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1.
Arch Pediatr ; 29(1): 27-29, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1561682

ABSTRACT

AIM: The COVID-19 pandemic has forced governments to impose lockdown policies, thus impacting patients with chronic diseases, such as type 1 diabetes. The aim of this study was to evaluate the impact of lockdown on glycemic control in type 1 diabetes patients. PATIENTS AND METHODS: We retrospectively evaluated patients using a continuous subcutaneous insulin infusion device during the nationwide lockdown. Children and adolescents aged 2-18 years followed up at the Pediatric Endocrinology Unit of Hospitalar São João in Portugal were included in the study. We collected data on the age, weight, insulin doses, and glycemic control of the patients before and after the restrictions. RESULTS: The study included 100 patients, 59 males, with a mean age of 12.5 years. Baseline data showed a suboptimal glycemic control with a median HbA1c of 7.9%. The lockdown was associated with an increase in the body mass index (BMI) of all patients (p = 0.009), particularly girls and older teenagers. Metabolic control deteriorated in the 10-13 age group (p = 0.03), with a 0.4% increase in HbA1c. CONCLUSION: To date, this is the largest study on the impact of lockdown on type 1 diabetes in patients using an insulin pump. The results highlight the importance of physical activity, parental supervision, and continuation of healthcare assistance through telemedicine in young individuals with type 1 diabetes.


Subject(s)
COVID-19/prevention & control , Diabetes Mellitus, Type 1/drug therapy , Glycemic Control/methods , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pandemics/prevention & control , Quarantine , Adolescent , Blood Glucose , COVID-19/epidemiology , Child , Communicable Disease Control/methods , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/epidemiology , Female , Glycated Hemoglobin A/analysis , Glycated Hemoglobin A/metabolism , Humans , Hypoglycemic Agents/therapeutic use , Infusions, Subcutaneous , Insulin Infusion Systems/adverse effects , Male , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2
2.
Br J Community Nurs ; 26(11): 544-552, 2021 Nov 02.
Article in English | MEDLINE | ID: covidwho-1506202

ABSTRACT

Type 1 diabetes is a lifelong condition which affects all age ranges, for reasons unknown, and the UK has one of the highest incidences of this complex condition in the world. Type 1 diabetes is caused by autoimmune damage to the insulin-producing ß-cells found in the pancreatic islet cells, leading to severe insulin deficiency. People with diabetes need to achieve a target glyosylated haemoglobin level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycaemic events. These can vary in severity and consequences but will likely always cause worry for the person living with diabetes. There are many risk factors and reasons to be explored when looking at hypoglycaemia. This case study explores the nursing interventions that can be safely worked through and prioritised, within the community setting, to allow people with diabetes to be safe from severe hypoglycaemia, thus improving their quality of life and safety, as well as reducing costs for the NHS.


Subject(s)
Blood Glucose Self-Monitoring/methods , Diabetes Mellitus, Type 1/nursing , Glycated Hemoglobin A/analysis , Hypoglycemia/prevention & control , Hypoglycemic Agents/administration & dosage , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemia/etiology , Hypoglycemia/nursing , Hypoglycemic Agents/therapeutic use , Quality of Life
3.
Diabetes Metab Syndr ; 15(4): 102174, 2021.
Article in English | MEDLINE | ID: covidwho-1267653

ABSTRACT

AIMS: To study the feasibility of diabetes education through telemedicine in patients with diabetes mellitus (DM) hospitalized for coronavirus disease 2019 (COVID-19) management. METHODS: This was a prospective study of 100 patients with DM who were admitted in a COVID isolation ward for management of COVID-19. Patients managed with multiple subcutaneous insulin injections were eligible. During teleconsultation, diabetes education including insulin injection technique was given by a diabetes educator via a phone call (audio and video) during hospitalization. They were also re-assessed after 2 weeks of discharge from the hospital via teleconsultation or in-person. RESULTS: Out of 100 patients, 72.0% had prior history of diabetes while 28.0% were newly diagnosed. The median age of our cohort was 56 years and median duration of diabetes was 7.0 years. Telemedicine as a mode of consult for diabetes education was accepted by 96.0% of patients during hospitalization. At 2 weeks' follow-up, 77.0% patients were following insulin instructions correctly and were satisfied with this mode of consultation. CONCLUSION: Diabetes education using telemedicine as a technology is feasible, acceptable, and effective in the management of most patients with DM. Telemedicine appears to be an effective way to replace routine visits in special situations.


Subject(s)
COVID-19/complications , Diabetes Mellitus/drug therapy , Hospitalization/statistics & numerical data , Insulin/administration & dosage , Remote Consultation/methods , SARS-CoV-2/isolation & purification , Adult , Aged , Aged, 80 and over , COVID-19/transmission , COVID-19/virology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/pathology , Diabetes Mellitus/virology , Dose-Response Relationship, Drug , Female , Humans , Hypoglycemic Agents/administration & dosage , India/epidemiology , Male , Middle Aged , Prospective Studies
4.
Expert Rev Endocrinol Metab ; 16(4): 181-189, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1233816

ABSTRACT

Introduction: The COVID-19 pandemic has affected the entire population with the most deleterious effects in elders. Elders, especially those with diabetes, are at the highest risk of COVID-19 related adverse outcomes and mortality. This is usually linked to the comorbidities that accumulate with age, diabetes-related chronic inflammation, and the pandemic's psychosocial effects.Areas covered: We present some approaches to manage these complicated elderly patients with diabetes during the COVID-19 pandemic. In the inpatient setting, we suggest similar (pre-pandemic) glycemic targets and emphasize the importance of using IV insulin and possible use of continuous glucose monitoring to reduce exposure and PPE utilization. Outside the hospital, we recommend optimal glycemic control within the limits imposed by considerations of safety. We also describe the advantages and challenges of using various technological platforms in clinical care.Expert opinion: The COVID-19 pandemic has lifted the veil off serious deficiencies in the infrastructures for care at both the individual level and the population level and also highlighted some of the strengths, all of which affect individuals with diabetes and COVID-19. We anticipate that things will not return to 'normal' after the COVID-19 pandemic has run its course, but rather they will be superseded by 'New Normal.'


Subject(s)
COVID-19/psychology , Diabetes Mellitus/drug therapy , Inflammation/complications , Personal Protective Equipment/ethics , Administration, Intravenous , Aged , Aged, 80 and over , Blood Glucose/analysis , Blood Glucose Self-Monitoring/methods , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/mortality , Chronic Disease , Comorbidity , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Disease Management , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Patient Education as Topic/methods , Personal Protective Equipment/standards , Prevalence , Risk Assessment , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Telemedicine/methods
5.
J Med Internet Res ; 23(4): e24552, 2021 04 06.
Article in English | MEDLINE | ID: covidwho-1177923

ABSTRACT

BACKGROUND: Telemedicine use in chronic disease management has markedly increased during health emergencies due to COVID-19. Diabetes and technologies supporting diabetes care, including glucose monitoring devices, software analyzing glucose data, and insulin delivering systems, would facilitate remote and structured disease management. Indeed, most of the currently available technologies to store and transfer web-based data to be shared with health care providers. OBJECTIVE: During the COVID-19 pandemic, we provided our patients the opportunity to manage their diabetes remotely by implementing technology. Therefore, this study aimed to evaluate the effectiveness of 2 virtual visits on glycemic control parameters among patients with type 1 diabetes (T1D) during the lockdown period. METHODS: This prospective observational study included T1D patients who completed 2 virtual visits during the lockdown period. The glucose outcomes that reflected the benefits of the virtual consultation were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated using specific computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose levels. If needed, we changed the ongoing treatment at the first virtual visit. RESULTS: Among 209 eligible patients with T1D, 166 completed 2 virtual visits, 35 failed to download glucose data, and 8 declined the visit. Among the patients not included in the study, we observed a significantly lower proportion of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) users (n=7/43, 16% vs n=155/166, 93.4% and n=9/43, 21% vs n=128/166, 77.1%, respectively; P<.001) compared to patients who completed the study. TIR significantly increased from the first (62%, SD 18%) to the second (65%, SD 16%) virtual visit (P=.02); this increase was more marked among patients using the traditional meter (n=11; baseline TIR=55%, SD 17% and follow-up TIR=66%, SD 13%; P=.01) than among those using CGM, and in those with a baseline GMI of ≥7.5% (n=46; baseline TIR=45%, SD 15% and follow-up TIR=53%, SD 18%; P<.001) than in those with a GMI of <7.5% (n=120; baseline TIR=68%, SD 15% and follow-up TIR=69%, SD 15%; P=.98). The only variable independently associated with TIR was the change of ongoing therapy. The unstandardized beta coefficient (B) and 95% CI were 5 (95% CI 0.7-8.0) (P=.02). The type of glucose monitoring device and insulin delivery systems did not influence glucometric parameters. CONCLUSIONS: These findings indicate that the structured virtual visits help maintain and improve glycemic control in situations where in-person visits are not feasible.


Subject(s)
Blood Glucose Self-Monitoring , COVID-19 , Diabetes Mellitus, Type 1/drug therapy , SARS-CoV-2 , Telemedicine , Adult , Diabetes Mellitus, Type 1/blood , Female , Humans , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Male , Pilot Projects , Prospective Studies
6.
PLoS One ; 16(4): e0249222, 2021.
Article in English | MEDLINE | ID: covidwho-1171642

ABSTRACT

OBJECTIVE: This study aims to assess the magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Addis Ababa, Ethiopia during the COVID-19 pandemic. METHODS: A multi-site cross-sectional design was conducted from 1st through 30th of August 2020 at public health facilities of the study area. Adult outpatients with T2DM and hypertension visiting hospitals and health centers were included in the study. A proportion to size allocation method was used to determine the required sample size per facility. Data was collected using the 8-item Morisky medication adherence scale. Descriptive statistics and binary logistic regression were used to analyze data. A 95% confidence interval and p≤0.05 statistical significance was considered to determine factors associated with poor medication adherence. RESULTS: A total of 409 patients were included in the present study. About 57% of the patients reported that the COVID-19 pandemic has posed negative impacts on either of their follow-up visits, availability of medications, or affordability of prices. And, 21% have reported that they have been affected in all aspects. The overall magnitude of poor medication adherence was 72%. Patients with extreme poverty were more likely to have good medication adherence (AOR: 0.59; 95%C.I: 0.36-0.97), whereas attendance to a health center (AOR: 1.71; 95%C.I: 1.02-2.85), presence of comorbidity (AOR: 2.05; 95%C.I: 1.13-3.71), and current substance use history (AOR: 11.57; 95%C.I: 1.52-88.05) predicted high odds of poor adherence. CONCLUSION: Over a three-fourth of the patients, in the study setting, have poor adherence to their anti-diabetic and antihypertensive medications. Health facility type, income level, comorbidity, and current substance use history showed a statistically significant association with poor adherence to medication. Stakeholders should set alternative strategies as perceived impacts of the COVID-19 pandemic on medication adherence are high in the study area.


Subject(s)
Antihypertensive Agents/administration & dosage , COVID-19 , Diabetes Mellitus, Type 2 , Hypertension , Hypoglycemic Agents/administration & dosage , Medication Adherence , Pandemics , Adult , COVID-19/drug therapy , COVID-19/epidemiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Ethiopia/epidemiology , Female , Follow-Up Studies , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Male , Middle Aged
7.
Trends Microbiol ; 29(10): 894-907, 2021 10.
Article in English | MEDLINE | ID: covidwho-1129199

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections present with increased disease severity and poor clinical outcomes in diabetic patients compared with their nondiabetic counterparts. Diabetes/hyperglycemia-triggered endothelial dysfunction and hyperactive inflammatory and immune responses are correlated to twofold to threefold higher intensive care hospitalizations and more than twice the mortality among diabetic coronavirus disease 2019 (COVID-19) patients. While comorbidities such as obesity, cardiovascular disease, and hypertension worsen the prognosis of diabetic COVID-19 patients, COVID-19 infections are also associated with new-onset diabetes, severe metabolic complications, and increased thrombotic events in the backdrop of aberrant endothelial function. While several antidiabetic medications are used to manage blood glucose levels, we discuss the multifaceted ability of metformin to control blood glucose levels and possibly attenuate endothelial dysfunction, inhibit viral entry and infection, and modify inflammatory and immune responses during SARS-CoV-2 infections. These actions make metformin a viable candidate drug to be considered for repurposing and gaining ground against the SARS-CoV-2-induced tsunami in diabetic COVID-19 patients.


Subject(s)
COVID-19/complications , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/administration & dosage , Metformin/administration & dosage , Animals , Blood Glucose/metabolism , COVID-19/metabolism , COVID-19/virology , Diabetes Mellitus/metabolism , Drug Repositioning , Humans , SARS-CoV-2/drug effects , SARS-CoV-2/genetics , SARS-CoV-2/physiology
9.
Endocrinol Diabetes Metab ; 4(3): e00228, 2021 07.
Article in English | MEDLINE | ID: covidwho-1082636

ABSTRACT

Introduction: Severe COVID-19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS-CoV-2, but evidence to support this is limited. To explore this, we compared insulin requirements in patients with severe COVID-19 and non-COVID-19 viral pneumonitis. Methods: This is a retrospective cohort study of patients with severe COVID-19 admitted to our intensive care unit between March and June 2020. A historical control cohort of non-COVID-19 viral pneumonitis patients was identified from routinely collected audit data. Results: Insulin requirements were similar in patients with COVID-19 and non-COVID-19 viral pneumonitis after adjustment for pre-existing diabetes and severity of respiratory failure. Conclusions: In this single-centre study, we could not find evidence of a unique diabetogenic effect of COVID-19. We suggest that high insulin requirements in this disease relate to its propensity to cause severe respiratory failure in patients with pre-existing metabolic disease.


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Respiratory Insufficiency/complications , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Dose-Response Relationship, Drug , Female , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Male
10.
J Clin Endocrinol Metab ; 106(5): 1255-1268, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1073065

ABSTRACT

OBJECTIVE: Diabetes has emerged as an important risk factor for mortality from COVID-19. Metformin, the most commonly prescribed glucose-lowering agent, has been proposed to influence susceptibility to and outcomes of COVID-19 via multiple mechanisms. We investigated whether, in patients with diabetes, metformin is associated with susceptibility to COVID-19 and its outcomes. RESEARCH DESIGN AND METHODS: We performed a propensity score-matched cohort study with active comparators using a large UK primary care dataset. Adults with type 2 diabetes patients and a current prescription for metformin and other glucose-lowering agents (MF+) were compared to those with a current prescription for glucose-lowering agents that did not include metformin (MF-). Outcomes were confirmed COVID-19, suspected/confirmed COVID-19, and associated mortality. A negative control outcome analysis (back pain) was also performed. RESULTS: There were 29 558 and 10 271 patients in the MF+ and MF- groups, respectively, who met the inclusion criteria. In the propensity score-matched analysis, the adjusted hazard ratios for suspected/confirmed COVID-19, confirmed COVID-19, and COVID-19-related mortality were 0.85 (95% CI 0.67, 1.08), 0.80 (95% CI 0.49, 1.30), and 0.87 (95% CI 0.34, 2.20) respectively. The negative outcome control analysis did not suggest unobserved confounding. CONCLUSION: Current prescription of metformin was not associated with the risk of COVID-19 or COVID-19-related mortality. It is safe to continue prescribing metformin to improve glycemic control in patients with.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Hypoglycemic Agents/administration & dosage , Metformin/administration & dosage , Aged , COVID-19/complications , Cohort Studies , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Propensity Score , Retrospective Studies
11.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1065842

ABSTRACT

BACKGROUND: Starting March 2020 the Italian Government imposed a lockdown to limit the spread of SARS-CoV-2. During lockdown outpatient visits were limited and telemedicine (TM) was encouraged. METHODS: We retrospectively analyzed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by subjects with type 1 diabetes and compared data obtained 4 weeks before and 4 weeks after structured telephonic visit. Variables considered were mean glucose, time spent in target (70-180 mg/dl), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl), coefficient of variation, and length of sensor use. RESULTS: During the 4 weeks following the telephonic visit there was an improvement of glycemic control, with a significant reduction of mean glucose values (161.1 before vs 156.3 mg/dl after, p = 0.001), an increase of the time spent in target (63.6 vs 66.3, p = 0.0009) and a reduction of time spent in hyperglycemia (33.4 vs 30.5, p = 0.002). No changes were observed regarding glucose variability, time spent in hypoglycemia, and length of sensor use. Similar results were observed in subjects treated with multiple daily injections or continuous subcutaneous insulin infusion. CONCLUSIONS: A structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1/drug therapy , Pandemics , Quarantine , Telemedicine/trends , Adult , Aged , Blood Glucose/analysis , Blood Glucose Self-Monitoring , Female , Glycemic Control , Humans , Hyperglycemia/epidemiology , Hypoglycemia/epidemiology , Hypoglycemic Agents/administration & dosage , Insulin Infusion Systems , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , Young Adult
12.
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
13.
Lancet Diabetes Endocrinol ; 9(3): 174-188, 2021 03.
Article in English | MEDLINE | ID: covidwho-1052051

ABSTRACT

Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.


Subject(s)
COVID-19/therapy , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/therapy , Disease Management , Hospitalization/trends , Hyperglycemia/therapy , Blood Glucose/drug effects , Blood Glucose/metabolism , COVID-19/blood , COVID-19/epidemiology , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/epidemiology , Humans , Hyperglycemia/blood , Hyperglycemia/epidemiology , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage
14.
Diabetes Technol Ther ; 23(6): 467-470, 2021 06.
Article in English | MEDLINE | ID: covidwho-1029729

ABSTRACT

Insulin pump training has traditionally been performed in-person. The coronavirus disease 2019 (COVID-19) pandemic necessitated vast increases in the number of virtual pump trainings for Tandem t:slim X2 insulin pump starts. A customized structured pump training curriculum specifically tailored to virtual learning was deployed in early 2020, and included (1) preparation for training with use of the t:simulator app, (2) use of the teach-back method during video training, and (3) automating data uploads for follow-up. Retrospective analysis from >23,000 pump training sessions performed from January 1, 2020 to July 28, 2020 showed sensor time-in-range for up to 6 months after training was 72% (60%-81%) for virtual training versus 67% (54%-78%) for in-person training. Higher user satisfaction (4.78 ± 0.52 vs. 4.64 ± 0.68; P < 0.01) and higher user confidence (4.61 ± 0.75 vs. 4.47 ± 0.0.85; P < 0.01) were reported after the virtual sessions. Virtual pump training was well received and proved safe and effective with the new virtual training curriculum.


Subject(s)
Diabetes Mellitus/drug therapy , Hypoglycemia/epidemiology , Hypoglycemic Agents/administration & dosage , Insulin Infusion Systems , Insulin/administration & dosage , Patient Education as Topic/methods , Telemedicine/methods , Adolescent , Adult , Age Factors , Aged , COVID-19 , Child , Curriculum , Diabetes Mellitus/metabolism , Educational Measurement , Feasibility Studies , Female , Glycated Hemoglobin A/metabolism , Humans , Hypoglycemic Agents/therapeutic use , Infusion Pumps, Implantable , Insulin/therapeutic use , Male , Middle Aged , SARS-CoV-2 , Young Adult
15.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1014995

ABSTRACT

BACKGROUND: Starting March 2020 the Italian Government imposed a lockdown to limit the spread of SARS-CoV-2. During lockdown outpatient visits were limited and telemedicine (TM) was encouraged. METHODS: We retrospectively analyzed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by subjects with type 1 diabetes and compared data obtained 4 weeks before and 4 weeks after structured telephonic visit. Variables considered were mean glucose, time spent in target (70-180 mg/dl), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl), coefficient of variation, and length of sensor use. RESULTS: During the 4 weeks following the telephonic visit there was an improvement of glycemic control, with a significant reduction of mean glucose values (161.1 before vs 156.3 mg/dl after, p = 0.001), an increase of the time spent in target (63.6 vs 66.3, p = 0.0009) and a reduction of time spent in hyperglycemia (33.4 vs 30.5, p = 0.002). No changes were observed regarding glucose variability, time spent in hypoglycemia, and length of sensor use. Similar results were observed in subjects treated with multiple daily injections or continuous subcutaneous insulin infusion. CONCLUSIONS: A structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1/drug therapy , Pandemics , Quarantine , Telemedicine/trends , Adult , Aged , Blood Glucose/analysis , Blood Glucose Self-Monitoring , Female , Glycemic Control , Humans , Hyperglycemia/epidemiology , Hypoglycemia/epidemiology , Hypoglycemic Agents/administration & dosage , Insulin Infusion Systems , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , Young Adult
16.
Therapie ; 75(4): 327-333, 2020.
Article in English | MEDLINE | ID: covidwho-1005621

ABSTRACT

According to previous reports, diabetes seems to be a risk factor which worsens the serious clinical events caused by COVID-19. But is diabetes per se a risk factor that increases the probability of getting the virus? This paper will discuss this point. There are not many research data on antidiabetic drugs in this context. The potential influence of glucose-lowering agents on the severity of COVID-19 has not been described yet. Dipeptidylpeptidase-4 (DPP-4) is a cell surface protein ubiquitously expressed in many tissues and it is also a soluble molecule found in serum/plasma fluids. DPP-4 is involved in infection of cells by some viruses. This paper reviews data about the use of DPP-4 inhibitors and others diabetes drugs on COVID-19 patients. As such, no available evidence has yet suggested that glucose-lowering drugs - including those targeting DPP4-related pathways - produce any significant harm or benefit in the context of human infections. However, insulin must remain the first-choice agent in the management of critically ill-hospitalized patients, while it is recommended to suspend other agents in unstable patients. This paper provides related French and international recommendations for people with diabetes who got infected by COVID-19 and upholds that infections may alter glucose control and may require additional vigilance.


Subject(s)
Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Hypoglycemic Agents/administration & dosage , Pneumonia, Viral/epidemiology , Animals , COVID-19 , Coronavirus Infections/physiopathology , Diabetes Mellitus/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/administration & dosage , Dipeptidyl-Peptidase IV Inhibitors/adverse effects , Dipeptidyl-Peptidase IV Inhibitors/pharmacology , Humans , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/pharmacology , Insulin/administration & dosage , Pandemics , Pneumonia, Viral/physiopathology , Risk Factors , Severity of Illness Index
17.
Endocr Res ; 46(2): 45-50, 2021.
Article in English | MEDLINE | ID: covidwho-960416

ABSTRACT

Background: The novel coronavirus (SARS CoV-2) has caused significant morbidity and mortality in patients with diabetes. However, the effects of diabetes control including insulin use remain uncertain in terms of clinical outcomes of patients with COVID-19.Methods: In this single-center, retrospective observational study, all adult patients admitted to Einstein Medical Center, Philadelphia, from March 1 through April 24, 2020 with a diagnosis of COVID-19 and diabetes were included. Demographic, clinical and laboratory data, insulin dose at home and at the hospital, other anti-hyperglycemic agents use, and outcomes were obtained. Multivariate logistic regression was used to evaluate the factors associated with diabetes control and mortality.Results: Patients who used insulin at home had higher mortality compared to those who did not (35% vs 18% p = .015), this was true even after adjustment for demographics, comorbidities and a1c OR 2.65 95% CI (1.23-5.71) p = .013. However, the mean a1c and the median home requirements of insulin did not significantly differ among patients who died compared to the ones that survived. Patients who died had significantly higher inpatient insulin requirements (highest day insulin requirement recorded in units during hospitalization) 36 (11-86) vs 21 (8-52) p = .043 despite similar baseline a1c and steroid doses received. After adjusting for demographics, comorbidities and a1c, peak insulin requirements remained significantly associated with inpatient mortality OR 1.022 95% CI (1.00-1.04) p = .044.Conclusion: Among diabetic patients infected with COVID-19, insulin therapy at home was significantly independently associated with increased mortality. Peak daily inpatient insulin requirements was also independently associated with increased inpatient mortality.


Subject(s)
COVID-19/complications , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Glycemic Control , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Aged , Blood Glucose/analysis , COVID-19/blood , COVID-19/mortality , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/mortality , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/mortality , Female , Glycated Hemoglobin A/analysis , Hospital Mortality , Hospitalization , Humans , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Male , Middle Aged , Retrospective Studies , Risk Factors , Survival Rate
18.
Eur Rev Med Pharmacol Sci ; 24(21): 11409-11420, 2020 11.
Article in English | MEDLINE | ID: covidwho-937848

ABSTRACT

OBJECTIVE: Diabetes is a lifestyle disease and it has become an epidemic worldwide in recent decades. In the ongoing COVID-19 pandemic situation, diabetes has become a serious health concern since large numbers of patients are vulnerable to die from the virus. Thus, diabetic patients affected by COVID-19 cause a major health crisis now. Reports show that large occurrence of diabetes makes it a serious comorbidity in COVID-19 patients. MATERIALS AND METHODS: It is crucial to understand how COVID-19 affects diabetes patients. This paper has reviewed published literature extensively to understand the pattern, importance, care, and medication. RESULTS: This review summarizes the association between COVID-19 and diabetes in terms of susceptibility for pneumonia and other diseases. It also discusses the harshness of COVID-19 with diabetes populations and immunological impacts. It further adds the ACE2 receptor role in diabetes with COVID-19 patients. CONCLUSIONS: Finally, this paper illustrates different types of diabetes management techniques, such as blood glucose management, self-management, mental health management, and therapeutic management. It also summarizes the current knowledge about diabetic patients with COVID-19 to fight this pandemic.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/immunology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Disease Susceptibility/immunology , Pneumonia, Viral/immunology , Angiotensin-Converting Enzyme 2 , Betacoronavirus/metabolism , Betacoronavirus/pathogenicity , Blood Glucose/drug effects , Blood Glucose/metabolism , COVID-19 , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/immunology , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/immunology , Humans , Hypoglycemic Agents/administration & dosage , Pancreas/pathology , Pandemics/prevention & control , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Severity of Illness Index , Spike Glycoprotein, Coronavirus/metabolism , Virus Replication/immunology
19.
Nat Rev Endocrinol ; 17(1): 11-30, 2021 01.
Article in English | MEDLINE | ID: covidwho-926817

ABSTRACT

Initial studies found increased severity of coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals to hyperglycaemia. Interacting with other risk factors, hyperglycaemia might modulate immune and inflammatory responses, thus predisposing patients to severe COVID-19 and possible lethal outcomes. Angiotensin-converting enzyme 2 (ACE2), which is part of the renin-angiotensin-aldosterone system (RAAS), is the main entry receptor for SARS-CoV-2; although dipeptidyl peptidase 4 (DPP4) might also act as a binding target. Preliminary data, however, do not suggest a notable effect of glucose-lowering DPP4 inhibitors on SARS-CoV-2 susceptibility. Owing to their pharmacological characteristics, sodium-glucose cotransporter 2 (SGLT2) inhibitors might cause adverse effects in patients with COVID-19 and so cannot be recommended. Currently, insulin should be the main approach to the control of acute glycaemia. Most available evidence does not distinguish between the major types of diabetes mellitus and is related to type 2 diabetes mellitus owing to its high prevalence. However, some limited evidence is now available on type 1 diabetes mellitus and COVID-19. Most of these conclusions are preliminary, and further investigation of the optimal management in patients with diabetes mellitus is warranted.


Subject(s)
COVID-19/drug therapy , COVID-19/epidemiology , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Angiotensin-Converting Enzyme 2/antagonists & inhibitors , Angiotensin-Converting Enzyme 2/metabolism , Blood Glucose/drug effects , Blood Glucose/metabolism , COVID-19/metabolism , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 2/metabolism , Disease Management , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/metabolism , Risk Factors
20.
Acta Diabetol ; 58(3): 383-388, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-893283

ABSTRACT

AIMS: Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with type 1 diabetes (T1D) prone to hypoglycaemia using sensor-augmented pump (SAP). METHODS: Patients with T1D prone to hypoglycaemia using SAP (640G Medtronic-Minimed®) for at least 6 months under the funding of a National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st to 14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data and total daily insulin were also analysed. RESULTS: Fifty-nine patients were included: 33 women, age 46.17 ± 13.0 years and disease duration of 30.2 ± 12.0 years. TIR 70-180 mg/dL (67.6 ± 11.8 vs. 69.8 ± 12.0%), time > 180 (28.1 ± 13.6 vs. 25.5 ± 13.1%), time > 250 (6.9 ± 6.1 vs. 5.1 ± 4.8) and estimated HbA1c (6.94 ± 0.8 vs. 6.75 ± 0.7%) significantly improved (PL vs. WL, respectively, p < 0.05). Time in hypoglycaemia, coefficient of variation, sensor usage and total daily insulin dose remained unchanged. CONCLUSIONS: Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycaemia control by population with DT1 prone to hypoglycaemia using SAP. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time hypoglycaemia.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1/drug therapy , Glycemic Control/methods , Hypoglycemia/blood , Insulin Infusion Systems , Pandemics , Quarantine , Adult , Aged , Blood Glucose/analysis , Diabetes Mellitus, Type 1/blood , Female , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Male , Middle Aged , Retrospective Studies , Treatment Outcome
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