Implementation of diabetes care and educational program via telemedicine in patients with COVID-19 in home isolation in Thailand: A real-worldexperience.

BACKGROUND: The coronavirus disease (COVID-19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self-management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home-isolated patients with COVID-19 infection. METHODS: A retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed. RESULTS: A volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high-risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same-day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE® platform) to assess the patient's clinical status and need. Real-time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin-naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home. CONCLUSION: Diabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID-19 pandemic was safe and effective.

Changing of the etiology of acute pancreatitis after using a systematic search.

BACKGROUND: Alcohol and gallstone are the 2 most common etiologies of acute pancreatitis (AP). In Thailand, alcohol has been believed to be the leading etiology of AP. However, a thorough and systematic search may discover real etiology of AP. MATERIAL AND METHOD: During 2006 to 2007, seventy-eight patients with AP were prospectively searched for the etiology by: 1. Performing liver chemistry tests and transabdominal ultrasonography (US) for gallstone in every case; 2. Measuring serum triglyceride and calcium in every case; 3. Investigating definite drugs use or other identified etiology; 4. Asking about the amount of alcohol ingestion (amount > 80 g/day for > 5 years was required for alcoholic AP; 5. Performing CT scan (if age > 40 years) and EUS if no etiology was identified. Results were compared with the retrospective data from medical records of 66 AP patients during 2003-2005. RESULTS: Of the 78 patients, the etiologies were alcohol in 32 (41%), gallstones in 29 (37%), miscellaneous in 13 (17%) and idiopathic AP in 4 patients (5%). When compared with the retrospective data of the 66 patients over the past 3 years, the etiologies were alcohol 53%, gallstone 22%, miscellaneous 11% and idiopathic 14%. Among the 45 patients of the study period (58%) who consumed alcohol more than the defined threshold for alcoholic AP, 13 (29%) were found to have other explainable causes of AP, i.e gallstones in 10, hypertriglyceridemia in 2 and AIDS cholangiopathy in 1 patient. CONCLUSION: Alcohol was probably over-diagnosed as a leading etiology of AP in the past. A systematic search of the etiologies lowered the frequency of alcoholic and idiopathic AP but discovered more patients with gallstone pancreatitis. One-fourth of AP patients who were heavy drinkers had other explainable etiologies of AP.