Impact of Japan’s State of Emergency on Trends in Diabetes Care during the COVID-19 Pandemic: A Retrospective and Descriptive Study (preprint)

Objective: This study examined the impact of Japan’s state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic. Design: A descriptive and retrospective study. Setting: Showa University Hospital, Japan. Participants: Patients with diabetes who received medical treatment from 2018 to 2020. Determinants of interest: Number of patients with diabetes visiting the hospital per week. To examine the impact of the Japan’s state of emergency, the number hospital visiting by patients with diabetes was summarized from 28 weeks of data, from calendar week 8 to week 35, for each year. Results: Compared with the mean of 2018 and 2019, no significant difference was found between the three periods (before, during, and after the state of emergency). However, the numbers of patients from both inside and outside Tokyo increased at 7 weeks after the state of emergency was lifted. Conclusions: A significant increase in the numbers of patients with diabetes was seen compared with the same period in 2018 and 2019, suggesting that the state of emergency may have hindered diabetes care. Therefore, patients with diabetes should be followed up continuous of diabetes care while keeping a close eye on measures.

Structural equation modeling of the effects of psychological distress and a fear of coronavirus disease 2019 on diabetes care in Japan (preprint)

This study aimed to examine the effects of psychological distress and a fear of coronavirus disease 2019 (COVID-19) on diabetes care in Japan. We used data from a 2020 nationwide internet survey in Japan involving 28,000 respondents aged 15–79 years. The question items included psychological factors (Kessler psychological distress scale and fear of COVID-19), employment, trust in neighbors, informal caregiving, and history of diabetes care. After excluding respondents with comorbidities and those who had not visited the hospital, 625 patients with diabetes were analyzed. Statistical mediation was then examined through a path analysis using structural equation modeling. Discontinued diabetes care was independently associated with psychological distress (risk ratio = 1.44, 95% confidence interval [1.01–2.06]) and a fear of COVID-19 (1.41 [1.01–1.95]). The results of the structural equation modeling indicated that a fear of COVID-19, employment, trust in neighbors, and informal caregiving were indirectly associated with continued diabetes care via psychological distress. These findings suggest that a fear of COVID-19 is associated with continued diabetes care via psychological distress. COVID-19 pandemic may affect psychological distress and lead to refrained diabetes care among Japanese patients with diabetes. Moreover, employment, trust in neighbors, and family caregiving were also found to buffer refrained diabetes care. As psychological factors and socioeconomic status can affect diabetes care, a fear of COVID-19 should be considered in patients with diabetes to help ensure the continuation of diabetes treatment.