key: cord-0809071-j4k6yyaz authors: Ceriello, Antonio title: “Diabetes as a case study of chronic disease management”: eight years later. The opportunity learned from the COVID-19 pandemic date: 2020-08-25 journal: Diabetes Res Clin Pract DOI: 10.1016/j.diabres.2020.108384 sha: a710f31e29b87b388919b66debb0c7552374fb12 doc_id: 809071 cord_uid: j4k6yyaz nan "Diabetes as a case study of chronic disease management": eight years later. The opportunity learned from the COVID-19 pandemic. (1) . People with diabetes are paying a very high price to COVID-19, in terms of worse prognosis and high possibility to die (1). Several recommendations have been published on how to manage several specific aspects when COVID-19 is present in people with diabetes (2) (3) (4) or on how to manage the diabetes therapy during the pandemic (4) (5) . However, it is clear that any recommendation to be followed needs an interaction between the person with diabetes and the health care professionals, which has been the major challenge in the period of lockdown and social distance (6) . Telemedicine adoption has rapidly accelerated since the onset of the COVID-19 pandemic. Telemedicine provides increased access to medical care and helps to mitigate risk by conserving personal protective equipment and providing for social/physical distancing in order to continue to treat patients (7) . Paradoxically, the pandemic has resulted in a major reorganization throughout the world in how diabetes care is delivered to outpatients (8) . Paradoxically, because, once again, diabetes has been confirmed as model for the management of a chronic disease and because the adoption of Telemedicine for diabetes management has moved from theory to daily clinical practice (9) . In 2012 a Group of Experts suggested "Diabetes provides a pertinent case of chronic disease management with a particular focus on patient self-management. This paper suggests using a six-step cycle for personalized diabetes (self-)management and collaborative use of structured blood glucose data (Figure 1 ). E-health solutions can be used to improve process efficiencies and allow remote access. Available evidence about the effectiveness of the cycle's constituting elements justifies expectations that the diabetes management cycle as a whole can generate medical and economic benefit" (9) . We had to wait for the COVID-19 pandemic for these words to be quickly translated into action. The most important evidence is that Telemedicine works and it works in Type 1 diabetes, Type 2 diabetes and, notably, in old people with Type 2 diabetes (10) (11) (12) (13) (14) (15) . This last evidence overcomes the idea that Telemedicine is a useful tool only for young persons. Prior to the COVID-19 pandemic, the use of Tele-health world-wide was quite limited, while during this pandemic many health care professionals have needed to adopt telemedicine expeditiously in their practices while studying the complex and variable issues surrounding its regulation and reimbursement (8) . In the post-COVID-19 era, Telemedicine will likely become an integral part of healthcare delivery, especially for chronic illnesses like diabetes. In fact patients will demand this service as they become comfortable with the technology. Furthermore, e-consults and teleconsults between primary care physicians and specialists will also increase. Similarly, the use of self-reflection, applications and tracking data from glucometers, insulin pumps or sensors can help to enhance the transmission of information between patients with diabetes and their healthcare providers. This rapid need for Telemedicine visits has generated the demand to effectively educate Health Care Professionals on how to optimize its utilization. Clearly, is it time for a different training of the Health Care Professionals, with Telemedicine use being a mandatory field of their education. However, this will be not enough until Telemedicine will be recognized as tool for the delivery of care and adequately reimbursed. Finally, the development of specific algorithms implemented in the Telemedicine adoption for the management of the disease will surely help. COVID-19 in people living with diabetes: an international consensus Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group. Issues of cardiovascular risk management in people with diabetes in the COVID-19 era Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group. Issues for the management of people with diabetes and COVID-19 in ICU Practical recommendations for the management of diabetes COVID-19 and diabetes management: what should be considered? Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis Virtually perfect? Telemedicine for Covid-19 Learning opportunities from COVID-19 and future effects on health care system Glycaemic control among people with Type 1 diabetes during lockdown for the SARS-CoV-2 outbreak in Italy Sustainable diabetes care services during COVID-19 pandemic Characteristics and outcomes of COVID-19 positive patients with diabetes managed as outpatients Managing newonset Type 1 diabetes during the COVID-19 pandemic: challenges and opportunities Inpatient transition to virtual care during COVID-19 pandemic The coronavirus disease 2019 pandemic: telemedicine in elderly patients with type 2 diabetes 1 -A process for personalized diabetes management: details in the text The "six-step cycle for personalized diabetes management" after twelve years seems never than before very useful for the diabetes management we have in front, whether the COVID-19 emergency will last or not.