Covid-19 Pandemic and Diabetes - Pandemic Effects on Blood Glucose Regulation

Research Article

Austin J Endocrinol Diabetes. 2023; 10(2): 1102.

Covid-19 Pandemic and Diabetes - Pandemic Effects on Blood Glucose Regulation

Muhammed Tunç¹*; Aslihan Türkmen Tunc²; Fayzanur Erdem³

¹Department of Internal Medicine, Vakif Universty, Bezmialem, Istanbul

²Department of Family Medicine, Plevne Family Health Center, Gaziosmanpasa, Istanbul

³Department of Family Medicine, Health Sciences Universty, Okmeydani Education and Research Hospital, Istanbul

*Corresponding author: Muhammed Tunç Department of Internal Medicine, Vakif Universty, Bezmialem, Istanbul Email: mtunc@bezmialem.edu.tr

Received: July 21, 2023 Accepted: September 02, 2023 Published: September 09, 2023

Abstract

Background: COVID-19 (Novel Coronavirus Disease) pandemic has led to quarantines and restrictions sometimes partly and sometimes throughout the country in Turkey and as well as many other countries. Many people remained inactive since they could not go out, and follow-up of chronic diseases has become difficult because of the inability to access hospital due to the pandemic.

Aim: In this study we aimed to investigate the effects of COVID-19 pandemic, which occasionally causes lockdown and partial quarantine implementations, on blood glucose regulation in patients with Type 2 Diabetes Mellitus (DM).

Study Design: Single-center, Retrospective, Observational study

Methods: The laboratory findings of type 2 DM patients who had been followed-up by our clinic for at least 2 years before the pandemic and who also came for control after the 3-months nationwide lockdown in Turkey (June 2020). Data were obtained from the hospital information system and examined. The values before pandemic and after lockdown were compared.

Results: The study included a total of 169 patients. Of the participants 49.7% were female and 50.3% were male. The mean age was 57.7 years in female patients and 54.8 years in male patients. Triglyceride level was significantly increased after the lockdown compared to before the pandemic in all patients (p<0.005). The levels of Fasting Blood Glucose (FBG) and glycated Hemoglobin (HbA1c) were significantly lower after the lockdown in the patients aged over 65 years, while these values were increased in the other age group, but the difference was not statistically significant.

Conclusion: COVID-19 pandemic led to statistically insignificant disruption in glucose regulation especially in young type 2 DM patients, while glucose regulation improved in the elderly population under quarantine conditions. Our study was conducted in a short-term and limited population and therefore, further studies with larger populations are needed.

Keywords: COVID-19; Pandemic; Type 2 diabetes mellitus; Fasting blood glucose; Glucose regulation

Introduction

COVID-19 infection has spread to all over the world from China at the end of December 2019, and the World Health Organization (WHO) declared it as a global pandemic as of March 2020 [1]. Since the outbreak first emerged, numerous studies have been performed about COVID-19 infection, which is new to the world.

Pathological alterations cause susceptibility to any type of infection in diabetic patients. Increase in morbidity and mortality is inevitable in the case of hyperglycemia, decreased immunity, damage to pulmonary functions and renal failure, cardiovascular disease and complications such as pulmonary microangiopathy [2].

Studies conducted from the beginning of the pandemic have found that diabetes is an important risk factor in mortality. Studies from Wuhan have found high prevalence of diabetes in COVID-19 patients, and similarly studies conducted in Italy have reported high prevalence of diabetes in hospitalized patients due to COVID-19 [3-7]. According to the 72.314 COVID-19 case report published by the China Center for Disease Control and Prevention, mortality was reported as approximately 3 folds higher in diabetic patients compared to the persons without diabetes [8]. Whereas in the majority of the initial studies performed in the beginning of the pandemic no distinction has been made between Type 1 and Type 2 DM, according to the recent studies clinical course of COVID-19 is negatively affected by Type 1 DM, but it was still better compared to Type 2 DM [9].

Besides increased risk of COVID-19 infection and mortality in diabetic patients, clinical course of diabetes itself has also been affected by the pandemic conditions. Physical activity and healthy diet that are among the indispensable lifestyle changes in follow-up of diabetes have been interrupted by pandemic and quarantine conditions, and have negatively affected blood glucose regulation in people with diabetes mellitus [10]. Since the beginning of the outbreak, the World Health Organization and national healthcare authorities have called for social isolation and “staying at home and not leaving home except when necessary” in order to reduce the spread rate of the disease. Also in our country lockdowns have been imposed sometimes in certain provinces, and sometimes in the whole country. Almost all hospitals at the beginning, and some hospitals after progression of the pandemic have been declared pandemic hospitals and these hospitals could not accept patients except for COVID-19. At beginning of pandemic, nationwide restrictions imposed at our country for 3 months, and at 1 June 2020 normalization process started, restrictions have begun to be reduced.

Declaration of pandemic and partial quarantine have changed people’s approach to food, causing and resulted in more "unhealthy" diets for most people. As a result of the combination of all these factors, people have remained physically inactive, many people have eaten unhealthy diets and presentation to hospitals for chronic disease follow-up has become difficult. Given the importance of diabetic patients to be physically active, to have a healthy diet and to be under physician control constantly, it seems inevitable that COVID-19 pandemic will adversely affect the clinical course of diabetic patients. In this study, we aimed to investigate the effects of COVID-19 pandemic in diabetic patients followed-up by our clinic.

Material and Methods

Study Design and Population

This study was designed as a single-center, retrospective, observational study and conducted in the internal diseases clinic of the Eyup Bezmialem Vakif University. A total of 160 patients with type 2 diabetes mellitus who had been followed-up by the internal diseases clinic of the Eyup Bezmialem Vakif University since 2 years before pandemic, and then presented to our clinic after lockdown and whose information, blood analysis outcomes were complete on the hospital information system were included in the study. Patients with missing information were excluded from the study. Patients’ causes of presentation, hospital files and biochemical data existing on the system were retrospectively examined. The values before pandemic and after lockdown were compared and statistically analyzed.

Ethical Considerations

Ethics approval of the study was received from the local ethics committee of the Eyup Bezmialem Vakif University with the 08/09/2020 dated and 15/309 numbered decision, and also the necessary permission was obtained from the TR Ministry of Health (2020-08-07T09_36_35).

Statistical Analysis

Statistical analysis was performed using SPSS version 20.0 for Windows statistical package software (IBM SPSS) at %95 confidence level. Kolmogorov Smirnov and Shapiro Wilks tests are used to determine normality of data, and data were found to be distributed normally. The measurement averages obtained before pandemic and after the lockdown in women and men and whether there is a significant difference between these averages were examined by t-test in dependent groups. The averages of the first and last measurements by gender, age group and whether the difference between these averages differ significantly was examined by independent t-test and one-way analysis of variance.

Results

Our study included a total of 169 patients. Of the participants 49.7% were female and 50.3% were male. The mean age was 57.7 years in female patients and 54.8 years in male patients. All participants were patients with Type 2 diabetes who had been followed up by our internal diseases clinic for at least 2 years before the pandemic and who presented to our clinic after the lockdown.

Biochemical analysis outcomes were evaluated in all patients as before the pandemic and after the lockdown. The mean triglyceride value from the cholesterol panel was significantly higher after the pandemic than before the pandemic in all patients (p<0.005). No statistically significant difference was found in the levels of Fasting Blood Glucose (FBG), glycated Hemoglobin (HbA1c) and urinary microalbumin between the mean values before pandemic and after the lockdown (p>0.005). Evaluation of the all patients’ investigations before pandemic and after lockdown is shown in Table 1.