In general, diabetics have passed the epidemic in a stable manner

February 16, 2022

How well do diabetics receive medical care during lockdown periods? How has the epidemic affected your living situation? And are there any health effects? The German Diabetes Foundation (DDS) addressed questions like these in the first year of the epidemic and funded several projects that examined the reality of care for people with type 1 and type 2 diabetes. Experts provided preliminary answers from studies starting at the time in an online press conference on 16 February 2022.

The coronavirus pandemic has shaped our daily lives for nearly two years. While healthy people were “only” affected by the influences in their private and professional lives during this time, people with chronic diseases also had to accept changes in medical care. During the first lockdown in particular, not all of the usual care offerings such as face-to-face counseling hours and training sessions were available, and some were avoided by patients themselves for fear of infection. “In the case of diabetics in particular, there is also the fact that they belong to a group vulnerable to an acute course of COVID-19,” says Professor Hans Honer, CEO of DDS and Director of the Else Kröner-Fresenius Center at the TUM Clinic on the right bank of the Isar River and in the center of Weihenstephan of Science. In addition to the potential consequences for metabolic health, an increased psychological burden from the epidemic was thus expected.

Fortunately, these concerns have not been confirmed in the studies now presented. “In general, people with diabetes who were already being treated for their metabolic disease before the pandemic have gone through the lockdown pretty well,” Hanner says happily. It is clear that people who have already learned how to manage their diabetes have routinely managed their disease even in the lockdown stages. One funded study shows that people with type 2 diabetes had neither lower metabolic control nor a higher BMI after the first lockdown. The rate of mental disorders also remained unchanged.

Switching to telemedicine solutions

Hauner stresses that a lot has also been done in a short time on the part of medical providers: diabetes advice and training has been converted to digital formats, and in Medicare, too, the lack of visits to the practice can be at least partially compensated by phone or video contacts. . “The boost that telemedicine has received from the pandemic will also benefit us in the long run,” Hanner says. Digital capabilities help fill supply gaps that don’t only exist during a pandemic. A video consultation is a huge relief, especially for people with diabetes who have limited mobility – it saves long trips, wait times and can ultimately increase the intensity of care.

Delayed diagnosis of type 1 diabetes

However, there have been notable epidemiological implications in the area of ​​new type 1 cases. Studies provide evidence that type 1 diabetes is often diagnosed late during a pandemic. “Especially in children under the age of six, there was an increased incidence of ketoacidosis” – severe metabolic imbalances that can occur with an unstable metabolic state, but also with undiagnosed and therefore untreated diabetes, Hanner explains. About three months after the respective waves of COVID-19, there was also a significant increase in the incidence of type 1 – the number of new cases during these phases temporarily increased by about 15 percent compared to the pre-pandemic level. “The cause of these buildups is still largely unclear,” Hanner says. Above all, the indirect effects of the epidemic – such as psychological stress – are potential causes.

Unavailability of supply data

As if under a magnifying glass, deficiencies also appear during a crisis – for example in the availability and structure of medical data. “It is still very difficult in Germany to get real care data,” says Hanner, summarizing the experience from the studies presented now. In the German healthcare system, a lot of routine data is collected on an ongoing basis, but it is rarely used – whether for reasons of data protection, bureaucratic hurdles, a lack of flexibility or simply out of a lack of interest. “Here, responsible political and health insurance bodies have to use or make available the incoming data while maintaining data protection,” says Hanner. This is the only way to quickly identify and specifically address existing issues. “It is incomprehensible that German health service research still relies on information from other countries because its routine data is not accessible,” said the DDS head.