COVID-19 pandemic brings opportunities for innovations in diabetes management
July 20, 2020 (Healio – Endocrine Today) — The COVID-19 pandemic offers diabetes teams an opportunity to restructure service models and create innovative pathways for chronic disease management, with a greater reliance on mobile technology and virtual care.
Due to the restrictions imposed during the pandemic, people with diabetes may experience longer-term harms resulting from inadequate clinical support and less frequent monitoring of diabetes-related complications, David C. Klonoff, MD, FACP, FRCPE, medical director of the Mills-Peninsula Medical Center (Sutter Health) Diabetes Research Institute in San Mateo, California, and clinical professor of medicine at University of California, San Francisco, and colleagues wrote in an article published in European Journal of Endocrinology. Outpatient services must be reorganized to focus on “proactive care” for those at highest risk, making use of telehealth and digital services for consultations, self-management and remote monitoring, where appropriate, the researchers wrote.
“It is unclear whether people with diabetes are at higher risk for contracting COVID-19; however, they are definitely at higher risk for poor outcomes if they have to be hospitalized,” Klonoff told Healio. “Other risk factors for poor outcomes include male sex, obesity, older age, comorbid chronic diseases, lower economic status, and the amount of virus in an exposure. Patients with diabetes sometimes delay regular medical follow-up for controlling blood pressure, foot infections or retinal problems while they avoid going to their doctor. Quarantined people can develop stress and depression, which can lead to an unhealthy diet and reduced physical activity. Those lifestyle changes can increase the risk for cardiovascular disease.”
Prevent avoidable admissions, readmissions
Klonoff and colleagues wrote that diabetes teams must work to maintain patient safety while accelerating patient flow through the hospital and delivering closely managed outpatient services. To do this, providers must articulate any evolving COVID-19 advice to people with diabetes so patients understand risk status and expectations around health care service interaction.
Clinicians must also work to prevent people with diabetes from developing diabetes-related complications, support inpatient teams to safely manage people with acute diabetes complications— including those admitted to the ICU with high insulin requirements — and provide education for front-line inpatient teams who may be unfamiliar with diabetes management.
Providers should also work to facilitate early discharge with programmed daily diabetes follow-up, when possible, to help prevent readmission to the hospital, as well as provide support for primary care diabetes management.
“Challenges of outpatient care delivery are compounded by reduced staffing levels due to illness and deployment of clinicians to front-line duties,” the researchers wrote. “Smaller numbers of staff are thus manning skeleton outpatient services. The duration of outpatient service disruption is currently uncertain.”
New tools for management
Klonoff told Healio that individuals with diabetes who are quarantined or dealing with lockdown restrictions can benefit from four modern technologies: remote telemedicine care; remote continuous glucose monitoring with wireless data transmission to the physician; mobile apps to monitor food intake, exercise, BP and weight; and websites from trusted organizations, such as the American Diabetes Association and NIH.
Stratification of patients for face-to-face or remote follow-up should be based on a balanced risk assessment, the researchers wrote.
“If someone already has diabetes and they develop COVID-19, they should see their physician as soon as possible to initiate treatment that will improve symptoms and decrease the risk for being hospitalized,” Klonoff said.
For more information:
David C. Klonoff, MD, FACP, FRCPE, can be reached at Diabetes Research Institute, Mills-Peninsula Medical Center, 100 S. San Mateo Drive, Room 5147, San Mateo, CA 94401; email: firstname.lastname@example.org.