, who should receive special attention and intensified protection in ambulatory care.


Subject(s)
Ambulatory Care , COVID-19 , Coronary Disease , Hypertension , Renal Insufficiency, Chronic , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Coronary Disease/epidemiology , Coronary Disease/therapy , Dementia/epidemiology , Dementia/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Female , Germany , Humans , Hypertension/epidemiology , Hypertension/therapy , Male , Middle Aged , Obesity/epidemiology , Obesity/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , Risk Assessment , Risk Factors
10.
BMJ Open ; 11(10): e052310, 2021 10 20.
Article in English | MEDLINE | ID: covidwho-1476607

ABSTRACT

OBJECTIVES: To investigate the association between baseline use of glucose-lowering drugs and serious clinical outcome among patients with type 2 diabetes. DESIGN: Territory-wide retrospective cohort of confirmed cases of COVID-19 between January 2020 and February 2021. SETTING: All public health facilities in Hong Kong. PARTICIPANTS: 1220 patients with diabetes who were admitted for confirmed COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Composite clinical endpoint of intensive care unit admission, requirement of invasive mechanical ventilation and/or in-hospital death. RESULTS: In this cohort (median age 65.3 years, 54.3% men), 737 (60.4%) patients were treated with metformin, 385 (31.6%) with sulphonylureas, 199 (16.3%) with dipeptidyl peptidase-4 (DPP-4) inhibitors and 273 (22.4%) with insulin prior to admission. In multivariate Cox regression, use of metformin and DPP-4 inhibitors was associated with reduced incidence of the composite endpoint relative to non-use, with respective HRs of 0.51 (95% CI 0.34 to 0.77, p=0.001) and 0.46 (95% CI 0.29 to 0.71, p<0.001), adjusted for age, sex, diabetes duration, glycated haemoglobin (HbA1c), smoking, comorbidities and drugs. Use of sulphonylureas (HR 1.55, 95% CI 1.07 to 2.24, p=0.022) and insulin (HR 6.34, 95% CI 3.72 to 10.78, p<0.001) were both associated with increased hazards of the composite endpoint. CONCLUSIONS: Users of metformin and DPP-4 inhibitors had fewer adverse outcomes from COVID-19 compared with non-users, whereas insulin and sulphonylurea might predict a worse prognosis.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Dipeptidyl-Peptidase IV Inhibitors , Metformin , Pharmaceutical Preparations , Aged , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Female , Glucose , Hong Kong/epidemiology , Hospital Mortality , Humans , Hypoglycemic Agents/therapeutic use , Male , Metformin/therapeutic use , Retrospective Studies , SARS-CoV-2
11.
BMC Health Serv Res ; 21(1): 1107, 2021 Oct 16.
Article in English | MEDLINE | ID: covidwho-1468064

ABSTRACT

BACKGROUND: COVID-19 has caused significant healthcare service disruptions. Surgical backlogs have been estimated but not for other healthcare services. This study aims to estimate the backlog of preventive care services caused by COVID-19. METHODS: This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were crudely estimated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada. RESULTS: The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (- 0.3% to - 14.7%; 95% CI), colorectal cancer decreased by 8.1% (- 0.3% to - 15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (- 0.2% to - 8.7%; 95% CI). Crude estimates imply 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI) may be overdue in Ontario. Nationally the deficits may be tripled these numbers. Re-opening measures have not reversed these trends. INTERPRETATION: COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Cohort Studies , Delivery of Health Care , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/prevention & control , Female , Humans , Ontario/epidemiology , SARS-CoV-2
12.
Prim Care Diabetes ; 15(5): 799-805, 2021 10.
Article in English | MEDLINE | ID: covidwho-1428316

ABSTRACT

AIMS: The research was conducted with the aim of determining the effect of the COVID-19 pandemic on levels of self-management in individuals with type 2 diabetes. METHODS: This cross-sectional descriptive type of study was conducted between 21 December 2020 and 1 April 2021. It was performed with 378 individuals with type 2 diabetes attending the endocrinology clinic and outpatients' department of a government hospital who agreed to participate in the research. In the collection of data, a Patient Identification Form, Visual Analog Scales (an Anxiety VAS and a Stress VAS), and the Diabetes Self-Management Questionnaire (DSMQ) were used. The Wilcoxon test, Independent Sample t test, One-Way Anova and binary logistic regression were used in the analysis of data. RESULTS: The Diabetes Self-Management Questionnaire (DSMQ) total mean score of the individuals with type 2 diabetes participating in the study during the COVID-19 pandemic was 5.25 ± 1.04. Their anxiety total mean score was 0.32 ± 1.56, and their total mean stress score was 7.06 ± 1.62. Being male, over the age of 65, married and having a diagnosis of diabetes for 6-11 years, increased smoking, the COVID-19 pandemic, reduced physical activity (not walking) and support obtained from health professionals, and increased anxiety and stress levels were found to be risk factors affecting diabetic self-management. CONCLUSIONS: The findings show that the COVID-19 pandemic has had a negative effect on the self-management levels of individuals with type 2 diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Self-Management , Anxiety/diagnosis , Anxiety/epidemiology , Child , Cross-Sectional Studies , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Humans , Male , Pandemics , SARS-CoV-2
13.
Diabetes Res Clin Pract ; 180: 109047, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1415357

ABSTRACT

AIM: The purpose of this study is to investigate the individual and contextual determinants of the perceived quality (PQ) of the telemedicine and teleassistance (TMTA) services and the willingness to continue (WC) with them among patients with diabetes using TMTA services during the COVID-19 pandemic in one large region of Italy. METHODS: A structured survey was administered to patients with type 1 and 2 diabetes who used TMTA during the first wave of the COVID-19 pandemic. The questionnaire contained questions on TMTA service experience and participants' socio-demographic characteristics. Multiple regression models investigated the independent factors associated with PQ and WC. RESULTS: The final analysis included 569 patients with diabetes (54.7% female), with an average age of 58.1 years. TMTA services' PQ and WC were high. A higher education and being unemployed were factors associated with an increased WC. Older age was negatively related to PQ. Perceived support from TMTA service was positively associated with PQ and WC. Perceived increase in disease self-management was positively associated with PQ and WC. CONCLUSIONS: Our study identified several determinants of PQ and WC. These socio-demographic and TMTA-related factors should be considered in the implementation of care pathways integrating in-person visits with TMTA.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Telemedicine , Aged , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
14.
World J Gastroenterol ; 27(33): 5502-5519, 2021 Sep 07.
Article in English | MEDLINE | ID: covidwho-1411115

ABSTRACT

Metabolic diseases are highly prevalent worldwide and have been associated with adverse clinical outcomes, including mortality, in patients developing coronavirus disease (COVID-19). Because of the close relationship between metabolic diseases such as type 2 diabetes mellitus and obesity and the presence of metabolic-associated fatty liver disease (MAFLD), a high number of cases of patients affected by both MAFLD and COVID-19 would be expected, especially in high-risk populations. Some studies have shown an increased risk of adverse clinical outcomes, viral shedding, and deep vein thrombosis, especially in patients with MAFLD- related liver fibrosis. The predisposition to poor outcomes and severe acute respiratory syndrome coronavirus 2 infection in patients with MAFLD could be secondary to mechanisms common to both, including preexisting systemic chronic inflammation, endothelial dysfunction, and involvement of the renin-angiotensin system. Because of the increased risk of adverse outcomes, MAFLD should be screened in all patients admitted for COVID-19. Available computed tomography scans could be of help, assessment of liver fibrosis is also recommended, favoring noninvasive methods to limit the exposure of healthcare workers. Liver involvement in this population ranges from abnormalities in liver chemistry to hepatic steatosis in postmortem biopsies. Finally, preventive measures should be strongly advocated in patients already known to have MAFLD, including the use of telemedicine and vaccination in addition to general measures.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Fatty Liver , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Fatty Liver/epidemiology , Fatty Liver/etiology , Humans , SARS-CoV-2
15.
Ann Med ; 53(1): 1642-1645, 2021 12.
Article in English | MEDLINE | ID: covidwho-1404914

ABSTRACT

OBJECTIVE: To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (-) [COVID (-)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area. METHODS: A cross-sectional study was conducted with patients admitted to an urban academic medical center between 1 March and 30 July 2020. Eligible patients met lab criteria for either DKA or HHS. Mixed DKA-HHS was defined as meeting all criteria for either DKA or HHS with at least 1 criterion for the other diagnosis. RESULTS: A total of 82 participants were stratified by COVID-19 status and type of hyperglycaemic crisis [26 COVID (+) and 56 COVID (-)]. A majority were either Black or Hispanic. Compared with COVID (-) patients, COVID (+) patients were older, more Hispanic and more likely to have type 2 diabetes (T2D, 73% vs 48%, p < .01). COVID(+) patients had a higher mean pH (7.25 ± 0.10 vs 7.16 ± 0.16, p < .01) and lower anion gap (18.7 ± 5.7 vs 22.7 ± 6.9, p = .01) than COVID (-) patients. COVID (+) patients were given less intravenous fluids in the first 24 h (2.8 ± 1.9 vs 4.2 ± 2.4 L, p = .01) and were more likely to receive glucocorticoids (95% vs. 11%, p < .01). COVID (+) patients may have taken longer to resolve their hyperglycaemic crisis (53.3 ± 64.8 vs 28.8 ± 27.5 h, p = .09) and may have experienced more hypoglycaemia <3.9 mmol/L (35% vs 19%, p = .09). COVID (+) patients had a higher length of hospital stay (LOS, 14.8 ± 14.9 vs 6.5 ± 6.0 days, p = .01) and in-hospital mortality (27% vs 7%, p = .02). DISCUSSION: Compared with COVID (-) patients, COVID (+) patients with DKA/HHS are more likely to have T2D. Despite less severe metabolic acidosis, COVID (+) patients may require more time to resolve the hyperglycaemic crisis and experience more hypoglycaemia while suffering greater LOS and risk of mortality. Larger studies are needed to examine whether differences in management between COVID (+) and (-) patients affect outcomes with DKA/HHS.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/complications , Acid-Base Equilibrium , Adult , Age Factors , Aged , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/blood , Female , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Hydrogen-Ion Concentration , Hyperglycemic Hyperosmolar Nonketotic Coma/blood , Length of Stay , Male , Middle Aged , SARS-CoV-2 , Safety-net Providers
16.
Int J Clin Pract ; 75(11): e14833, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1402929

ABSTRACT

BACKGROUND-AIM: Diabetes, obesity and hypertension are common comorbidities associated with increased severity and mortality rates from Corona Virus Disease (COVID)-19. METHODS: In this narrative review (using the PubMed database), we discuss epidemiological data and pathophysiological links between diabetes and COVID-19. The potential effects of glycaemic control and antidiabetic drugs on the prevalence and outcomes of COVID-19 are also reviewed, as well as the role of telemedicine and diabetes self-management in the post-COVID-19 era. RESULTS: Diabetes has been linked to COVID-19 morbidity and mortality, although further research is needed to elucidate this association. In the meantime, physicians should be aware of the potential rise in the prevalence of diabetes (due to unhealthy lifestyle changes during the pandemic), its severity and complications and focus on achieving optimal diabetes prevention and management. Telemedicine and diabetes self-management may help towards this direction. Dipeptidyl-peptidase 4 (DPP4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose transporter 2 (SGLT2) inhibitors may affect viral entry and infection, and thus COVID-19 outcomes, as shown in observational studies. CONCLUSION: Diabetes has been associated with COVID-19 development and progression. Certain antidiabetic drugs may influence COVID-19 prevention and management. The results of ongoing randomized clinical trials will shed more light on this field.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Sodium-Glucose Transporter 2 Inhibitors , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Humans , Hypoglycemic Agents/therapeutic use , SARS-CoV-2
17.
Nutr Metab Cardiovasc Dis ; 31(11): 3243-3246, 2021 10 28.
Article in English | MEDLINE | ID: covidwho-1401752

ABSTRACT

BACKGROUND AND AIMS: Vaccine Hesitancy (VH) is a relevant obstacle for the COVID-19 vaccination campaign. The aim of this study is to assess the proportion of subjects unwilling to vaccinate among patients with type 1 (T1DM) and 2 (T2DM) diabetes, exploring factors associated with VH. METHODS AND RESULTS: A purposely created interview was delivered from physicians to a consecutive series of adult (>18 years) subjects with diabetes referring to the Diabetes Outpatient Clinic of Careggi Hospital, Florence, from January 1st to April 30th 2021. Out of 502 subjects enrolled, 92 were vaccine hesitant respondents (18.3%); the corresponding figure for T1DM and T2DM was 13.0% (N = 14), and 19.9% (N = 78), respectively. After adjusting for age, higher HbA1c (1.07 [1.02-1.13], p = 0.008) and triglycerides levels (1.03 [1.01-1.06], p = 0.011) were positively associated with VH, among patients with T1DM. At multivariate analysis, after adjusting for age, creatinine, and statin use, patients with T2DM affected by obesity (9.98 [4.89-9.59], p < 0.01) and with lower levels of creatinine (0.36 [0.21-0.54], p = 0.029) were more likely to refuse COVID vaccination. CONCLUSIONS: Hesitancy toward COVID-19 vaccination among subjects with diabetes is not negligible and seems to be more prevalent in individuals with lower adherence to medical prescriptions and/or reduced concerns over their health. This suggests the need for specific interventions to increase awareness and counter prejudices on vaccines.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/therapy , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Vaccination/psychology , Adult , Aged , Aged, 80 and over , COVID-19/psychology , Diabetes Mellitus, Type 1/psychology , Diabetes Mellitus, Type 2/psychology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Multivariate Analysis , SARS-CoV-2 , Surveys and Questionnaires , Vaccination Refusal/psychology
18.
BMJ Open Diabetes Res Care ; 9(1)2021 09.
Article in English | MEDLINE | ID: covidwho-1398617

ABSTRACT

INTRODUCTION: People with type 2 diabetes (T2D) have an increased rate of hospitalization and mortality related to COVID-19. To identify ahead of time those who are at risk of developing severe diseases and potentially in need of intensive care, we investigated the independent associations between longitudinal glycated hemoglobin (HbA1c), the impact of common medications (metformin, insulin, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and corticosteroids) and COVID-19 severity in people with T2D. RESEARCH DESIGN AND METHODS: Retrospective cohort study was conducted using deidentified claims and electronic health record data from the OptumLabs Data Warehouse across the USA between January 2017 and November 2020, including 16 504 individuals with T2D and COVID-19. A univariate model and a multivariate model were applied to evaluate the association between 2 and 3-year HbA1c average, medication use between COVID-19 diagnosis and intensive care unit admission (if applicable), and risk of intensive care related to COVID-19. RESULTS: With covariates adjusted, the HR of longitudinal HbA1c for risk of intensive care was 1.12 (per 1% increase, p<0.001) and 1.48 (comparing group with poor (HbA1c ≥9%) and adequate glycemic control (HbA1c 6%-9%), p<0.001). The use of corticosteroids and the combined use of insulin and metformin were associated with significant reduction of intensive care risk, while ACEIs and ARBs were not associated with reduced risk of intensive care. CONCLUSIONS: Two to three-year longitudinal glycemic level is independently associated with COVID-19-related severity in people with T2D. Here, we present a potential method to use HbA1c history, which presented a stronger association with COVID-19 severity than single-point HbA1c, to identify in advance those more at risk of intensive care due to COVID-19 in the T2D population. The combined use of metformin and insulin and the use of corticosteroids might be significant to prevent patients with T2D from becoming critically ill from COVID-19.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19 Testing , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Humans , Retrospective Studies , SARS-CoV-2
19.
Environ Int ; 156: 106725, 2021 11.
Article in English | MEDLINE | ID: covidwho-1397331

ABSTRACT

BACKGROUND: Long-term exposure to fine particulate matter (PM2.5) is associated with an increased risk of type 2 diabetes (T2D). However, limited data on trends in the global burden of T2D attributed to PM2.5, particularly in different regions by social-economic levels. We evaluated the spatio-temporal changes in the disease burden of T2D attributed to PM2.5 from 1990 to 2019 in 204 countries and regions with different socio-demographic indexes (SDI). METHODS: This is a retrospective analysis with data from the Global Burden of Disease Study 2019 (GBD2019) database. The burden of T2D attributed to PM2.5, age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) were estimated according to sex, age, nationality and SDI. The annual percentage change (APCs) and the average annual percentage change (AAPCs) were calculated by using the Joinpoint model to evaluate the changing trend of ASMR and ASDR attributed to PM2.5 from 1990 to 2019. The Gaussian process regression model was used to estimate the relationship of SDI with ASMR and ASDR. RESULTS: Overall, the global burden of T2D attributable to PM2.5 increased significantly since 1990, particularly in the elderly, men, Africa, Asia and low-middle SDI regions. The ASMR and ASDR of T2D attributable to PM2.5 in 2019 were 2.47 (95% CI: 1.71, 3.24) per 100,000 population and 108.98 (95% CI: 74.06, 147.23) per 100,000 population, respectively. From 1990 to 2019, the global ASMR and ASDR of T2D attributed to T2D increased by 57.32% and 86.75%, respectively. The global AAPCs of ASMR and ASDR were 1.57 (95% CI: 1.46, 1.68) and 2.17 (95% CI: 2.02, 2.32), respectively. Declining trends were observed in North America, South America, Europe, Australia, and other regions with high SDI. CONCLUSIONS: Over this 30-years study, the global T2D burden attributable to PM2.5 has increased particularly in regions with low-middle SDI. PM2.5 remains a great concern on the global burden of diabetes.


Subject(s)
Diabetes Mellitus, Type 2 , Aged , Diabetes Mellitus, Type 2/epidemiology , Global Burden of Disease , Global Health , Humans , Male , Particulate Matter/adverse effects , Quality-Adjusted Life Years , Retrospective Studies
20.
Diabetes Metab Syndr ; 15(5): 102242, 2021.
Article in English | MEDLINE | ID: covidwho-1397297

ABSTRACT

INTRODUCTION: Emergence of COVID-19 pandemic has led to increased use of telemedicine in health care delivery. Telemedicine facilitates long-term clinical care for monitoring and prevention of complications of diabetes mellitus. GUIDELINES: Precise indications for teleconsultation, clinical care services which can be provided, and good clinical practices to be followed during teleconsultation are explained. Guidance on risk assessment and health education for diabetes risk factors, counselling for blood glucose monitoring, treatment compliance, and prevention of complications are described. CONCLUSION: The guidelines will help physicians in adopting teleconsultation for management of diabetes mellitus, facilitate access to diabetes care and improve health outcomes.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/therapy , Remote Consultation/standards , Biomedical Research/organization & administration , Biomedical Research/standards , COVID-19/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Diabetes Mellitus, Type 2/epidemiology , Expert Testimony , Humans , India/epidemiology , Pandemics , Remote Consultation/methods , Remote Consultation/organization & administration , Telemedicine/organization & administration , Telemedicine/standards
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