Living and working environments are important determinants of glycemic control in patients with diabetes during the COVID‐19 pandemic: A retrospective observational study

Abstract

Aim: To investigate (1) the association of lifestyle changes and living and working conditions with glycemic control and (2) whether treatment was intensified appropriately in patients with diabetes under the first COVID-19 state of emergency in Japan. Materials and Methods: A total of 321 participants were included. Participants completed a questionnaire regarding lifestyle changes, including diet, physical activity, and living and working conditions during the COVID-19 pandemic. The change in hemoglobin A1c (HbA1c) levels was estimated before (June 1, 2019 to August 31, 2019) and during (June 1, 2020 to August 31, 2020) the pandemic. Factors associated with changes in HbA1c levels were examined by multiple linear regression analysis. The proportion of patients who received treatment intensification for diabetes was compared between before and during the pandemic. Results: There was no significant change in HbA1c levels before the pandemic and during the pandemic (7.13 -0.98% vs 7.18 -1.01%, P = 0.186). Teleworking (estimate 0.206, P = 0.004) and living with a dog (estimate -0.149, P = 0.038) were significantly associated with changes in HbA1c levels after adjusting for covariates. There was no significant difference in the proportion of patients who received treatment intensification for diabetes during the pandemic and before the pandemic in either the elderly or nonelderly patients. Conclusions: Overall glycemic control did not worsen during the pandemic. Nonetheless, environmental factors, including telework, were found to influence glycemic control in patients with diabetes. Further studies are needed to clarify whether the COVID-19 pandemic could affect treatment intensification for diabetes.

Impact of the first announced state of emergency owing to coronavirus disease 2019 on stress and blood pressure levels among patients with type 2 diabetes mellitus in Japan

“… 18 reported that HbA 1c levels significantly decreased in the unstressed group, whereas Terakawa et al . 28 suggested a relationship between the worsening of glycemic control and living and working environments. Final conclusions for the change in HbA 1c during the COVID‐19 pandemic could not be drawn from these retrospective studies, including the present study.…”

The patient-centered diabetes management during the COVID-19 pandemic

“…Changes in behavioral patterns had a significant impact on the self-management of diabetes. Due to lifestyle restrictions, body weight gain, reduced physical activity, and changes in eating habits affected glycemic control (5)(6)(7)(8)(9). Table 1 summarizes the results of past studies conducted to monitor changes in hemoglobin A1c (HbA1c) and body weight before and during the COVID-19 pandemic.…”

“…The effects of lifestyle changes on glycemic control during the COVID-19 pandemic in patients with diabetes (n = 321) were studied at our institution (5). The overall HbA1c levels showed no significant difference before and during the COVID-19 pandemic.…”

“…In the diabetic state, the RAS is activated in the pancreas, and angiotensin II (AngII), downstream of the RAS, is strongly associated with islet dysfunction in experimental models. Angiotensin-converting enzyme 2 (ACE2) promotes the degradation of AngII into angiotensin (1)(2)(3)(4)(5)(6)(7) [Ang(1-7)] (8,9), and Ang(1-7) acts through the G protein-coupled receptor Mas and opposes many of the actions of AngII (28,29). The ACE2/Ang(1-7)/Mas axis serves as a protective and negative regulator of RAS (30).…”

Home-Based High-Intensity Interval Exercise Improves the Postprandial Glucose Response in Young Adults with Postprandial Hyperglycemia

“…In addition, the emergence of the severe acute respiratory syndrome–associated coronavirus 2 virus at the end of 2019 affected daily life worldwide, especially regarding physical activity, with reports of decreased physical activity in various countries compared with pre-coronavirus disease 2019 (COVID-19) pandemic levels [ 13 , 14 , 15 ]. Although the COVID-19 pandemic has been reported to have no effect on glycated hemoglobin in diabetic patients, there is a relationship between decreased physical activity and increased glycated hemoglobin caused by telecommuting [ 16 ]. In fact, it has been reported that the amount of physical activity in diabetic patients is decreasing [ 17 ], and it is not certain what the long-term effects will be.…”