Beyond the virus: Ensuring continuity of care for people with diabetes during COVID-19

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Article

Reference

Beyond the virus: Ensuring continuity of care for people with diabetes during COVID-19

BERAN, David Henri, et al.

Abstract

The current COVID-19 pandemic is a major concern for the diabetes community. A meta-analysis in China found that the proportions of people with COVID-19 and diabetes was 9.7% and that having diabetes resulted in a two-fold increased risk of having a severe case.

Global guidance on confinement measures for the prevention of COVID-19 have a particular emphasis on vulnerable populations which include people with diabetes. These recommendations are coherent to avoid the spread of SARSCoV-2 infection, but are in contradiction with comprehensive diabetes care, which requires regular patient-provider interactions for patient education, prescriptions and possible management of complications or mental health. Moreover, confinement drives risk for unhealthy diets, decreased physical activity, mental health related concerns, in parallel to delayed care-seeking due to fear of contracting COVID-19. Another weakness in the current COVID-19 response is the focus on hospital care which overlooks the importance of Primary Care in guaranteeing continuity of care. Ensuring the availability of insulin, other medicines, self-monitoring and [...]

BERAN, David Henri, et al . Beyond the virus: Ensuring continuity of care for people with diabetes during COVID-19. Primary Care Diabetes , 2021, vol. 15, no. 1, p. 16-17

PMID : 32535088

DOI : 10.1016/j.pcd.2020.05.014

Available at:

http://archive-ouverte.unige.ch/unige:149106

Disclaimer: layout of this document may differ from the published version.

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PrimaryCareDiabetes15(2021)16–17

ContentslistsavailableatScienceDirect

Primary Care Diabetes

jo u r n al hom e p ag e :htt p:// w w w . e l s e v i e r . c o m / l o c a t e / p c d

Commentary

Beyond the virus: Ensuring continuity of care for people with diabetes during COVID-19

David Beran

^a,∗

, Sigiriya Aebischer Perone

^b

, Montserrat Castellsague Perolini

^b

, Chappuis Franc¸ ois

^b

, Pierre Chopard

^c

, Dagmar M. Haller

^d

,

Frédérique Jacquerioz Bausch

^b^,^e

, Hubert Maisonneuve

^d

, Nicolas Perone

^d

, Giacomo Gastaldi

^f

aDivisionofTropicalandHumanitarianMedicine,UniversityofGenevaandGenevaUniversityHospitals,Switzerland

bDivisionofTropicalandHumanitarianMedicine,GenevaUniversityHospitals,Switzerland

cDivisionofQualityofCare,GenevaUniversityHospitals,Switzerland

dPrimaryCareUnit,UniversityofGeneva,Switzerland

eInfectiousDiseaseTaskforceforCoronavirus,GenevaUniversityHospitals,Switzerland

fDivisionofEndocrinology,Diabetology,HypertensionandNutrition,Switzerland

a r t i c l e i n f o

Articlehistory:

Received16May2020 Accepted26May2020 Availableonline30May2020

Keywords:

Diabetes PrimaryCare COVID-19 Healthsystems

a b s t r a c t

ThecurrentCOVID-19pandemicisamajorconcernforthediabetescommunity.Ameta-analysisin ChinafoundthattheproportionsofpeoplewithCOVID-19anddiabeteswas9.7%andthathavingdiabetes resultedinatwo-foldincreasedriskofhavingaseverecase.Globalguidanceonconﬁnementmeasuresfor thepreventionofCOVID-19haveaparticularemphasisonvulnerablepopulationswhichincludepeople withdiabetes.TheserecommendationsarecoherenttoavoidthespreadofSARSCoV-2infection,butarein contradictionwithcomprehensivediabetescare,whichrequiresregularpatient–providerinteractionsfor patienteducation,prescriptionsandpossiblemanagementofcomplicationsormentalhealth.Moreover, conﬁnementdrivesriskforunhealthydiets,decreasedphysicalactivity,mentalhealthrelatedconcerns, inparalleltodelayedcare-seekingduetofearofcontractingCOVID-19.Anotherweaknessinthecurrent COVID-19responseisthefocusonhospitalcarewhichoverlookstheimportanceofPrimaryCarein guaranteeingcontinuityofcare.Ensuringtheavailabilityofinsulin,othermedicines,self-monitoring anddiagnostictoolsisanotherchallenge.Theseareallglobalconcernsforthediabetescommunity,as wellasforthosesufferingfromotherchronicconditions.Undoubtedly,theglobalpriorityistocontain thespreadandimpactofCOVID-19.However,healthsystemsstillneedtomeettheneedsoftheentire population,includingindividualswithdiabetes.Clearguidanceforpreparedness,crisisandpost-crisis managementofdiabetesandchronicdiseasesduringmassdisruptionstohealthsystemsarelacking.

Therefore,inparalleltotheepidemicresponseeffortstoensureexistinghealthcareserviceskeeprunning shouldbesupportedtoavoidhealthconsequencesthatmightbeworsethantheepidemicitself.This includestargetedmessagingforpeoplewithdiabetesandvulnerablepopulationswithregardstopossible riskofinfectionaswellastheirdisease-relatedmanagement;continuedsupportviatelephone,video conferencingorevenhomevisits;ensuringaccesstoinsulinandothermedicinesandsuppliesboth nationallyandindividually;andmostimportantly,preparingforthefuture.

Thecurrent COVID-19pandemic is a major concernfor the diabetescommunity.Ameta-analysisinChinafoundthatthepro- portionsof people withCOVID-19 and diabetes was9.7 % and

∗ Correspondingauthorat:DivisionofTropicalandHumanitarianMedicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1211 Geneva 14, Switzerland.

E-mailaddress:[email protected](D.Beran).

thathavingdiabetesresultedinatwo-foldincreasedriskofhavingaseverecase[1].Inadditionobesityhasbeenfoundtobea riskfactorforCOVID-19severity[2].Globalguidanceonconﬁne- mentmeasuresforthepreventionofCOVID-19haveaparticular emphasisonvulnerablepopulations whichinclude peoplewith diabetes.Theserecommendationsarecoherenttoavoidthespread ofSARS-CoV-2 infection,but arein contradictionwithcompre- hensive diabetes care, which requires regular patient–provider

https://doi.org/10.1016/j.pcd.2020.05.014

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D.Beranetal./PrimaryCareDiabetes15(2021)16–17 17

interactionsforpatienteducation,prescriptionsandpossiblemanagementofcomplicationsormentalhealth.

Moreover, conﬁnement drives risk for unhealthy diets, decreasedphysicalactivity,mentalhealthrelatedconcerns,inparalleltodelayedcare-seekingduetofearofcontractingCOVID-19 [3].Anotherweaknessin thecurrentCOVID-19response isthe focusonhospitalcaretopreventthehealth systembeingover- burdenedwiththisbeingimplementedina“stateofemergency”.

Thisoverlooksthe importanceof PrimaryCarein guaranteeing continuityofcare.Followingnaturaldisastersandabreakinthe continuity of care management of chronic conditions worsens, especiallyforthemostvulnerable,impactinghealthcarecostsand life-expectancy,aswasseenintheaftermathof HurricaneKat- rina[4].RecentdropsinemergencyroomvisitsduetoCOVID-19 areofconcernaspeoplemightnotbeaccessingcareforchronic conditionsaswellasacutecomplications[5].

Ensuring the availability of insulin, other medicines, self- monitoringanddiagnostictoolsisanotherchallenge,bothinterms ofnationalsupplyandofdistributionthroughoutcountriesdur- ingperiodoflockdown.Inparallelaffordabilityisofproblemin allsettingswherepeopleneedtopayfortheirmedicinesoutof pocket,withmanyindividualshavinglosttheirincomeduetothe pandemic.

Theseareallglobalconcernsfor thediabetescommunity,as wellasforthosesufferingfromotherchronicconditions.Undoubt- edly, theglobalpriorityis tocontainthespread and impactof COVID-19.However,healthsystemsstillneedtomeettheneeds oftheentirepopulation,includingindividualswithdiabetes.Clear guidanceforpreparedness,crisisandpost-crisismanagementof diabetesandchronicdiseasesduringmassdisruptionstohealth systemsarelacking.Therefore,inparalleltotheepidemicresponse effortstoensureexistinghealthcareservices,especiallyPrimary Care, keeprunningshouldbesupportedtoavoid healthconse-

quencesthatmightbeworsethantheepidemicitself.Thisincludes targetedmessagingforpeoplewithdiabetesandvulnerablepopu- lationswithregardstopossibleriskofinfectionaswellastheir disease-related management; continued support via telephone, videoconferencingorevenhomevisits;ensuringaccesstoinsulin andothermedicinesandsuppliesbothnationallyandindividually;

andmostimportantly,preparingforthefuture.AsConfuciussaid,

“Successdepends upon previouspreparation,and withoutsuch preparationthereissuretobefailure.”Letushopethatthesil- verliningfromtheCOVID-19pandemicwillbebetterpreparation forthefuture.

Competinginterests

Theauthorsdeclarehavingnocompetinginterestswithregards tothissubmission.

References

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[2]A.Simonnet,M.Chetboun,J.Poissy,V.Raverdy,J.Noulette,A.Duhamel,etal., Highprevalenceofobesityinsevereacuterespiratorysyndromecoronavirus-2 (SARS-CoV-2)requiringinvasivemechanicalventilation,Obesity(SilverSpring) (2020),http://dx.doi.org/10.1002/oby.22831[publishedonlineaheadofprint, 2020April9].

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[5]J.Thornton,Covid-19:A&EvisitsinEnglandfallby25%inweekafterlockdown, BMJ369(2020)m1401.