key: cord-0870760-xw4tod4f authors: Misra, Anoop; Bloomgarden, Zachary title: Diabetes during the COVID‐19 Pandemic: A Global Call to Reconnect with Patients and Emphasize Lifestyle Changes and Optimise Glycemic and Blood Pressure Control date: 2020-05-17 journal: J Diabetes DOI: 10.1111/1753-0407.13048 sha: 328aee385103c087cf98df24274bb376d8582962 doc_id: 870760 cord_uid: xw4tod4f nan Individuals with diabetes, obesity and hypertension are at heightened risk of adverse outcome of coronavirus-associated disease-2019 . Data from many studies show that patients with diabetes have increased risk of admission in intensive care units and of mortality (1). Hypertension is highly prevalent in patients with COVID-19 (2) , and was the most common cardiovascular comorbidity in a meta-analysis, contributing to increase in mortality (3) . Further, in a retrospective analysis of French patients with COVID-19, obesity (BMI >30 kg/m 2 ) and severe obesity (BMI >35 kg/m 2 ) were present in 47.6% and 28.2% of cases, respectively. In this study, patients with higher BMI vales were at greater risk for invasive mechanical ventilation than those who were non obese (4) . These data show high mortality risk in patients with COVID-19 patients with diabetes, hypertension, and obesity. COVID-19 prevalence is likely to vary with different ethnic groups, country, socioeconomic stratum, and healthcare support (5). Many countries or part of countries are under 'lockdown', restricting movements of individuals. Such approaches are likely to have undesirable effects on patients with diabetes: on exercise, on diet, on obtaining adequate supplies of medicines, insulin, and glucose testing reagent strips, and on interaction with healthcare providers (HCPs). In addition, psychological impacts of the COVID-19 pandemic including anxiety and depression affect more than half of the population (6). All these factors may destabilise glycemic and blood pressure control and may worsen obesity. A recent analysis from mathematical modelling in India predicts that lockdown will cause substantial increase in HbA1c and future diabetesrelated complications (7) . Patients with diabetes having poorly controlled glycemia may in turn be at greater risk for COVID-19 complications and mortality. Patients with diabetes often have insufficient health education to modify drug/insulin dosages when it is difficult to communicate with or visit their primary HCPs, particularly in disadvantaged and marginalised populations, and in elderly without support (8, 9) . Increases in blood glucose or blood pressure levels with little expert help and inadequate knowledge to control them is likely to further increase psychological stress in patients. Fortunately, we have reached a threshold of use of telemedicine services, including video chats, telephone calls, and short messaging services to impart advice and guide treatment (10) . telemedicine studies before the COVID-19 pandemic show that these communication strategies can effectively lower HbA1c (11) . In 4-year follow up of a study of nearly 1000 persons with diabetes randomized to a telemedicine self-management behavioural intervention, all-cause and diabetes-related hospitalizations were reduced 11 and 17%, respectively, with consequent cost-savings (12) . The call for "an immediate digital revolution to face this crisis" of COVID-19 (13) seems eminently appropriate. Importantly, there is good evidence to emphasise control of glycemia and hypertension as telemedicine goals, and reasonable strategies have been outlined (14) . Approaches to exercise within confined spaces and to healthy diets can be encouraged. Patients should try to maintain previous schedule of meal timings and should adhere to their medication regimens. Education about changes in doses of drugs and insulin can be imparted to empower patients in self-management of their diabetes and hypertension, emphasizing use of self-monitoring of glucose and blood pressure levels and ongoing communication with HCPs. An emphasis on the potential of improved outcome of COVID19 when diabetes and hypertension are under good control is reasonable. In developing countries, keeping financial implications in mind, low cost therapies and simple treatment regimens should be prescribed to underprivileged and underserved populations. Efforts should be made to reconnect with patients and impart appropriate prevention and management advice. In our clinical practices, we already have begun such efforts and have seen benefit (15) . We encourage all our readers to follow such approaches. 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