International type 2 prevention drive suggested by COVID-19 review

An international drive to highlight to the importance of prevention and adequate management of diabetes has been proposed following a review of diabetes care following the COVID-19 pandemic.

A team of the world’s leading experts on diabetes has also advised how countries should deal with the backlog of care for people with type 1 and type 2 diabetes created by lockdowns and restrictions to health services caused by the coronavirus.

The experts, drawn from Europe, North American, Latin America, Africa and Asia, made the recommendations, based on evidence and experiences of the impact of the pandemic on diabetes services from across the globe.

The experts also reviewed the direct and indirect effects of COVID-19 on people with type 1 and type 2 diabetes in the paper ‘The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery’ published by The Lancet Diabetes & Endocrinology.

For people with diabetes, recurrent lockdowns and public health measures throughout the pandemic have restricted access to routine diabetes care, limiting new diagnoses, and affecting self-management and access to medications, the researchers said. These effects have compromised care for optimising glycaemic control, it was concluded.

The recommendations on how best to prepare for any future pandemic or natural crisis outlined by the researchers include ensuring that achieving universal health coverage, as already committed to by governments in the Sustainable Development Goals and in international declarations need to assume even greater priority. 

They also call for renewed efforts to implement the UN High Level Declaration on Prevention and Control of Non-Communicable Diseases, taking measures that will improve our ecosystem by reducing poverty, empowering those in need of care, and creating a health-enabling environment that promotes a healthy diet and physical activity.

The team says that the international community should recognise that manufacturers of harmful products, including notably energy dense foods and sugar-sweetened beverages, are a large part of the problem, and recommend that they introduce comprehensive legislative and regulatory packages that tackle the drivers of consumption, price, availability and marketing.

Professor Kamlesh Khunti CBE – Director of National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) East Midlands and Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester – said: “A major global crisis, such as a pandemic, is an opportunity to reflect on things that are taken for granted. This concept is encapsulated by the building back better strategy espoused by the UN to reduce the risk of future disasters on nations and communities.”

Professor Sam Seidu, Clinical Professor in Primary Care Diabetes and Cardio-metabolic Medicine at the University of Leicester and co-author, said: “The COVID-19 pandemic has reminded the global community of the importance of prevention, often seen as a less urgent issue to health-care providers than treatment. We, therefore, recommend that all stakeholders and governments should implement strategies aimed at preventing and optimising diabetes care so that the world is more prepared to minimise the adverse outcomes associated with diabetes before the next global health threat.

“In the UK, the National Health Service Diabetes Prevention Programme has provided remote and digital delivery of lifestyle interventions by non-health-care professionals, fostering programme resilience throughout the two years of the pandemic.”

A strategy for prioritising recall for diabetes reviews, based on identifiable clinical need, is also proposed, with those with high-risk factor burden prioritised for review within three months.

Highlighting the impact of the coronavirus on people with diabetes, the researchers cited a number of studies. One revealed that the odds ratios for in-hospital COVID-19-related deaths, compared with the general population, were 3.51 in people with type 1 diabetes and 2.03 in those with type 2 diabetes.

To view the paper, click here: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00278-9/fulltext.