ENDOCRINOLOGY IN THE TIME OF COVID-19: Remodelling diabetes services and emerging innovation.
Deborah J WakeFraser W GibbPartha KarBrian KennonDavid C KlonoffGerry RaymanMartin K RutterChris SainsburyRobert K SemplePublished in: European journal of endocrinology (2020)
The COVID-19 pandemic is a major international emergency leading to unprecedented medical, economic and societal challenges. Countries around the globe are facing challenges with diabetes care and are similarly adapting care delivery, with local cultural nuances. People with diabetes suffer disproportionately from acute COVID-19 with higher rates of serious complications and death. In-patient services need specialist support to appropriately manage glycaemia in people with known and undiagnosed diabetes presenting with COVID-19. Due to the restrictions imposed by the pandemic, people with diabetes may suffer longer-term harm caused by inadequate clinical support and less frequent monitoring of their condition and diabetes-related complications. Outpatient management need to be reorganised to maintain remote advice and support services, focusing on proactive care for the highest risk, and using telehealth and digital services for consultations, self-management and remote monitoring, where appropriate. Stratification of patients for face-to-face or remote follow-up should be based on a balanced risk assessment. Public health and national organisations have generally responded rapidly with guidance on care management, but the pandemic has created a tension around prioritisation of communicable vs non-communicable disease. Resulting challenges in clinical decision-making are compounded by a reduced clinical workforce. For many years, increasing diabetes mellitus incidence has been mirrored by rising preventable morbidity and mortality due to complications, yet innovation in service delivery has been slow. While the current focus is on limiting the terrible harm caused by the pandemic, it is possible that a positive lasting legacy of COVID-19 might include accelerated innovation in chronic disease management.
Keyphrases
- coronavirus disease
- healthcare
- sars cov
- type diabetes
- public health
- glycemic control
- cardiovascular disease
- palliative care
- primary care
- mental health
- affordable care act
- quality improvement
- risk factors
- respiratory syndrome coronavirus
- risk assessment
- decision making
- emergency department
- health insurance
- end stage renal disease
- chronic kidney disease
- case report
- hepatitis b virus
- ejection fraction
- liver failure
- chronic pain
- newly diagnosed
- peritoneal dialysis
- aortic dissection