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Experts discuss how to best protect people with diabetes from serious COVID-19 outcomes in a newly published article that summarizes in-depth discussions on the topic from a conference held online last year.
Lead author and Diabetes Technology Society founder and director David C. Klonoff, MD, told Medscape Medical News: “To my knowledge this is the largest article or learning that has been written anywhere ever about the co-occurrence of COVID-19 and diabetes and how COVID-19 affects diabetes…There are a lot of different dimensions.”
The 37-page report covers all sessions from the Virtual International COVID-19 and Diabetes Summit, held August 26-27, 2020, which had 800 attendees from six continents, on topics including pathophysiology and COVID-19 risk factors, the impact of social determinants of health on diabetes and COVID-19, and psychological aspects of the COVID-19 pandemic for people with diabetes.
The freely available report was published online January 21 in the Journal of Diabetes Science and Technology by Jennifer Y. Zhang, BA, of the Diabetes Technology Society, Burlingame, California, and colleagues.
Other topics include medications and vaccines, outpatient diabetes management during the COVID-19 pandemic and the growth of telehealth, inpatient management of diabetes in patients with or without COVID-19, ethical considerations, children, pregnancy, economics of care for COVID-19, government policy, regulation of tests and treatments, patient surveillance/privacy, and research gaps and opportunities.
“A comprehensive report like this is so important because it covers such a wide range of topics that are all relevant when it comes to protecting patients with diabetes during a pandemic. Our report aims to bring together all these different aspects of policy during the pandemic, patient physiology, and patient psychology, so I hope it will be widely read and widely appreciated,” Zhang told Medscape Medical News.
Two important clinical trends arising as a result of the pandemic — the advent of telehealth in diabetes management and the use of continuous glucose monitoring (CGM) in hospital — are expected to continue even after COVID-19 abates, said Klonoff, medical director of the Diabetes Research Institute at Mills-Peninsula Medical Center, San Mateo, California
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Telehealth in Diabetes Here to Stay, in US at Least
Klonoff noted that with diabetes telehealth, or “tele-diabetes” as it’s been dubbed, by using downloaded device data patients don’t have to travel, pay for parking, or take as much time off work. “There are advantages…patients really like it,” he said.
And for healthcare providers, an advantage of remote visits is that the clinician can look at the patient while reviewing the patient’s data. “With telehealth for diabetes, the patient’s face and the software data are right next to each other on the same screen. Even as I’m typing I’m looking at the patient…I consider that a huge advantage,” Klonoff said.
Rule changes early in the pandemic made the shift to telehealth in the United States possible, he said.
“Fortunately, Medicare and other payers are covering telehealth. It used to be there was no coverage, so that was a damper. Now that it’s covered I don’t think that’s going to go back. Everybody likes it,” he said.
CGM in Hospitals Helps Detect Hypoglycemia on Wards
Regarding the increase of inpatient CGM prompted by the need to minimize patient exposure of nursing staff during the pandemic and the relaxing of US Food and Drug Administration (FDA) rules about its use, Klonoff said this phenomenon has led to two other positive developments.
“For FDA, it’s actually an opportunity to see some data collected. To do a clinical trial [prior to] March 2020 you had to go through a lot of processes to do a study. Once it becomes part of clinical care, then you can collect a lot of data,” he noted.
Moreover, Klonoff said there’s an important new area where hospital use of CGM is emerging: detection of hypoglycemia on wards.
“When a patient is in the ICU, if they become hypoglycemic or hyperglycemic it will likely be detected. But on the wards, they simply don’t get the same attention. Just about every doctor has had a case where somebody drifted into hypoglycemia that wasn’t recognized and maybe even died,” he explained.
If, however, “patients treated with insulin could all have CGMs that would be so useful. It would send out an alarm. A lot of times people don’t eat when you think they will. Suddenly the insulin dose is inappropriate and the nurse didn’t realize. Or, if IV nutrition stops and the insulin is given [it can be harmful].”
Another example, he said, is a common scenario when insulin is used in patients who are treated with steroids. “They need insulin, but then the steroid is decreased and the insulin dose isn’t decreased fast enough. All those situations can be helped with CGM.”
Overall, he concluded, COVID-19 has provided many lessons, which are “expanding our horizons.”
Zhang has reported no relevant financial relationships. Klonoff has reported being a consultant for Dexcom, EOFlow, Fractyl, Lifecare, Novo Nordisk, Roche Diagnostics, Samsung, and Thirdwayv.
J Diabetes Sci Technol. Published online January 21, 2021. Full text