key: cord-0766502-t541zf3s
authors: Panchangam, Ramakanth Bhargav; Kota, Sunil Kumar; Mayilvaganan, Sabaretnam
title: Letter to the Editor: Endocrine and diabetes clinical practice during national lockdown and post lockdown period
date: 2020-04-29
journal: Diabetes Metab Syndr
DOI: 10.1016/j.dsx.2020.04.037
sha: 1147875bb7aab61bf871fe3b767316d327592a14
doc_id: 766502
cord_uid: t541zf3s

nan

Dear Editor:

We read article of Ghosh et al 1 , with interest. It has great deal of relevance related to specialist practice of endocrine disorders. Impact of coronavirus infection (COVID19) on practices of all clinicians is unprecedented. National lockdown has resulted in near closure of endocrine and diabetes clinics to grinding halt. This has adversely affected our clinical practices, and more importantly, communication with the patients. Major problems: e.g. financial losses and closure of some hospital for doctors, and deterioration of health due to unsupervised medical condition for patients, have occurred and would further increase with longer period of lockdown.

From point of view of patients of diabetes, this would lead to uncontrolled glycemia in many, increase in micro-and macrovascular complications 2 . Many patients would gain weight due to absence of physical activity and imbalanced diets; and may suffer from medical consequences of obesity. In addition, there is likely to be consequences related to other endocrine diseases which otherwise would require close monitoring: hypo/hyperthyroidism, pituitary diseases, osteoporosis, hypo/ hypercortisolism etc. Further, clinical follow-up of endocrine surgical patients is also compromised leading to unattended hypocalcemia (after parathyroidectomy), hypo/ hyperthyroidism (after thyroidectomy), hypocortisolism (after adrenalectomy) etc. Moreover, surgical treatment of many endocrine diseases is delayed resulting in deleterious consequences.

One potential solution is to implement a virtual OPD through telemedicine (according to prescribed norms with proper certification) 1 . Telemedicine would also help in appropriate preoperative optimisation of hormonal function and other management before surgery. We believe that about 70-80% of clinical problems related to diabetes and endocrine diseases could be managed on telemedicine platforms. Selected patients may require face-to-face consults 1 . Since post lockdown, many patients would still have problems in accessing mass transits and hesitation in coming to hospitals, telemedicine is likely to be an important clinical management platform of any diabetologist/endocrinologist in future.

Telemedicine for diabetes care in India during COVID19 pandemic and national lockdown period: Guidelines for physicians

Estimation of effects of nationwide lockdown for containing coronavirus infection on worsening of glycosylated haemoglobin and increase in diabetes-related complications: A simulation model using multivariate regression analysis

As this is Correspondence and not clinical trial, it was not required to register under ICMJE