A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India

Abstract

Background and aims: Uncontrolled diabetes has been associated with poorer clinical outcomes in COVID-19. We aimed to evaluate and assess the impact of COVID-19 pandemic on management of diabetes and challenges faced by people with diabetes in India during and after the lockdown phase. Methods: A cross-sectional study based on an online questionnaire survey was designed. The questions collected socio-demographic details, medical and social history, and impact of the pandemic on medical and social life from 1582 participants. Linear regression was employed to evaluate association of different parameters with the change in glycemic levels. Results: The frequency of clinical visits during the COVID-19 pandemic were reduced in 87.28% of participants. 92.45% of participants were able to monitor their blood glucose levels (BGLs) in which 78.42% (49.35%, 20.91%, and 8.16%) participants experienced an increase in BGL (mild, moderate, and severe respectively). Only 47.41% of participants possessed the digital glucometer at home. 69.07% of participants reported a decrease in physical activity while 46.88% reported an increase in food intake. 80.06% of participants were able to buy all medicines and 29.80% were gone for virtual consultations while 87.81% reported that they didn’t have access to healthcare services. Overall, 89.47% participants experienced disruption in therapy. A highly significant correlation (r = 0.89, p = 0.0145) was found between increasing age and reporting of higher BGLs. Conclusion: This study provides a firsthand evidence of major disruption in diabetes care activities during and after the lockdown phase in India and increased risk of poorer clinical outcomes, if infected by SARS-CoV-2.

COVID-19 associated with diabetes and other noncommunicable diseases led to a global health crisis

“…An increase in screen time was also reported in Brazil -48.9% watching TV and 53.5% surfing the internet [33]. In addition, 38.4% of consultations or lab exams were postponed or cancelled in Brazil [33], while in India, 89.5% of PwD had their therapy disrupted by COVID-19 pandemic (which presented a significant positive correlation with age) [35]. In India, increase in mean HbA1c from 8.8% (73 mmol/mol) to 10% (86 mmol/mol) in individuals with type 1 diabetes (T1D), was attributed to, among other factors, "non availability of insulin/glucose strips during the lockdown period" [36].…”

“…In the case of diabetes, whilst general measures of physical distancing, wearing face masks, hand hygiene and stay-at-home should be followed, additional strategies to protect these individuals' health and self-care routine must be planned. During the pandemic, glycemic changes were reported as a consequence of altered routine and difficulties to access health services and medicines [33,35,36]. Among individuals with diabetes, 59.4% and 78.4% experienced glycemic fluctuations in Brazil and in India, respectively [33,35].…”

“…During the pandemic, glycemic changes were reported as a consequence of altered routine and difficulties to access health services and medicines [33,35,36]. Among individuals with diabetes, 59.4% and 78.4% experienced glycemic fluctuations in Brazil and in India, respectively [33,35]. Some of the potential causes included: increase in food consumption in 29.8% and 46.9% and decrease in physical activity in 59.5% and 69.1% PwD respectively in Brazil and India [33,35].…”

“…Among individuals with diabetes, 59.4% and 78.4% experienced glycemic fluctuations in Brazil and in India, respectively [33,35]. Some of the potential causes included: increase in food consumption in 29.8% and 46.9% and decrease in physical activity in 59.5% and 69.1% PwD respectively in Brazil and India [33,35]. An increase in screen time was also reported in Brazil -48.9% watching TV and 53.5% surfing the internet [33].…”

“…In Brazil, individuals depending exclusively on the public health system were less compliant with the stay-at-home recommendations and often experienced an increase in BG [31,33]. In India, only 47.4% had a glucometer at home, 62.5% did not buy all the medicine they needed due to financial reasons, and only 29.8% had access to teleconsultation during the pandemic [35]. In Africa, a similar scenario was reported as many PwD were unable to buy their medicines, rationed insulin, skipped oral drugs and/or were unable to selfmonitor their BG [16].…”