COVID-19 pandemic: a double trouble for Indian adolescents and young adults living with type 1 diabetes

Diabetes and natural and man-made disasters: prevention, preparation, response and recovery

Both the global prevalence of diabetes and the frequency of natural and man-made disasters are increasing. Of all chronic diseases, the consequences of sudden loss of medical supplies are most serious for those with diabetes, with people living with type 1 diabetes being at risk of death within a few days without insulin. This review considers how to prepare for and respond to sudden reductions in medical supplies to those with diabetes. Recent experiences with the COVID-19 pandemic in India, the war in Ukraine and the war/blockade in the Tigray region of Ethiopia are described, and the importance of prevention, preparedness, response and recovery are discussed. It is hoped that lessons from these and other disasters and ongoing advocacy and other actions may help to mitigate the risks of significant morbidity and mortality for people with diabetes in disaster-impacted regions across the world.

The Effect of Metabolic Control on Diabetes Complication Rates and the Need for Medical Care During COVID-19 Social Isolation in Adjara, Georgia

INTRODUCTION

Social isolation or distancing during the COVID-19 pandemic was associated with poor metabolic control in patients with diabetes mellitus. It might have contributed to the high mortality rate of those with diabetes who became infected. This study aims to determine the degree or level of metabolic control in patients with diabetes mellitus, the progression of its complications, and the need for emergency care during social isolation caused by the COVID-19 pandemic.

MATERIALS AND METHODS

A retrospective study was conducted in Georgia on 752 diabetic patients aged under 65 years old. Results showed that many patients did not control their blood glucose levels, measure their blood pressure, or know their cholesterol and glycated hemoglobin levels before and after the pandemic. Over 35% of patients experienced glycemic profile fluctuations. We compared metabolic rates with complications of diabetes and the need for emergency medical care during isolation. It was found that the testability of glycemia (p = 0.006), fluctuations in glucose (p = 0.001), and glycated hemoglobin levels before (p = 0.001) and after the pandemic (p = 0.004) increased the prevalence of diabetes-related heart disease and multiple micro- and macroangiopathies. Blood pressure (p = 0.001), cholesterol levels (p = 0.001), and glucose control (p = 0.012) affected the condition of patients with diabetes mellitus. It increased the need for medical care due to infarction, hypertension crisis, and hyperglycemia.

CONCLUSIONS

In a crisis where medical care is limited, the management of diabetes patients requires more attention. Our study proves that active middle-aged patients during isolation had poor metabolic control in terms of self-control of the disease. It is necessary to constantly inform and educate patients about the importance of metabolic parameters in progressing diabetes complications. Proper metabolic control could prevent complications of diabetes and improve a patient's quality of life.

Psychosocial impact of the COVID-19 pandemic for adolescents with type-1-diabetes: a qualitative interview study involving adolescents and parents

This study aims to investigate the psychosocial impact of the COVID-19 pandemic on adolescents with type-1-diabetes (T1D). We conducted 18 semi-structured interviews including adolescents with T1D (n = 10, 50% female, 15-18 years) and their parents (n = 8, 88% mothers). The main topics addressed were experiences during confinement regarding everyday life, lifestyle behaviors, diabetes management and treatment. We applied thematic analysis to identify common patterns of meanings. Being aware of belonging to a potential COVID-19 risk group caused worries especially in parents which resulted in strict adherence to preventive measures. Information from trustworthy sources regarding the actual risk mitigated the concerns. Digital diabetes treatment was well accepted and experienced as highly usable. The pandemic situation either facilitated or hindered the transition from parental control to diabetes self-management. While some patients managed to improve healthy lifestyle behaviors as their everyday lives seemed more predictable, others had difficulties in adapting to changed daily routines resulting in increased sedentary behavior and snacking. The perceived level of stress was directly associated with blood glucose levels. In conclusion, the implementation of psychological interventions (both for adolescents with T1D and their parents) addressing mental health literacy and media literacy seems to be important to promote positive coping skills for dealing with the pandemic situation.

Metabolic control of diabetic patients assisted by private and public health care systems during the COVID-19 pandemic: A retrospective cohort study

AIMS

We sought to analyze the impacts of social restriction measures imposed by the pandemic COVID-19 on the control of metabolic parameters in diabetic patients.

METHODS

We accessed the medical records of patients who underwent clinical follow-up in the public and private health systems between July 2019 and June 2021. The sample consisted of 288 patients (111 adults and 177 older individuals). A two-way ANOVA mixed model was used to test the effects of intra- (time: baseline and after 24 months) and inter-subject factors. Linear regression analysis was used to predict the difference in body weight considering age, sex, HbA1c, health care system and insulin use.

RESULTS

Among adults, we observed an increase in body weight and LDL-c levels, especially for insulin users (p ≤ 0.05). Adults assisted by the public health care system showed higher HbA1c levels (p = 0.001). Among older individuals using insulin, blood glucose levels decreased (p = 0.019). Body weight decreased in those assisted by the private system (p = 0.005), while glycemia decreased for patients assisted by both health care systems (p = 0.043). The linear regression model confirmed that the increase in body weight was more pronounced in adults than in older individuals.

CONCLUSION

The social restriction measures imposed by the pandemic affected the metabolic control of diabetic patients, especially adults assisted by the public health care system.

Psychological consequences of the COVID-19 pandemic in people with type 1 diabetes: A systematic literature review

OBJECTIVE

A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors.

METHODS

A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included.

RESULTS

Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5-60.7%, n = 13 studies), anxiety (7-27.5%, n = 16 studies), and distress (14-86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality.

CONCLUSIONS

Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.

Psychological Outcomes of the COVID-19 Pandemic on People with Type 1 Diabetes Globally: A Scoping Review

BACKGROUND

People with type 1 diabetes (T1D) face heightened risks for morbidity and mortality from the 2019 Coronavirus (COVID-19). They also have elevated risks for disparate psychological outcomes during the COVID-19 pandemic, given their predisposition to mental health disorders, including anxiety and depression, and skyrocketing rates of these conditions among the general population.

METHODS

To investigate the psychological ramifications of the COVID-19 pandemic on people with T1D globally, we conducted a scoping review of recent literature across eight online databases. Articles were screened via a rigorous process, and data pertaining to psychological outcomes were coded into thematic areas for analysis.

RESULTS

Forty articles presenting data from 27 countries and 14 categories of psychological outcomes affecting people with T1D were included in this review. Psychological outcomes, in order of most to least frequently identified, included: stress, anxiety, social factors, worry, distress, fear, sleep habits, quality of life, depression, attitudes regarding COVID-19, other psychological issues, mental health services utilization, burnout, and temperament. Recurring findings demonstrated significant increases in the prevalence of mental health conditions, changes in sleeping habits, reductions of social support, and extensive psychosocial concerns among people with T1D. Associations between patients' psychological issues and demographic characteristics, diabetes self-management behaviors, glycemic control, and overall wellbeing were evident.

CONCLUSION

During the COVID-19 pandemic, people with T1D experienced pervasive psychological burdens. This review calls for further research examining the long-term impacts of the pandemic and strengthens awareness of the need for interventions to offset psychological challenges affecting people with T1D.

Children with type 1 diabetes in COVID-19 pandemic: Difficulties and solutions

Children/adolescents with type 1 diabetes (T1D) require holistic approach and continuous care. However, the coronavirus disease 2019 (COVID-19) pandemic has made challenges for the T1D children and their caregivers, professionals, and the healthcare system. This minireview aims to consolidate and discuss the difficulties and solutions of children with type 1 diabetes in the COVID-19 pandemic. T1D has been the most common type of diabetes in children and adolescents and the last decades has seen a rapid increase in the prevalence of T1D in youths worldwide, which deserves a public concern particularly in the COVID-19 pandemic. As reported in previous studies, T1D is a risk factor related to severe cases, while the virus may induce new-onset diabetes and serious complications. Moreover, restriction strategies influence medical availability and lifestyle, impact glycemic control and compilation management, and thus pose stress on families and health providers of youths with T1D, especially on those with certain fragile conditions. Therefore, special treatment plans are required for children provided by caregivers and the local health system. Latest health tools such as improved medical devices and telemedicine service, as well as a combined support may benefit in this period. This minireview emphasises that continued medical access and support are required to prevent deteriorated condition of children and adolescents with diabetes throughout this pandemic. Therefore, strategies are supposed to be formulated to mitigate the difficulties and stress among this group, particularly in the most at-risk population. Proposed solutions in this minireview may help individuals and the health system to overcome these problems and help youths with T1D in better diabetes management during such emergency situations.

Anxiety, Distress and Stress among Patients with Diabetes during COVID-19 Pandemic: A Systematic Review and Meta-Analysis

The prevalence of mental health disorders has increased during the COVID-19 pandemic. Patients with chronic diseases, such as diabetes, are a particularly vulnerable risk group. This study aims to assess the levels and prevalence of anxiety, distress, and stress in patients with diabetes during the COVID-19 pandemic. A systematic review was conducted in CINAHL, Cochrane, LILACS, Medline, SciELO, and Scopus in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Thirty-seven articles with a total of 13,932 diabetic patients were included. Five meta-analyses were performed. The prevalence of anxiety was 23% (95% CI = 19–28) in T1DM and 20% (95% CI = 6–40) in T2DM patients. For diabetes distress it was 41% (95% CI = 24–60) for T1DM and 36% in T2DM patients (95% CI = 2–84). For stress, the prevalence was 79% (95% CI = 49–98) in T1DM patients. People with diabetes have significant psychiatric comorbidity as well as psychological factors that negatively affect disease management, increasing their vulnerability in an emergency situation. To establish comprehensive care in diabetic patients addressing mental health is essential, as well as including specific policy interventions to reduce the potential psychological harm of the COVID-19 pandemic.

Glycemic control among children and adolescents with type 1 diabetes during COVID-19 pandemic in Egypt: a pilot study

Background

The COVID-19 pandemic and the consequences of lockdown significantly impacted glycemic control.

Aim

To evaluate the impact of the pandemic and lockdown on glycemic control among Egyptian children and adolescents with type 1 diabetes.

Methods

Cross-sectional study conducted through an online questionnaire. The participants were patients with type 1 diabetes and/or their caregivers

Results

A total of 115 valid responses to the questionnaire were received. During the lockdown, almost 64% of patients showed worsening of their HbA1C with significant increment of HbA1c after the lockdown (p < 0.001). Synchronous simple telemedicine service was initiated through phone calls and social media applications, and 97% of the patients and their families were successfully able to continue follow-up. Almost 76% of the patients/caregivers showed moderate stress which was significantly correlated with HbA1C (p < 0.05). Fear of hospital admission and fear from shortage of medical supplies were the main COVID-19-related worries.

Conclusion

The lockdown negatively impacted glycemic control and initiated a set of COVID-19 worries and stress among patients and their caregivers in Egypt. Telemedicine service, even simple tools, is effective and important for the continuity of care among patients. The limited availability and the fear of shortage of medical supply forced patients to ration glucose monitoring.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13410-021-00968-y.

COVID-19 pandemic and psychological wellbeing among health care workers and general population: A systematic-review and meta-analysis of the current evidence from India

Introduction

Coronavirus disease 2019 (COVID-19) was declared as pandemic and measures adopted for its control included quarantine of at-risk, isolation of infected along with other measures such as lockdown, restrictions on movement, and social interactions. Both the pandemic and these measures have the potential to cause mental health problems among individuals.

Objective

The present study aimed to investigate and estimate the prevalence of psychological well-being, particularly from an Indian perspective using systematic review and meta-analysis of existing literature.

Methods

We searched in the PubMed database, starting from the onset of the current pandemic and until 10th October 2020 to synthesize evidence on mental health outcomes from India. DerSimonian and Laird method of the random-effects meta-analysis was employed and heterogeneity between studies was assessed using the Chi-square based Cochran's Q statistic and I-squared (I²) statistics.

Results

The pooled prevalence of stress in nine studies was 60.7% (95% CI: 42.3%–77.7%), depression in eight studies was 32.7% (95% CI: 24.6%–41.3%), anxiety in six studies was 34.1% (95% CI: 26.3%–42.3%) and sleep disturbances in six studies was 26.7% (95% CI: 13.9%–41.8%). As expected, high heterogeneity was observed in the above-mentioned outcomes. Sub-group analysis showed that Health Care Workers (HCWs) had a higher prevalence of stress, anxiety, depression & psychological distress in comparison to the general population.

Conclusion

A significant impact on psychological well-being during COVID-19 was observed in India as common adverse outcomes were stress (61%), psychological distress (43%), anxiety (34%), depression (33%), and sleep disturbances (27%). Thus the COVID-19 pandemic represents an unprecedented threat to mental health, which should become a priority for public health strategies.

How Do you Focus on Quality of Life When Kids Cannot Go to School or Outside?

Purpose of Review

This paper seeks to explore the definitions of quality of life and its application to pediatric research and clinical practice. This paper also highlights some of the imperfections in evaluating patient-reported outcomes designed to measure quality of life in pediatrics. Additionally, this paper explores some of the unique challenges in promoting quality of life during the COVID-19 pandemic.

Recent Findings

There are numerous different measurement scales to examine quality of life in children of different ages, and with a variety of disease states.

Summary

Despite the number of quality of life measurement tools, not every patient population has a validated measure, including patients with palliative care needs. There is no consensus on how to incorporate findings from patient-reported outcomes into clinical practice recommendations. Professional organizations offer guidance and resources for families to encourage focus on quality of life during the COVID-19 pandemic.