Introduction Poor outcomes of coronavirus disease 2019 (COVID‐19) have been linked to diabetes but its relation to pre‐infection glycemic control is still unclear. Methods To address this question we report here the association between pre‐infection HemoglobinA1c (A1C) levels and COVID‐19 severity as assessed by need for hospitalization in a cohort of 2068 patients with diabetes tested for COVID‐19 in Leumit Health Services, Israel, between February 1 and April 30, 2020. Using the LHS integrated electronic medical records system we were able to collect a large amount of clinical information including age, sex, socioeconomic status, weight, height, body mass index, A1C, prior diagnosis of ischemic heart disease, depression/anxiety, schizophrenia, dementia, hypertension, cerebrovascular accident, congestive heart failure , smoking and chronic lung disease. Results Of the patients included in the cohort, 183 (8.85 %) were diagnosed with COVID‐19 and 46 were admitted to hospital. More hospitalized patients were female, came from higher socioeconomic background and had a higher baseline A1C. A prior diagnosis of cerebrovascular accident and chronic lung disease conferred an increased risk of hospitalization but not obesity or smoking status. In a multivariate analysis, controlling for multiple prior clinical conditions, the only parameter associated with a significantly increased risk for hospitalization was A1C≥9%. Conclusion Using pre‐infection glycemic control data we identify A1C as a clear predictor of COVID‐19 severity. Pre‐infection risk stratification is crucial to successfully manage this disease, efficiently allocate resources and minimize the economic and social burden associated with an undiscriminating approach. This article is protected by copyright. All rights reserved.

The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes. Design:A descriptive qualitative research using content analysis of interviews.Methods: Participants were invited through the National DiNPs' Forum. Semistructured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories. Findings: Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles;and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization. Conclusions:The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth.Clinical relevance: Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.

No abstract

No abstract