What was the general effect of the pandemic?
Eighteen months into the COVID-19 pandemic, epidemiologic studies indicate that diabetes is a central contributor to severe COVID-19 morbidity. Conversely, COVID-19 has had a devastating effect on the population with diabetes. In a multicountry study of industrialized countries during the first wave of the pandemic, overall death rates were 18% higher than those in previous years. Of the excess cases, 75–80% were officially attributed to COVID-19. The causes of the remaining ∼20–25% not attributed to COVID-19 have not been precisely estimated but are likely some combination of underreporting of COVID-19 and indirect impacts of the pandemic. For example delayed treatment or undertreatment of other conditions cause increases in other causes of death.
The excess mortality relative to historic trends was 51% higher in type 1 diabetes and 64% higher in type 2 diabetes, with about two-thirds of deaths officially attributed to COVID-19. As COVID-19–related excess mortality in the general population has been ∼20%, this means that the COVID-19 pandemic waves have had more than twice the impact on the populations with diabetes.
Predictors of COVID19-related Morbidity and Mortality Among Case Series with Diabetes
A comprehensive systematic review of 22 studies of the predictors of COVID-19 severity and death found male sex, age, several comorbid conditions, insulin use, and several laboratory predictors on admission, including elevated glucose levels, white blood cell count, neutrophil count, and lymphocyte count to all be significant. Being overweight or obese was associated with ∼30% increased risk of severe COVID outcomes but was not associated with mortality. Metformin use tended to be associated with a reduced risk of both COVID-19 severity and death. Of note, diabetes duration, smoking, hypertension, and concurrent cancer were not associated with COVID-19 severity or death among those hospitalized for COVID-19. Findings suggest that among adult populations, at any given age, individuals with type 1 diabetes have at least the same risk of poor COVID-19–related outcomes as those with type 2 diabetes.
Risk of Morbidity and Mortality Among Hospitalized Individuals
The prevalence of diabetes is particularly alarming among young and middle-aged adults, reflected in 14 states from the Center for Disease Control and Prevention COVID-NET, where hospitalized adults aged 50–64 years had a prevalence of diabetes (32%) as high as those aged 65 years and older (31%). Further, a closer examination reveals a high prevalence of previously undiagnosed diabetes among persons hospitalized for COVID-19, wherein hyperglycemia and diagnosis may have been precipitated by the COVID-19 infection.
On average, 33% of hospitalized individuals with severe COVID-19–related morbidity and 39% of deaths had diabetes. Among individuals with diabetes, 21–43% developed severe disease (i.e., respiratory distress, mechanical ventilation, intensive care unit admission) and case fatality ranged from 24% to 29%. Studies examining specific treatment outcomes found that diabetes is a potent predictor of the need for invasive mechanical ventilation, extracorporeal membrane oxygenation, and continuous renal replacement therapy.
What Was the Indirect Impact of COVID-19 on the Population With Diabetes?
For most people, the most profound effects of the pandemic are not coronavirus infection, but rather the diverse and extended societal disruption the pandemic has caused through changes to health system functioning, behaviors, and community support; environmental changes; or the stress of COVID-19 illness on family members. This disruption could have adverse indirect effects on detection, prevalence, and management of diabetes and other conditions, worsening or improving health behaviors and self-management. Recognizing the indirect effects of the pandemic due to shielding and changes in routines is particularly important for understanding future public health needs for the population with diabetes.
Depending on local policies, the shifts to teleworking from home and closures of or reduced access to grocery stores, restaurants, and fast food could have both short-term or long-term effects on diet quality as well as physical activity habits and diabetes self-management. The consumption of homemade meals and fruits and vegetables increased but so did intake of comfort food, snacking, number of meals consumed per day, and overall food intake. Other studies found 20–40% increased consumption of sweets. Furthermore, 64 studies observed a change in physical activity; most studies saw a decline in all physical activity and an increase in sedentary behavior but also saw increases in leisure-time physical activity. A meta-analysis found 32% of the general population experiences sleep problems but did not assess changes across the pandemic.
What can you do to prevent the problem?
To do our best to protect our own health, we need to lead a proper lifestyle and manage our diabetes consciously. As diabetes is an increased risk during the pandemic, it is worth following ‘the rules of the game’. Because of COVID19 can change your daily routine in a negative way, you are more likely to be at increased risk for a bad outcome of the disease. To reduce the risk factors of type 2 diabetes, we can use several technologies to manage diabetes appropriately, like glucometers, insulin pumps and logging applications. One of the most outstanding logging applications - with unique features that competing solutions do not have - is DiabTrend.
In order to pay attention to nutrition, physical activity of appropriate intensity and regularity, mental health, and systematic repetition of blood glucose measurement and drug / insulin dosing on a daily basis, even in such difficult times, it is advisable to choose DiabTrend. It helps to develop a conscious and healthy lifestyle and provides a lot of useful knowledge regarding the treatment of diabetes. If you are interested, do not hesitate to try it!
Android: https://play.google.com/store/apps/details?id=com.diabtrend
Or register via computer: https://app.diabtrend.com/
