Diabetes nurses report more health risks for patients, disrupted care during COVID-19
The COVID-19 pandemic has led to physical and psychological distress for people with diabetes, along with substantial disruptions in clinical diabetes services, according to responses from a survey of diabetes nurses in Europe.
“This survey has provided some novel and timely insights into the impact of COVID-19 on people living with diabetes and diabetes services across Europe,” Rita Forde, PhD, a postdoctoral research fellow at King’s College London, and colleagues wrote in a study published in Diabetic Medicine. “Overall, the data suggest that the pandemic has negatively impacted the physical and psychological health risks of people with diabetes, with reported increases in acute diabetes events; new diagnoses; and anxiety, diabetes distress and depression. The survey has also revealed significant disruption to routine diabetes care, particularly in relation to self-management and psychological support.”
Researchers conducted a cross-sectional survey distributed to diabetes nurses from 27 European countries. The survey included questions on the respondents’ characteristics and work context, the impact of COVID-19 on patients with diabetes who respondents cared for, and the impact of COVID-19 on diabetes care delivery. The survey was distributed from early June to July through email and social media platforms known to diabetes nurse networks and other groups.
Researchers analyzed responses from 1,829 participants. All responders were registered nurses, with 62% reporting 8 or more years of experience working in diabetes and 83% having a diabetes qualification.
Data showed 48% of participants said they believed that psychological health risks increased “a lot” and 37% said risks increased “a little” for people with diabetes during the pandemic. Anxiety, diabetes distress and depression were the three most common psychological problems mentioned by respondents. In addition, 75% of respondents said physical health risks increased either “a little” or “a lot” for patients. Of the study population, 29% said diabetes-related hospital admission increased during the pandemic, and 25% reported an increase in diabetic ketoacidosis.
Most of the respondents said COVID-19 caused a disruption to routine diabetes care, with 47% describing the disruption as “severe” or “extreme.” Diabetes education, psychological support and self-management support were the areas with greatest disruption. Respondents said modest disruption was found in diabetes technology and medicines support. About two-thirds of participants said it was necessary to prioritize care for those at the highest risk for complications, such as the newly diagnosed, those with elevated glucose levels, pregnant women and those who have a diabetes event. Telephone was the most common way respondents contacted patients, followed by email. Group interaction dropped from the second most common way of contacting patients before COVID-19 to the least common during the pandemic.
“Worryingly, at this time of heightened need for people with diabetes, the survey showed that diabetes care provisions have been significantly disrupted during the pandemic, most notably in relation to diabetes self-management support,” the researchers wrote. “The impact on group education is a major concern, as it may mean that many newly diagnosed or those with established diabetes may experience delays in accessing structured education programs.”
The United Kingdom had more participants reporting more severe psychological effects compared with other European countries (64% vs. 42%) as well as more severe physical effects (31% vs. 27%). Nurses working with people with type 2 diabetes said there were more negative physical effects compared with those who work with people with type 1 diabetes (38% vs. 23%).
Researchers said the findings reveal some of the biggest problems those with diabetes face during the pandemic and spotlights the areas where providers should focus on improving care.
“As the COVID-19 situation continues, we need to adapt care systems with some urgency to minimize the impact of the pandemic on the diabetes population,” the researchers wrote.