Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

TY - JOUR

T1 - Telemonitoring, Telemedicine and Time in Range During the Pandemic

T2 - Paradigm Change for Diabetes Risk Management in the Post-COVID Future

AU - Danne, Thomas

AU - Limbert, Catarina

AU - Puig Domingo, Manel

AU - Del Prato, Stefano

AU - Renard, Eric

AU - Choudhary, Pratik

AU - Seibold, Alexander

N1 - Funding Information: Sponsorship for this study and journal?s Rapid Service Fee were funded by Abbott Diabetes Care. Editorial assistance in the preparation of this manuscript was provided by Dr Robert Brines of Bite Medical Consulting. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Thomas Danne and Alexander Seibold had the idea for the article, all authors contributed to the literature search and data analysis. Thomas Danne, Catarina Limbert and Alexander Seibold drafted the first version of the manuscript, all authors contributed to subsequent versions and read and approved the final manuscript. Editorial assistance in the preparation of this article was provided by Rob Brines and Wiebke Jessen. Support for this assistance was funded by Abbott Diabetes Care. Thomas Danne reports grants and personal fees from Abbott, AstraZeneca, Boehringer, DexCom, Lilly, Medtronic, Novo Nordisk, Roche, Sanofi outside the submitted work and is a shareholder of DreaMed Ltd. Catarina Limbert reports grants and personal fees from Abbott, Ipsen and Sanofi. Pratik Choudhary reports grants and personal fees from Abbott, Dexcom, Lilly, Novo Nordisk, Sanofi and Insulet. Manuel Puig-Domingo reports grants, consultant and speaker fees from Sanofi, Novo Nordisk, AstraZeneca, Lilly, Recordati, Pfizer, Ipsen and Novartis outside the submitted work. Eric Renard reports personal fees as consultant/advisor for Abbott, Air Liquide, AstraZeneca, Boehringer Ingelheim, Cellnovo, Dexcom, Eli Lilly, Insulet, Johnson & Johnson (Animas, LifeScan), Medirio, Medtronic, Novo Nordisk, Roche Diagnostics, Sanofi-Aventis and Tandem, and research grant/material support from Abbott, Dexcom, Insulet, Roche Diagnostics and Tandem. Stefano Del Prato has served on the scientific board and received honoraria for consulting fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Merck & Co., Novartis Pharmaceuticals, Novo Nordisk, sanofi, servier, Takeda Pharmaceuticals. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Data sharing is not applicable to this article as no new data sets were generated during the current study. Funding Information: Sponsorship for this study and journal’s Rapid Service Fee were funded by Abbott Diabetes Care. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/9

Y1 - 2021/9

N2 - People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

AB - People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

KW - Ambulatory glucose profile

KW - Continuous glucose monitoring

KW - COVID-19

KW - Diabetes

KW - Insulin pumps

KW - Mortality

KW - Risk management

KW - Telemedicine

KW - Telemonitoring

KW - Virtual care

UR - http://www.scopus.com/inward/record.url?scp=85111885173&partnerID=8YFLogxK

U2 - 10.1007/s13300-021-01114-x

DO - 10.1007/s13300-021-01114-x

M3 - Review article

AN - SCOPUS:85111885173

SN - 1869-6953

VL - 12

SP - 2289

EP - 2310

JO - Diabetes Therapy

JF - Diabetes Therapy

IS - 9

ER -