Restrictions imposed during the COVID-19 pandemic have had an outsized effect on patients with chronic conditions who require regular access to care and consistent monitoring. In addition, the SARS-CoV-2 virus that causes COVID-19 has taken an especially sharp toll on patients with type 1 and type 2 diabetes. According to a U.K. study based on data from 61 million medical records, 30% of patients who died of COVID-19 had diabetes. For cases reported in China between December 2019 and mid-February 2020, the COVID-19 mortality rate for diabetics was 7.3%, which is three times the rate among the general population.
The root cause of this increased mortality remains unclear. Poor glycemic control causes tissue damage, and the associated inflammation and strain on the immune system likely play a role. Dr. Daniel Drucker, a senior investigator at the Lunenfeld-Tanenbaum Research Institute at Mt. Sinai Hospital in Toronto, notes that some studies point to the comorbidities of obesity, hypertension, and other cardiovascular diseases as contributors to the heightened likelihood of poor outcomes for diabetics who contract COVID-19.
“People who have really poorly controlled diabetes are more susceptible to more severe infection, whether it’s influenza or tuberculosis,” Dr. Drucker said, speaking to STAT News. “Elevated blood sugar directly impairs our immune function.”
This higher risk has led to additional complications for diabetic patients. With many offices closed or patients apprehensive about seeking in-person care, important diagnostic data can be missed. A recent study in Diabetes Care reported a greater than threefold increase in the risk of amputation for patients admitted to a tertiary care center with diabetic foot ulceration in the Spring of 2020 relative to January through May 2019. Patients may also be less likely to maintain a fitness routine to help manage their health due to fear of infection. These indirect effects of the pandemic carry tremendous personal costs and place an added burden on health systems.
Telehealth and RPM for diabetes-related care have been adopted by greater numbers during the pandemic. This is thanks in part to an easing of restrictions around telehealth during the public health emergency, allowing patients to access care without increasing their risk of contracting COVID-19. With about 34.2 million patients with diabetes in the U.S. and another 88 million who are prediabetic, many people can benefit from access to RPM. Continuous glucose monitoring has been used in hospital settings to reduce the use of PPE and limit exposure to COVID-19 among patients and hospital staff. Blood glucometers also allow patients with diabetes to monitor themselves from home and share their readings with a healthcare professional (HCP).
Foot sensors can provide additional data to help prevent diabetes-related foot disease. Foot temperature monitoring for early detection of hot spots at risk of developing into an ulcer, smart insoles to identify high plantar pressure, and offloading footwear that can monitor adherence to its use are all emerging tools that can build patients’ awareness of their needs and aid them in managing their health. Patients with a history of diabetes-related foot disease also have a greater risk of overall mortality and fatal myocardial infarctions relative to diabetics without foot disease. Therefore, these patients have been shown to benefit from RPM for blood pressure tracking and lowering their levels of low-density lipoprotein.
HCPs like Eric Johnson, MD at the University of North Dakota School of Medicine and Health have been using telehealth with their patients since well before the pandemic and have found it to be a highly effective way of staying connected to patients. In a webinar for the American Diabetes Association, Dr. Johnson explained of telehealth, “It’s so much more than just a phone call or a call, and I think patients do like that.”
RPM goes beyond simply gathering information. Regular measurements of blood glucose and other physiological data can show how a particular patient’s body responds to changes in diet and exercise and can give the patient greater control over their health while also building a stronger patient-HCP relationship.
Additional Resources: American Diabetes Association COVID-19 FAQ