Impact of covid-19 lockdown on glycemic control in patients with type 1 diabetes.

BACKGROUND: In 2019, a new virus known as severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has emerged. Coronavirus disease 2019 (COVID-19) was classified as a pandemic in a short period of time. In order to reduce the spread of COVID-19, many countries have imposed a lockdown with movement restrictions, social distancing and home confinement, which has affected routine healthcare activities and everyday life. The aim of this systematic review was to examine the impact of the COVID-19 lockdown on glycemic control in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS: We systematically identified studies by searching the databases Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, EMBASE, and CINAHL until April 2021. We included n = 33 observational studies of which n = 25 investigated T1D and n = 8 T2D. RESULTS: Overall, we analyzed n = 2881 T1D patients and n = 1823 T2D patients. Glycemic values in patients with T1D improved significantly during lockdown. Overall, n = 18 (72%) T1D studies indicated significant improvements in glycemic outcomes. Meta-analysis revealed a mean difference in HbA1c of - 0.05% (95% CI - 0.31 to 0.21) due to lockdown, and in time in range (TIR) of + 3.75% (95% CI 2.56 to 4.92). Lockdown determined a short-term worsening in glycemic values in patients with T2D. Overall, n = 4 (50%) publications observed deteriorations in glycemic control. Meta-analysis demonstrated a mean difference in HbA1c of + 0.14 (95% CI - 0.13 to 0.40) through the lockdown. Moreover, n = 3 (75%) studies reported a not significant deterioration in body weight. CONCLUSIONS: Glycemic values in people with T1D significantly improved during COVID-19 lockdown, which may be associated with positive changes in self-care and digital diabetes management. In contrast, lockdown rather determined a short-term worsening in glycemic parameters in patients with T2D. Further research is required, particularly into the causes and effective T2D management during lockdown.

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Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review.

Parathyroid carcinoma (PC) may occur as part of a complex hereditary syndrome or an isolated (i.e., non-syndromic) non-hereditary (i.e., sporadic) endocrinopathy. Studies of hereditary and syndromic forms of PC, which include the hyperparathyroidism-jaw tumor syndrome (HPT-JT), multiple endocrine neoplasia types 1 and 2 (MEN1 and MEN2), and familial isolated primary hyperparathyroidism (FIHP), have revealed some genetic mechanisms underlying PC. Thus, cell division cycle 73 (CDC73) germline mutations cause HPT-JT, and CDC73 mutations occur in 70% of sporadic PC, but in only ∼2% of parathyroid adenomas. Moreover, CDC73 germline mutations occur in 20%-40% of patients with sporadic PC and may reveal unrecognized HPT-JT. This indicates that CDC73 mutations are major driver mutations in the etiology of PCs. However, there is no genotype-phenotype correlation and some CDC73 mutations (e.g., c.679_680insAG) have been reported in patients with sporadic PC, HPT-JT, or FIHP. Other genes involved in sporadic PC include germline MEN1 and rearranged during transfection (RET) mutations and somatic alterations of the retinoblastoma 1 (RB1) and tumor protein P53 (TP53) genes, as well as epigenetic modifications including DNA methylation and histone modifications, and microRNA misregulation. This review summarizes the genetics and epigenetics of the familial syndromic and non-syndromic (sporadic) forms of PC.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/humu.23337

Molecular genetics of syndromic and non-syndromic forms of parathyroid carcinoma

COVID-19 and diabetes: A bidirectional relationship

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide pandemic has been devastating particularly for older adults and those from vulnerable groups, including racial and ethnic minority populations. Additionally, people with certain underlying medical conditions, including diabetes, are also at increased risk of severe illness from coronavirus disease 2019 (COVID-19) (1,2). Some children experience significant disease (3), and pediatric deaths have been reported (4). Because “diabetes” (generally grouping together type 1 diabetes and type 2 diabetes) and chronically elevated hyperglycemia have been associated with worse outcomes in adults with COVID-19 (5), the pediatric community has voiced great concerns about risk and outcomes for children with diabetes.

A foundation of pediatrics is caution about the extrapolation of adult practice to children. Many publications report poor outcomes from COVID-19 and diabetes without emphasizing that data reported are from adults, frequently older adults with additional comorbidities. Moreover, there have been warnings related to COVID-19 and immunosuppression leading to confusion, predominately outside the medical community, about the difference between immunocompromised and autoimmune. In sum, these worries have led to increases in frequency and severity of diabetic ketoacidosis (DKA), due in part to families being reluctant to enter health care settings, especially in areas where COVID-19 cases cluster (6,7).

Data scarcity regarding many aspects of how COVID-19 is affecting children with both new-onset and established diabetes has magnified these concerns. In this issue of Diabetes Care , Rabbone et al. (8) describe cross-sectional data from Italy, an early pandemic epicenter. This team examined diabetes diagnoses as well as reports of DKA and SARS-CoV-2 infection in children with new-onset and established type 1 diabetes from 20 February to 14 April 2020. They compare data on new presentations and DKA rates to data from the same period in 2019. They report …

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COVID-19 and Children With Diabetes-Updates, Unknowns, and Next Steps: First, Do No Extrapolation.

Diabetes is one of the most common comorbidities in hospitalized patients with coronavirus disease 2019 (COVID-19). Inpatient hyperglycemia during this pandemic has been associated with worse outcomes, so it is mandatory to implement effective glycemic control treatment approaches for inpatients with COVID-19. The shortage of personal protective equipment, the need to prevent staff exposure, or the fact that many of the healthcare professionals might be relatively unfamiliar with the management of hyperglycemia may lead to worse glycemic control and, consequently, a worse prognosis. In order to reduce these barriers, we intend to adapt established recommendations to manage hyperglycemia during this pandemic in critical and noncritical care settings.

/pdf/inpatient-hyperglycemia-management-and-covid-19-11r45t2oo6.pdf

Inpatient Hyperglycemia Management and COVID-19.

Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.

/pdf/the-challenge-of-sustainable-access-to-telemonitoring-tools-153p76dzx8.pdf

The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond.

Time-in-range for monitoring glucose control: Is it time for a change?

Diabetes mellitus (DM) is one of the most common comorbid conditions in persons with COVID-19 and a risk factor for poor prognosis. The reasons why COVID-19 is more severe in persons with DM are currently unknown although the scarce data available on patients with DM hospitalized because of COVID-19 show that glycemic control is inadequate. The fact that patients with COVID-19 are usually cared for by health professionals with limited experience in the management of diabetes and the need to prevent exposure to the virus may also be obstacles to glycemic control in patients with COVID-19. Effective clinical care should consider various aspects, including screening for the disease in at-risk persons, education, and monitoring of control and complications. We examine the effect of COVID-19 on DM in terms of glycemic control and the restrictions arising from the pandemic and assess management of diabetes and drug therapy in various scenarios, taking into account factors such as physical exercise, diet, blood glucose monitoring, and pharmacological treatment. Specific attention is given to patients who have been admitted to hospital and critically ill patients. Finally, we consider the role of telemedicine in the management of DM patients with COVID-19 during the pandemic and in the future.

Virginia Bellido

Papers

Impact of covid-19 lockdown on glycemic control in patients with type 1 diabetes.

Inpatient Hyperglycemia Management and COVID-19.

The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond.

Time-in-range for monitoring glucose control: Is it time for a change?

COVID-19 and Diabetes