What Diabetes Can Teach us About Dealing With COVID-19 and Could it Be a Catalyst for Change in Diabetes?

I have learned that diabetes—type 1, 2, gestational—is a disease that sneaks up on you, lets you live with it—mainly unhurt—for quite a while. Suddenly, and out of the blue, it strikes with a vengeance and causes great harm that often cannot be cured anymore and, in the worst cases, barely managed. And how are people with diabetes often asked to deal with their disease—with behavioral change! Sounds like COVID-19?

Timelines for diabetes-related complications are longer than any timeline of the current pandemic. Patients with diabetes (PWDs) have developed traits that can uniquely prepare them for a public health crisis like this—even though they are at higher risks during such a crisis.^1,2

Some examples of PWD 101 preparation: (1) anticipate failures (pump, continuous glucose monitors, pen) and prepare for it—hope it will never happen; (2) have enough supplies (COVID-19 language: pantry with nonperishable food); (3) be guided by expert advice; (4) be resilient; (5) have a support network; (6) do not try to fight this alone and (7) do not be pulled down by the situation.

All types of scientist have stepped up to the challenge—including ones who focus on diabetes research. ³ While PWD 101 preparation can teach us all a lot on how to prepare for a crisis, the effect of the actual pandemic, specifically on PWDs, is yet unknown. ⁴ T1D Exchange, for example, launched a study of COVID-19 prevalence, presentation, and outcomes in type 1 diabetes. ⁵

In March 2020 in the United States, Ascensia was starting the virtual study “REALL”—examining how blood glucose meters linked with apps can improve the ability of adults with diabetes to manage their blood glucose levels, diet, and exercise. Understanding the need to expand on the research, we developed a COVID-19 questionnaire and were able to include it in the study.

Diabetes—like COVID-19—poses challenges, the only difference here being the individual vs the larger society. As with diabetes, people who are economically disadvantaged are likely to suffer more than people who are not, i.e. do not have the chance to stock up, work in the gig economy ⁶ which has evaporated overnight, or whose insurance company will not cover more than a 30-day medical supply. Will technology save us? It has to—eventually. In the meantime, however, we must rely on behavioral change to get us to a place where we can survive while we await technology to enable us to actually thrive.

In the future, I predict there will be both effective treatments, and more importantly, a vaccine for COVID-19. I also wonder if this pandemic will lead to a further increase in the cases of type 2 down the road—due to less physical activity or forced to buy less healthy foods i.e. loss of jobs in families. ⁷ For diabetes care delivery, I predict nothing will change—unless there is strong leadership to force and make the changes we are experiencing, such as wide usage of telemedicine, permanent and sustainable. Until just a few weeks ago, telemedicine was still viewed as an “experiment,” needed to be “evaluated,” encumbered by lots of red tape, and rarely reimbursed.^8,9

Today, remote is a stark reality for healthcare providers across many specialties. Change always needs a catalyst. For women, it was World War II that opened up the workforce for them. To catapult telemedicine for diabetes or even broader society into the next century, it might have needed this global “social distancing” policy. Digital and virtual health management has been talked up by institutions and companies for a long time, but now is being required by governments. ¹⁰

Prior to this pandemic, payers saw little need to cover remote health management. COVID-19 might have opened the door for a “New Deal” as it comes to remote diabetes management. Diabetes is a data driven disease—why not take advantage of this and use the scarce resources of ANY healthcare system i.e., highly trained endocrinologist and diabetes specialists for follow-up, and artificial intelligence and algorithm driven solutions as the first line of defense against this sneaky disease.

Diabetes, despite complications and mortality, has not gotten the true attention it demands and requires.^11-13 The novel Coronavirus exploits weakness in health and healthcare, be it advanced age, a comorbidity like diabetes or access to care. It brought out encouraging news—showing compassion, people shopping for others, food donations, and diabetes industry stepping up to support people in need.^14-17 Hopefully, this global public health crisis forces us to reflect on shortfalls that have been exposed—in politics, society, or overall healthcare delivery—and will build a more equitable and efficient way for healthcare workers to care for people in need.