Mental health burden of patients with diabetes before and after the initial outbreak of COVID-19: predictors of mental health impairment

Social Determinants as Mediators of the Emotional State of People With Type 2 Diabetes and/or Hypertension During the COVID-19 Pandemic in Ecuador and Spain

INTRODUCTION

We aimed to explore the impact of the COVID-19 pandemic and the resulting restrictions on the emotional state of people with type 2 diabetes mellitus (T2DM) and/or hypertension in Ecuador and Spain. Given the differences in sociopolitical and socioeconomic contexts between these two countries, the research focused on how these diverse environments and their management of social policies and pandemic strategies influenced the emotional well-being of individuals with chronic illnesses.

METHODS

We conducted 36 semi-structured telephone interviews between August and December 2020 with adults diagnosed with T2DM and/or hypertension (19 in Ecuador, 17 in Spain). The interviews were recorded, anonymized and transcribed for thematic analysis. This approach allowed us to systematically identify and analyse themes related to the participants' emotional experiences during the pandemic.

RESULTS

The results revealed a significant deterioration in the emotional state of participants, attributable to the stress generated by the health crisis and concerns related to their chronic illnesses. The situation elicited a range of emotions among participants, from boredom and apathy to fear, uncertainty and depression. The study highlighted how the impact on emotional well-being was shaped by the interplay between conjunctural determinants (measures to control COVID-19 infections) and structural factors driving inequalities (social class, gender, ethnicity).

CONCLUSION

We developed a conceptual framework illustrating how measures to control COVID-19 infections directly influenced economic, health and social determinants, which interacted with pre-existing inequalities and had a differential impact on individuals' emotional well-being. This framework can be useful for designing more effective and equitable social policies during future health crises, ensuring they address social needs and safeguard psychological and emotional well-being, particularly among vulnerable groups such as those with chronic illnesses.

PATIENT AND PUBLIC CONTRIBUTION

Thirty-six participants diagnosed with T2DM and/or hypertension (19 in Ecuador, 17 in Spain) contributed to the study by sharing their emotional experiences during the pandemic. Their detailed accounts enriched the research by providing valuable insights into how the pandemic affected their emotional well-being. There was no additional involvement or contribution from the public in the design, conduct, analysis or interpretation of the study, nor in the preparation of the manuscript.

Investigating the prevalence and associated factors of depression, anxiety, and loneliness among people with type-2 diabetes in Bangladesh: a community-based study

Diabetes mellitus is a major worldwide health concern. Diabetes has been associated with a number of adverse mental health conditions including depression, anxiety, and loneliness that can negatively impact diabetes outcomes. This study aimed to investigate factors associated with depression, anxiety, and loneliness in people, in the community, suffering with diabetes in Bangladesh. A cross-sectional study was conducted with 600 people with type-2 diabetes (54.83% females; mean age: 52.70 ± 11.56 years) between July and September 2022. Purposive sampling method was used to recruit the participants. A validated semi-structured questionnaire was used to collect demographic and other data. Depression, anxiety, and loneliness were measured using the PHQ-9, GAD-7, and UCLA Loneliness scale, respectively. Bivariate and multivariable linear regression analyses were conducted to ascertain factors that were significantly associated with these mental health conditions. The prevalence of depression, anxiety, and loneliness was 31.17%, 21.83%, and 28.00%, respectively. A lack of formal education, and not taking part in physical activities were significantly associated with all three mental health states. Duration of diabetes and being on medication for high cholesterol were also associated with depression and anxiety. Older age and being widowed were significantly associated with loneliness. This study found that depression, anxiety, and loneliness are prevalent among Bangladeshi people with diabetes, with certain sociodemographic and diabetes-related factors associated with increased risk. The findings emphasize the need for targeted interventions to people within the communities, at grassroot levels in order to improve reduce health inequality, and improve the mental health of people living with diabetes.

How Does the Psychological Impact of COVID-19 Affect the Management Strategies of Individuals with Type 1 and Type 2 Diabetes? A Mixed-Method Study

(1) Background: During and after the pandemic, individuals with type 1 and type 2 diabetes struggled to maintain a healthy lifestyle due to psychological distress and the struggle to accommodate contextual challenges and changes in their family and work obligations and expectations. This study aims to explore the long-term impacts of the pandemic on proactive self-management behaviors and outcomes that consider contextual and environmental factors, such as family and work dynamics. (2) Methods: In this mixed-method study, data were collected from 418 participants using the Hospital Anxiety and Depression Scale (HADS) and the Insomnia Severity Index (ISI), followed by 16 individual interviews. (3) Results: The prevalence of depression was 37.1%, that of anxiety was 59.1%, and that of insomnia was 66.3%. Significant differences were observed in anxiety by age (p = 0.02), while individuals with other comorbidities were more likely to report insomnia (p = 0.3). Overall, various challenges during the pandemic have exacerbated emotional distress and complicated self-care routines and adherence to healthy lifestyles. (5) Conclusions: The COVID-19 pandemic has prompted individuals with type 1 and 2 diabetes to adopt alternative health-management methods, such as self-care, proactive initiatives, and daily challenges. Enhancing proactiveness, awareness, and an understanding of individuals' needs is crucial for alleviating stress, controlling disease, and preparing for potential future health crises in the wake of the pandemic's long-term effects.

Incident Functional Limitations Among Older Adults With Diabetes During the COVID-19 Pandemic: An Analysis of Prospective Data From the Canadian Longitudinal Study on Aging

OBJECTIVES

The objectives of this study were 1) to examine and compare changes in functional limitations during the COVID-19 pandemic among older adults with and without diabetes; and 2): to identify key risk factors associated with developing functional limitations among older adults with and without diabetes during the pandemic.

METHODS

We analyzed data collected from the Canadian Longitudinal Study on Aging. The analysis was restricted to those with no functional limitations in the follow-up 1 wave (2015 to 2018) (final sample N=6,045). Regression models were used to describe associations between diabetes status and functional limitation outcomes. We conducted stratified analyses to evaluate whether these associations varied by sociodemographic indicators. We also predicted the probability of the development of ≥1 functional limitation among those with and without diabetes for various patient profiles.

RESULTS

Older adults with diabetes were 1.28-fold (95% confidence interval 1.02 to 1.60) more likely to develop ≥1 functional limitation than older adults without diabetes after controlling for relevant sociodemographic and health covariates. Risk factors for incident functional limitations among older adults, both with and without diabetes, include increasing age, low socioeconomic status, obesity, multimorbidity, and physical inactivity.

CONCLUSIONS

Our findings indicate that older adults with diabetes were at an increased risk of developing functional limitations during the pandemic when compared with older adults without diabetes, even when controlling for several key risk factors. Targetting modifiable risk factors, such as physical activity, may help to reduce the risk of functional limitations among older adults with diabetes.

Determinants of anxiety and depression among type 2 diabetes mellitus patients: A hospital-based study in Bangladesh amid the COVID-19 pandemic

Anxiety and depression are common psychological disorders in patients with type 2 diabetes mellitus (T2DM), which was upsurging worldwide amid the COVID-19 pandemic. This study aimed to explore factors associated with anxiety and depression among T2DM patients in Bangladesh during the COVID-19 pandemic. A cross-sectional study was conducted among T2DM patients using face-to-face interviews. Anxiety and depressive symptoms were measured using the CAS and PHQ-9 scales. Outcomes were assessed including sociodemographic, lifestyle, anthropometric, and challenges of getting routine medical and healthcare access-related questions. The prevalence of anxiety and depressive symptoms were 29.8% and 22.7%, respectively. Regression analysis reported that males older than 50 years, illiterate, unemployed or retired, urban residents, below the recommended level of moderate to vigorous physical activity (MVPA), low dietary diversity score (DDS) and obese respondents were associated with higher odds of anxiety and depressive symptoms. Moreover, respondents with transport difficulties, unaffordable medicine, medicine shortages, close friends or family members diagnosed with COVID-19 and financial problems during COVID-19 had higher odds of anxiety and depressive symptoms than their counterparts, respectively. Our study suggests providing psychological support, such as home-based psychological interventions, and highlighting policy implications to ensure the well-being of T2DM patients in Bangladesh during the pandemic.

Stress and Depressive and Anxiety Symptoms in the General Population and in SARS-CoV-2-Infected Patients-Findings from a Population-Based Three-Wave Study

Objective: Understanding factors that impaired mental health during the COVID-19 pandemic is extremely relevant in order to mitigate long-term consequences of the pandemic and to promote resilience in future crises. Method: Data were collected in southern Germany in a population-based survey study (CoKoS) with three times of measurement in May 2020, November 2020 and July 2021. Predictors of depressive and anxiety symptoms were measured with a short version of the Patient Health Questionnaire (PHQ-4) in the general population (N = 758) and individuals who were infected with SARS-CoV-2 in the beginning of the pandemic (N = 412). We investigated differences between both samples and how stress components (worry, tension, demands and joy) measured with the Perceived Stress Questionnaire (PSQ) varied with depressive and anxiety symptoms over time. Three linear mixed models (GLMMs) were fitted to predict the PHQ-4 stepwise, including sociodemographic variables and stress (PSQ). Results: Depressive and anxiety symptoms increased from May 2020 to November 2020 and remained stable until July 2021. There were no differences between people with SARS-CoV-2 infection and the general population. Those with a pre-existing disease and lower education reported higher levels of depressive and anxiety symptoms. Stress explained a substantial fraction of variance in depressive and anxiety symptoms. The stress component worry emerged as the strongest predictor of depressive and anxiety symptoms, whereas joy seemed to buffer these symptoms. Conclusions: The results suggest that mitigating people's worry and increasing joy may promote resilience in future crises. Future studies should assess mental health interventions targeted at vulnerable groups, such as those with lower socioeconomic status and poorer health.

Insomnia and common mental disorder among patients with pre-existing chronic non-communicable diseases in southern Ethiopia: a survey during COVID-19 pandemic

Background

COVID-19 has been causing significant mental health problems and other health-related issues. Despite the fact that COVID-19 has a significant impact on chronic disease patients, there is scant research on insomnia, common mental health disorders (CMD), and their associated factors among chronic disease patients.

Objective

The purpose of this study was to assess the prevalence of insomnia and common mental disorders (CMD) and their associated factors among patients with pre-existing chronic NCDs in Sidama, southern Ethiopia.

Methods

A multicenter cross-sectional study was undertaken between June 1 and September 1, 2021. The study included 633 participants. CMD and insomnia were assessed using a 20-item Self-Reported Questionnaire (SRQ-20) and a 7-item Insomnia Severity Index (ISI) scale, respectively. To describe the various variables, descriptive statistics were used. We performed multivariable logistic regression analysis to identify independent factors associated with CMD and insomnia. A value of p < 0.05 was considered statistically significant at a 95% confidence interval.

Results

The prevalence of insomnia and CMD was found to be 39.3% and 46.8%, respectively. Being merchant (AOR = 0.33; 95% CI = 0.13, 0.82), having a diagnosis of diabetes mellitus (AOR = 1.89; 95% CI = 1.04, 3.46), comorbid diagnosis (AOR = 3.96; 95% CI = 2.27, 6.89), low social support (poor (AOR = 3.37; 95% CI = 1.51, 7.57) and moderate (AOR = 3.13; 95% CI = 1.46, 6.69)), symptoms of insomnia (AOR = 12.08; 95% CI = 7.41, 19.72) and poor quality of life (QOL) (AOR = 1.67; 95% CI = 1.04, 2.72) were independent predictors of CMD. We also found out that, having cardiovascular disorders (CVDs) (AOR = 2.48; 95% CI = 1.18, 5.19), CMD (AOR = 12.09; 95% CI = 7.46, 19.61), and poor QOL (AOR = 2.04; 95% CI = 1.27, 3.26) were significantly associated with insomnia symptoms.

Conclusion

Our study suggests that substantially high prevalence of CMD and insomnia. Significant association between CMD and occupation, diagnosis, comorbidity, social support, insomnia, and QOL were found. We also revealed that having CVDs, CMD, and poor QOL were significantly associated with insomnia symptoms. Therefore, dealing with the mental health problems of patients with chronic NCDs is an essential component of public health intervention during the COVID-19 pandemic.

Gestational diabetes mellitus and COVID-19: The epidemic during the pandemic

During the global coronavirus disease 2019 (COVID-19) pandemic, people worldwide have experienced an unprecedented rise in psychological distress and anxiety. In addition to this challenging situation, the prevalence of diabetes mellitus (DM), a hidden epidemic, has been steadily increasing in recent years. Lower-middle-income countries have faced significant barriers in providing accessible prenatal care and promoting a healthy diet for pregnant women, and the pandemic has made these challenges even more difficult to overcome. Pregnant women are at a higher risk of developing complications such as hyper-tension, preeclampsia, and gestational diabetes, all of which can have adverse implications for both maternal and fetal health. The occurrence of gestational diabetes has been on the rise, and it is possible that the pandemic has worsened its prevalence. Although data is limited, studies conducted in Italy and Canada suggest that the pandemic has had an impact on gestational diabetes rates, especially among women in their first trimester of pregnancy. The significant disruptions to daily routines caused by the pandemic, such as limited exercise options, indicate a possible link between COVID-19 and an increased likelihood of experiencing higher levels of weight gain during pregnancy. Notably, individuals in the United States with singleton pregnancies are at a significantly higher risk of excessive gestational weight gain, making this association particularly important to consider. Although comprehensive data is currently lacking, it is important for clinical researchers to explore the possibility of establishing correlations between the stress experienced during the pandemic, its consequences such as gestational gain weight, and the increasing incidence of gestational DM. This knowledge would contribute to better preventive measures and support for pregnant individuals during challenging times.

Construct validity of the General Health Questionnaire (GHQ-12) in patients with COVID-19 and its demographic and medical correlates

Introduction

The present cross sectional study aimed to evaluate the construct and criterion validity, reliability, and gender and age differences of the 12-item General Health Questionnaire (GHQ-12) among hospitalized patients with COVID-19 in 2020. The criterion validity was assessed via its link with perceived stress, sleep quality, daily life activities, and demographic and medical characteristics.

Methods

A total of 328 COVID-19 patients (55.8% men; Mage = 50.49, SD = 14.96) completed the GHQ-12, the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), the Activities of Daily Life (ADL)-Katz Scale, and the Lawton Instrumental Activities of Daily Living Scale (IADL).

Results

Among 13 factorial models, the three-factor model (successful coping, self-esteem, and stress) was shown to have the best fit. GHQ-12 was positively associated with PSQI, PSS, Hyperlipidemia, psychiatry disorders, hospitalization duration, the change in sleep time, and use of sleeping pills, and negatively correlated with educational level, and the number of family members. The GHQ-12 also had a negative correlation with ADL and IADL in over 60 years of age group. Females scored higher on total GHQ-12 scores, compared to males. Finally, the hospitalization duration was longer for patients over 60 (mean = 8.8 days, SD = 5.9) than patients under 60 (mean = 6.35 days, SD = 5.87).

Discussion

Overall, the findings provided evidence that mental distress in patients with COVID-19 is correlated with high perceived stress, low sleep quality, low ADL and IADL, and a range of demographic features and medical conditions. Designing psychological interventions for these patients that target the aforementioned correlates of mental distress is warranted.

Anxiety and depression among people with type 2 diabetes visiting diabetes clinics of Pokhara Metropolitan, Nepal: a cross-sectional study

OBJECTIVES

To estimate the prevalence of anxiety and depression and identify the associated factors among people with type 2 diabetes mellitus (T2DM) visiting diabetes clinics of Pokhara Metropolitan, Nepal.

DESIGN

Cross-sectional study.

SETTING

Three diabetes clinics in Pokhara Metropolitan, Nepal, from May to July 2021.

PARTICIPANTS

283 people with T2DM visiting selected diabetes centres of Pokhara Metropolitan.

OUTCOME MEASURES

Anxiety and depression were the outcome measures. Face-to-face interviews were conducted using a structured questionnaire comprising information related to participants' sociodemographic profile and several factors along with Hospital Anxiety and Depression-Anxiety subscale and Patient Health Questionnaire-9 to assess the levels of anxiety and depression, respectively. Pearson's Χ² tests and binary logistic regression were performed to examine association between dependent and independent variables at 5% level of significance.

RESULTS

The prevalence of anxiety and depression was 31.4% (95% CI 26.2% to 37.5%) and 36.4% (95% CI 30.8% to 42.0%), respectively. Anxiety was found to be associated with a lower level of perceived social support (adjusted OR (AOR) 2.442, 95% CI 1.020 to 5.845), multiple complications (AOR 2.758, 95% CI 1.015 to 7.334) and comorbidities (AOR 2.110, 95% CI 1.004 to 4.436), severe COVID-19 fear (AOR 2.343, 95% CI 1.123 to 4.887) and sleep dissatisfaction (AOR 1.912, 95% CI 1.073 to 3.047). Economical dependency (AOR 1.890, 95% CI 1.026 to 3.482), no insurance (AOR 2.973, 95% CI 1.134 to 7.093), lower perceived social support (AOR 2.883, 95% CI 1.158 to 7.181), multiple complications (AOR 2.308, 95% CI 1.585 to 6.422) and comorbidities (AOR 2.575, 95% CI 1.180 to 5.617), severe COVID-19 fear (AOR 2.117, 95% CI 1.009 to 4.573), alcohol use (AOR 2.401, 95% CI 1.199 to 4.806) and sleep dissatisfaction (AOR 1.995, 95% CI 1.093 to 3.644) were found to be associated with depression.

CONCLUSION

This study showed high prevalence levels of anxiety and depression among people with T2DM. Strengthening social support and focusing on people with diabetes suffering from comorbidity and complications could help to reduce their risk of mental health problems.

From Zero to Hero: Type 2 Diabetes Mellitus Patients Hike on the Way of St. James-A Feasibility Study with Analyses of Patients' Quality of Life, Diabetes Distress and Glucose Profile

This study investigates the feasibility of an accompanied 5-day hiking tour (Way of St. James) for type 2 diabetes mellitus (T2DM) patients and its impact on their quality of life/well-being, diabetes distress and glucose profile. Twenty-three T2DM patients (with and without insulin therapy) participated in the study. The 120 km pilgrimage (from Ferrol to Santiago de Compostela, Spain) was accompanied by three physicians, two diabetes counselors and one sports scientist. Quality of life/well-being was assessed by the World Health Organization’s (WHO)-5 questionnaire, and diabetes distress was evaluated based on the Problem Areas in Diabetes (PAID) scale. The glucose levels of six insulin-treated patients were measured using continuous glucose monitoring (CGM) devices, considering that insulin-treated patients can be at increased risk of exercise-induced hypoglycemia. A significant improvement in quality of life/well-being was reported (p < 0.001), while diabetes distress did not change significantly (p = 0.203). Only two of the six insulin-treated patients showed moderate hypoglycemic episodes between 0.97% and 5.21% time below range per day, with glucose levels between 53−70 mg/dL. Hiking tours such as the one organized for this study can improve quality of life/well-being without increasing diabetes distress and are considered relatively safe for T2DM patients, even for those being treated with insulin.

Evaluation of oral health-related quality of life and its association with mental health status of patients with type 2 diabetes mellitus in the post-COVID-19 pandemic era: A study from Central Saudi Arabia

Background and objectives

The association between oral and mental health is reciprocal, in which poor oral health may lead to several mental health issues, especially among patients with diabetes. The present study evaluated oral health-related quality of life (OHRQOL) and its association with mental health conditions among patients with type 2 diabetes mellitus (T2DM) in central Saudi Arabia.

Methods

The Arabic version of the Oral Health Impact Profile-14 (OHIP-14) questionnaire and the Depression, Anxiety, and Stress Scale-21 Items (DASS-21) were used to assess the OHRQOL and mental health status of patients with diabetes. We utilized logistic regression analysis to identify the predictors of poor OHRQOL, and Spearman's correlation test to identify any correlations between OHIP-14 and overall DASS-21 scores, as well as each subscale.

Results

Of the 677 patients included in the present study, 52.7% had a poor OHRQOL, which was significantly higher (positive association) among patients with a longer duration of diabetes (adjusted odds ratio [AOR] = 3.31; 95% confidence interval [CI] = 1.96-4.17) and those who did not periodically monitor their oral health (AOR = 2.85; 95% CI = 1.76-3.89). Some forms (mild, moderate, severe, or extremely severe) of depression, anxiety, and stress were observed in 59.7, 71.1, and 67.1% of the participants, respectively. Furthermore, we found that the total OHRQOL scores had a significant positive association with depression (AOR = 2.32, 95% CI = 1.34-3.71, p = 0.001), anxiety (AOR = 1.81, 95% CI = 1.22-2.79, p = 0.003), and stress (AOR = 1.43, 95% CI = 1.14-2.19, p = 0.026).

Conclusion

The results of the present study suggest the importance of appropriate and targeted health education programs for T2DM patients to ensure periodic dental examinations and oral health. Additionally, we recommend counseling sessions for all T2DM patients with trained healthcare providers to improve their mental health status during follow-up visits at outpatient diabetes care centers.

Prevalence of Depression and Related Factors among Patients with Chronic Disease during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

The management of chronic diseases in the midst of the COVID-19 pandemic is especially challenging, and reducing potential psychological harm is essential. This review aims to determine the prevalence of depression during the COVID-19 pandemic in patients with chronic disease, and to characterize the impacts of related factors. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The meta-analysis was performed using StatsDirect software. The review identified 33 articles with a total of 50,905 patients with chronic diseases. Four meta-analyses were performed to estimate the prevalence of depression. In diabetic patients, the prevalence ranged from 17% (95% CI = 7-31) (PHQ-9) to 33% (95% CI = 16-51) (PHQ-8); in obese patients, the prevalence was 48% (95% CI = 26-71); and in hypertensive patients, the prevalence was 18% (95% CI = 13-24). The factors significantly associated with depression were female sex, being single, deterioration in the clinical parameters of diabetes, a decrease in self-care behavior, reduced physical activity and sleep time and fear of contagion. The COVID-19 pandemic has significantly increased levels of depression among persons with chronic disease. Pandemics and other emergency events have a major impact on mental health, so early psychological interventions and health management policies are needed to reinforce chronic patients' physical and mental health.

Gender-Specific Effect of Couple-Based Intervention on Behavioral and Psychological Outcomes of Older Adults with Type 2 Diabetes during the COVID-19 Partial Lockdown in Guangzhou, China

This study aimed to evaluate the gender-specific effect of a couple-based intervention on the management behaviors and mental well-being of community-dwelling older adults with type 2 diabetes mellitus during the COVID-19 partial lockdown in Guangzhou. Out of 207 participants involved in a prior randomized controlled trial (Trial no. ChiCTR1900027137), 156 (75%) completed the COVID-19 survey. Gendered differences in management behaviors and depressive symptoms between the couple-based intervention group and the patient-only control group were compared by distance to the high-risk areas cross-sectionally and longitudinally using random intercept models. Cross-sectionally, female patients of the intervention group had more positive behavior change scores (β = 1.53, p = 0.002) and fewer depressive symptoms (β = −1.34, p = 0.02) than the control group. Over time, female patients lived closer to the high-risk areas (<5 km) and showed decreasing depressive symptoms (β = −4.48, p = 0.008) in the intervention group vs. the control group. No statistically significant between-group difference was found for males. Females tended to benefit more from the coupled-based intervention than males did, particularly among these closer to the high-risk areas. Chronic disease management can be better sustained with active spousal engagement.

Sex and Gender Impact Mental and Emotional Well-Being During COVID-19 Pandemic: A European Countries Experience

Objective: The COVID-19 pandemic influences mental health drastically. Therefore, our aim was to investigate whether biological sex and gender-related factors are associated with mental health during the COVID-19 pandemic. Materials and Methods: The International COVID-19 Awareness and Responses Evaluation Study is an international multiwave cross-sectional observational cohort study of public awareness, attitudes, and responses to public health policies (www.mbmc- cmcm.ca/covid19). The study is led by the Montreal Behavioural Medicine Centre in collaboration with 200 international collaborators from 42 countries. It has received research ethics board approval from the Comité d'éthique de recherche du CIUSSS-NIM (Centre intégré universitaire de santé et de services sociaux du Nord- de-l'île-de-Montréal), approval no.: 2020-2099/25-03-2020. Recruitment began on March 27, 2020, and the survey is available in 34 languages. The associations between biological sex, sociocultural gender, and mental health were assessed in multivariate logistic regression models only for the European population (n = 12,300). Results: Positive correlations were found between female sex and "feeling nervous, anxious or worried" (OR = 3.2, p < 0.001, 95% CI 1.87-5.63) and "feeling sad, depressed or hopeless" (OR 1.8, p = 0.031, CI 1.05-3.05). Male sex was related to more frequently "feeling irritable, frustrated, and angry" (OR = 1.8, p = 0.04, 95% CI 1.03-2.99). Concerning gender, a negative correlation between being employed and "feeling lonely or isolated" (OR = 0.26, p < 0.001, 95% CI 0.11-0.59) was observed in the female cohort. Conclusion: Sex and gender differences exist in the emotional responses during the COVID-19 pandemic. Especially, within the female cohort, unemployment is negatively associated with mental health. Therefore, this study suggests more targeted psychological and social support for females during the pandemic.

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.

The future of telehealth in type 1 diabetes

PURPOSE OF REVIEW

Although telemedicine and telehealth services have been a part of type 1 diabetes (T1D) clinical care for several decades, the expansion of in-home telemedicine during the COVID-19 pandemic significantly increased interest in long-term use as part of routine care. This review highlights the current literature regarding telemedicine in T1D care as well as the benefits and barriers to use in a postpandemic world.

RECENT FINDINGS

Telemedicine has increased patient contact with healthcare providers, allowing for more frequent insulin dose adjustments and improvements in glycemic outcomes. In addition to routine clinical care, T1D device training and mental healthcare have been successful through telemedicine. Significant barriers to continued telemedicine care exist, including patient access and technology knowledge, language, and loss of face-to-face interaction. Healthcare providers additionally face unpredictable reimbursement and loss of continuity across state lines, and lack of resources and training for device downloads and telemedicine software.

SUMMARY

Telemedicine can be successfully used in T1D care and has the potential to significantly impact glycemic and long-term outcomes. Due to continued interest for in-person visits by people with T1D and providers, it is likely that long-term telemedicine use will include a hybrid format.

Effects of the COVID-19 pandemic on clinically diagnosed psychiatric disorders in persons with type 2 diabetes

AIMS

To examine whether the incidence rates of diagnosed depression, anxiety disorders and stress reactions, as well as prescription rates of antidepressants and anxiolytics were higher during the COVID-19 pandemic than before in persons with type 2 diabetes in Germany. Contrary to earlier studies, clinical diagnoses of psychiatric disorders (ICD classification) were used.

METHODS

The German Disease Analyzer (DA) database is an outpatient database containing routine data on patients´ diseases and treatments provided by a representative panel of physician practices selected from across Germany. We assessed incidence rates of depressive disorders (ICD-10: F32, F33), anxiety disorders (F41) and stress reactions (F43) in quarters from January 2019 to March 2021 in 95,765 people with type 2 diabetes included in the DA in 2019 (mean age 68.9 years, 58% men). Prescription rates of antidepressants and anxiolytics in quarters from January 2020 to March 2021 were compared with prescription rates from 1 year earlier.

RESULTS

During the study period, the incidence rate of newly diagnosed depressive disorders in persons with type 2 diabetes declined slightly, while the incidence rates of anxiety and stress disorders remained largely constant. The rates of new prescriptions for antidepressants and anxiolytics were lower in all quarters of 2020 and in the first quarter of 2021 than in the quarters 1 year earlier. Diabetes-related complications were more prevalent in persons with incident psychiatric disorders than in those without.

CONCLUSIONS

No increase in the incidence rates of clinically diagnosed psychiatric disorders was observed during the COVID-19 pandemic in Germany in persons with type 2 diabetes.

Psychosocial Impact of the COVID-19 Pandemic on People With Type 1 Diabetes: Results of an Ecological Momentary Assessment Study

Aims

Psychological distress due to living with diabetes, demanding self-management tasks, impacts on life, and risks of complications is common among people living with diabetes. COVID-19 could pose a new additional risk factor for psychological distress in this group. This study aimed to analyze levels of COVID-19-related burdens and fears, variables explaining these levels, and associations with the concurrent 7-day COVID-19 incidence in people with type 1 diabetes (T1D).

Methods

A total of 113 people with T1D (58% women; age: 42.3 ± 9.9 years) participated in an ecological momentary assessment (EMA) study between December 2020 and March 2021. The participants reported daily levels of COVID-19-related burdens and fears over 10 consecutive days. Global ratings of COVID-19-related burdens and fears were assessed using questionnaires, as were current and previous levels of diabetes distress (PAID), acceptance (DAS), fear of complications (FCQ), depressive symptoms (CES-D), and diabetes self-management (DSMQ). Current levels of diabetes distress and depressive symptoms were compared with pre-pandemic ratings gained during an earlier study phase. Associations between burdens and fears, psychosocial and somatic aspects, and the concurrent 7-day incidence rate were analyzed using multilevel regression.

Results

Diabetes distress and depressive symptoms reported during the pandemic were comparable to pre-pandemic levels (PAID: p = .89; CES-D: p = .38). Daily EMA ratings reflected relatively low mean COVID-19-related burdens and fears in everyday life. However, there was substantial day-to-day variation per person indicating higher burdens on specific days. Multilevel analyses showed that daily COVID-19-related burdens and fears were significantly predicted by pre-pandemic levels of diabetes distress and diabetes acceptance but were not associated with the concurrent 7-day incidence rate nor with demographic and medical variables.

Conclusions

This study observed no increase in diabetes distress and depressive symptoms during the pandemic in people with T1D. The participants reported low to moderate levels of COVID-19-related burdens. COVID-19-related burdens and fears could be explained by pre-pandemic levels of diabetes distress and acceptance but not by demographic and clinical risk variables. The findings suggest that mental factors may constitute stronger predictors of COVID-19-related burdens and fears than objective somatic conditions and risks in middle-aged adults with T1D.

Psychological Health and Diabetes Self-Management among Patients with Type 2 Diabetes during COVID-19 in the Southwest of Saudi Arabia

Background and objectives: The prevalence of type 2 diabetes in Saudi Arabia is high and rising steeply. However, the management of type 2 diabetic patients has largely employed a medical approach and ignored the self-care management approach. This observation has even been obscured further by the COVID-19 pandemic, which has affected the psychological health of these patients. This study aimed to understand the effects of psychological health and DSM on type 2 diabetic patients in the Jazan region during COVID-19. Materials and methods: An analytical cross-sectional study was employed in this study. Participants were type 2 diabetic patients from the diabetic center at Jazan, Saudi Arabia. The Arabic-translated version of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to collect data. Data were analyzed using SPSS software. Results: Depression and anxiety were higher in females compared to males and were more reported by participants from urban compared to rural settings. Smoking and Khat chewing were inappropriate diabetic self-care management practices while exercising was appropriate. A negative correlation was observed between depression vs. health care utilization, and depression vs. diabetic self-care management. Anxiety results also showed similar findings to that of depression. Additionally, depression and anxiety were easily predicted by urban residence, and diabetic self-care management was predicted by exercise. Conclusions: Adequate self-care behavior in patients with type 2 diabetes is needed. Medical professionals should ensure improved efforts to accurately ascertain how an individual can implement the recommended lifestyle changes and facilitate self-care education.

The interface of COVID-19, diabetes, and depression

Comorbid diabetes with depression is a challenging and often under-recognized clinical problem. During the current COVID-19 pandemic, a communicable disease is thriving on the increasing incidences of these non-communicable diseases. These three different health problems are bidirectionally connected forming a vicious cycle. Firstly, depressed individuals show a higher risk of developing diabetes and patients with diabetes have a higher risk of developing symptoms of depression. Secondly, patients with diabetes have a higher risk of developing severe COVID-19 as well as of experiencing breakthrough infections. Thirdly, in both patients with type 2 diabetes and in COVID-19 survivors the prevalence of depression seems to be increased. Fourthly, lockdown and quarantine measurements during the COVID-19 pandemic has led to an increase in depression. Therefore, it is of importance to increase the awareness of this interface between depression, diabetes and COVID-19. Finally, as symptoms of post-COVID, diabetes and depression may be overlapping, there is a need for educating skilled personnel in the management of these comorbidities.