A recent study published in The Lancet Diabetes & Endocrinology discussed the impact of coronavirus disease 2019 (COVID-19) on individuals with diabetes.
There have been more than 633 million COVID-19 cases worldwide, with more than 6.60 million deaths. COVID-19 has disproportionately affected some subsets of the population, such as older individuals and ethnic minorities. Besides, these population groups have a high prevalence of diabetes, cardiovascular, kidney, and some respiratory diseases. In the present study, the authors discussed the effects of COVID-19 on diabetic individuals.
Direct and indirect effects of COVID-19
Mounting evidence suggests hyperglycemia significantly contributes to COVID-19 severity. A study conducted in England during the first COVID-19 wave found a higher risk of in-hospital deaths in COVID-19 patients with diabetes than those without. Another study from the same period reported a 59.1% increase in death registrations in people with type 1 diabetes.
Severe COVID-19 manifestations include hematologic disorders, endothelial dysfunction, hyperimmune responses, and long COVID. There was also increasing research interest in newly-diagnosed or potentially new-onset diabetes in those with COVID-19. Hyperglycemia might upregulate angiotensin-converting enzyme 2 (ACE2), the host cellular receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and aggravate the diabetic state.
Further, the economic impact of COVID-19 has been significant to health systems, individuals, and taxpayers. The exacerbation of COVID-19-associated health and financial costs may compound the concerns of health equity among underprivileged sections, people with frailty or chronic conditions, and minority ethnic populations. This financial burden may hamper the introduction of new, effective treatments for diabetic individuals.
Recurrent public health measures and lockdowns throughout the COVID-19 pandemic have limited access to routine diabetes care and medications, affecting care-seeking behavior and self-management. A global survey involving healthcare professionals from 47 countries revealed that diabetes was the most affected chronic condition due to disruptions in care by COVID-19.
A surveillance study of adult patients in the United States (US) reported deficiencies in routine diabetes care. Individuals with diabetes also experienced hardships during the pandemic due to lost income or unemployment, which might have reduced their ability to afford medicines. Moreover, many people, including those with diabetes, delayed or avoided seeking medical care due to fear of SARS-CoV-2 infection or to help lower the strain on healthcare services, overwhelmed by COVID-19.
Reports suggest the adverse impact of COVID-19 on mental health and healthy lifestyles. A US study involving more than 2500 older adults with type 2 diabetes reported an increased prevalence of depressive symptoms and loneliness during the pandemic relative to pre-pandemic times. Higher anxiety and psychological distress rates have been observed in the general population and those with chronic disorders.
Evolution of conventional healthcare model on the road to recovery
Delays in the delivery of self-management programs are concerning as these educational programs benefit physical and psychological health. The rapid transition to telehealth and electronic consultations was driven by the necessity to minimize COVID-19 spread. Healthcare professionals face multiple challenges as services are being restored, particularly workforce pressure due to clinician fatigue, self-isolation, and illness.
Further, diabetic individuals continue to fear seeking medical care due to the emergence of mutant SARS-CoV-2 variants. While physical consultations are increasing, the hybrid model of physical and virtual consultations is likely to remain. Evidence suggests that telehealth interventions could also offer opportunities in diabetes care and improve patient outcomes compared to conventional care.
Nevertheless, an individual’s state of health, prior diseases, poor environmental factors, psychosocial stressors, health-related habits and beliefs, and low socio-economic status can result in digital exclusion. Likewise, disparities in access to digital care and literacy can widen (telehealth) care gaps. Therefore, while electronic consultations are being increasingly advocated, non-medical barriers must be overcome before telehealth services can become a part of routine care.
Actions and recommendations
In the Pan-European Commission on Health and Sustainable Development, experts suggested actions beyond immediate priorities and advocated for strengthening pandemic preparedness. Several of its recommendations are relevant to diabetes and focus on health inequalities, specifically the need for improved ethnicity data and a comprehensive approach to health.
Socio-economically vulnerable communities suffered highly from poor care for diabetes during the COVID-19 pandemic. Therefore, achieving universal health coverage is paramount as we advance into the post-COVID-19 era. The authors call for efforts to implement the United Nations (UN) High-Level Declaration on Prevention and Control of Non-Communicable Diseases.
Further, the authors urged the international community to recognize that manufacturers of products, such as sugar-sweetened beverages and energy-dense foods, are part of the problem and recommended introducing regulatory and legislative actions to tackle the drivers of consumption. This is essential to lower the dual burden of diabetes and obesity.