REVIEW

Improving diabetes self-management during the COVID-19 pandemic: a scoping review

Francisca Diana da Silva Negreiros¹, Tatiana Rebouças Moreira¹, Maria de Jesus Nascimento de Aquino¹, Açucena Leal de Araújo², Lucilane Maria Sales da Silva², Thereza Maria Magalhães Moreira²

¹Federal University of Ceará, Fortaleza, CE, Brazil

²Ceará State University, Fortaleza, CE, Brazil

ABSTRACT

Objective: To synthesize the available evidence on nursing-based actions to improve diabetes self-management during the COVID-19 pandemic. Method: Scoping review using the Joanna Briggs Institute methodology (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research covered academic studies and gray literature from seven primary and six secondary databases. Two independent reviewers assessed the studies, and the data were analyzed descriptively. Results: A total of 1,322 titles were identified, of which 31 studies were included. All studies were published in 2020, mainly in English. Teleconsultation was a relevant strategy to help patients manage diabetes and their general health. Conclusion: The review indicates that the nursing-based actions carried out during the COVID-19 pandemic to improve diabetes self-management are not different from what has been consolidated, but some adaptations have been undertaken. The need for self-care, social support, and a collaborative and patient-centered approach is reinforced.

Descriptors: Coronavirus; Self-Management; Diabetes Mellitus.

INTRODUCTION

At the end of December 2019, an unexpected outbreak of pneumopathy caused by the coronavirus Sars-CoV-2, known as COVID-19, emerged. The exponential growth of affected patients has made it a major threat to global public health, culminating in the World Health Organization (WHO) declaration of pandemic status. Metabolic comorbidities make patients susceptible to COVID-19, exacerbating the infection(1).

Diabetes mellitus (DM) is an independent predictor of morbidity and mortality in patients with the new coronavirus(2). From this perspective, optimizing glycemic control and COVID-19 preventive measures are vital. Besides, integrated and timely measures that contribute to disease self-management and self-care, uninterrupted follow-up of treatment, and adherence to the care plan must be articulated(3). Given the above, diabetes self-management is considered a continuous process that facilitates the individual's knowledge and skills to control the disease successfully(4).

Blockages during the pandemic compromised the regular follow-up of diabetic patients, putting their glycemic control at risk and compromising their self-care. Besides, the uncertainty that goes along with the COVID-19 pandemic causes the perception of an immediate threat, reinforcing the need for new strategies for diabetes management(5).

Individual and community measures are key to mitigating the pandemic's escalation, given the challenges of the pandemic and the fact that people with diabetes are a vulnerable group. Therefore, specific, integrated, and timely interventions are of utmost importance in the current times. Some therapeutic goals may not be easy to achieve. Therefore, strategies are needed to protect the health of such patients, including self-management interventions, enhanced support of health services, and dissemination of preventive measures(3).

Health professionals are the first line of defense in the pandemic, providing preventive and therapeutic strategies to vulnerable groups, including education and counseling. Counseling involves active, individualized, and client-centered guidance and listening. It presupposes the ability to establish a relationship of trust, aiming to mobilize the patient's internal resources so that he becomes an active subject in determining his or her own health(6).

A previous search of literature reviews on the subject was conducted by the authors in scientific databases (Medline via PubMed, LILACS, and Web of Science), and no published or on-going literature reviews were yet done on nursing-based actions to improve diabetes self-management during the COVID-19 pandemic, reinforcing the novelty of the present review. Therefore, this scoping review was conducted to synthesize the available evidence on nursing-based actions to improve diabetes self-management during the COVID-19 pandemic.

METHOD

Study design

This scoping review was registered with the Open Science Framework (OSF) (osf.io/fdyp2). The review protocol was developed based on the Joanna Briggs Institute's (JBI) methodology(7) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist(8).

The nine steps recommended in the JBI's methodology were followed: (1) definition and alignment of objectives and questions, (2) development and alignment of the inclusion criteria with the objectives and questions, (3) description of the planned approach to evidence screening, selection, data extraction, and presentation of evidence, (4) evidence search, (5) evidence selection, (6) evidence extraction, (7) evidence analysis, (8) presentation of results, and (9) summarization of the evidence concerning the purpose of the review, making conclusions and noting any implications of the findings(7).

Search strategies

The review was guided by the following question: What nursing-based actions have been taken to improve diabetes self-management during the COVID-19 pandemic? This question was created using the Population-Concept-Context (PCC) framework(7): Population: patients with diabetes, Concepts: nursing care and self-management, and Context: the COVID-19 pandemic. The inclusion criteria were defined using the PCC framework: Population: articles involving patients with diabetes, Concept: articles on health care, nursing care, and self-management; and Context: articles about the COVID-19 pandemic. Primary, empirical, quantitative, and qualitative studies of any design and published in any language were considered eligible.

The search strategies were developed by a librarian aiming at optimal sensitivity and refinement. The following databases were searched on November 6, 2020: Medline, Lilacs, Web of Science, Scopus, CINAHL, Cochrane Library, and Embase. The following sources were used to retrieve gray literature: Google Scholar, Brazilian Digital Library of Theses and Dissertations, CAPES Catalog of Theses and Dissertations, OpenGrey, NYAM Library, and ProQuest Dissertations and Theses. The retrieval of documents on Google Scholar was carried out on the first ten pages with a 2019-2020 frame considering the time of the outbreak of COVID-19. Controlled and uncontrolled terms were used to achieve high sensitivity and to expand the search results, as shown in Table 1.

Table 1 - Search terms used based on the PCC strategy. Fortaleza, CE, Brazil, 2022

Source: Elaborated by the authors, 2022.

Initially, a search strategy using controlled vocabularies was pilot tested, but it has resulted in limited results. Thus, the research team used controlled and uncontrolled vocabularies (Table 1). Besides, during the search and prior analysis of the results, it was clear that other terms could be added. However, when testing them, the search results were not modified quantitatively, or, in other cases, they generated results that did not fit the research question. Then, a highly sensitive search strategy was built to achieve consistent results and minimize possible losses, based on the Peer Review Electronic Search Strategy (PRESS) guidelines(9). The three search strategies created are shown in Supplementary Material 1.

After the execution of the three search strategies, all titles and abstracts were screened by two independent reviewers. Next, the full texts were read by the same reviewers independently to confirm eligibility. Any inconsistencies were discussed with an additional reviewer. The results obtained in the databases were exported to the Rayyan® reference manager, developed by the Qatar Computing Research Institute (QCRI) to remove duplicates and for two independent researchers' selection and screening processes. A third reviewer resolved discrepancies. Additionally, manual searches were performed in reference lists of the included studies to identify additional documents.

Data extraction and quality assessment

Data were extracted to a spreadsheet by two reviewers independently. The characteristics of the individual studies extracted for this review included country, year of publication, design, objectives, and main findings. In addition, the studies' evidence level was established based on the JBI criteria(7). A third reviewer confirmed the selection and extraction processes.

Data synthesis

The results presentation and discussion were carried out descriptively by two researchers who elaborated main themes and independently completed the data analysis and synthesis. This step was carried out to increase the rigor of the analysis and the reliability of the results. Discrepancies were solved through discussions with the third member of the research team.

RESULTS

The search identified 1,322 potentially relevant studies in the databases and other sources, of which 736 duplicates were removed. Then, 586 publications were analyzed by their titles and abstracts, and 426 studies were excluded for not meeting the inclusion criteria. One hundred thirty articles and reference lists were fully evaluated for eligibility. In the end, 25 articles and 6 publications from the reference lists were selected, totaling 31 articles(10-40). Figure 1 shows the process of study selection.

Source: Elaborated by the authors, 2022.

Figure 1 - PRISMA-ScR flow diagram outlining the process of study selection. Fortaleza, CE, Brazil, 2022

Most of the studies originated in India (n = 5) and the United Kingdom (n = 6), followed by the United States (n = 3) and Australia (n = 2). All studies were published in 2020, predominantly in English (n = 30). The studies' levels of evidence and other characteristics are shown in Supplementary Material 2.

Information from the studies about diabetes self-management actions can be summarized into the following areas: dietary counseling(10-12,15,19,20,22-25,27,29,31,33-35,37-39), physical activity recommendations (towards improved immunity and controlled stress and anxiety)(10-13,15,20,22,24,25,27,29-31,33-35,37,39), glycemic monitoring(10,11,14,15,17,20,23-25,27-31,33-35,37), hypoglycemia management(10,11,22,37), medication adherence(10,11,17,21,24,27,28), COVID-19 prevention and control measures(13,22,23), and use of social media to gain health information(18,20). Furthermore, the findings pointed to remote monitoring (telehealth) as a tool to improve adherence to self-care practices during the COVID-19 pandemic, with a focus on maintaining a healthy diet, practicing physical activities, adhering to glycemic monitoring and drug therapy, attending psychosocial care activities, reducing stress, anxiety, and depression, and preventing diabetes-related complications(10-12,15,19,24-27,28,30,31,36,40).

DISCUSSION

This review identified different nursing-based actions to improve diabetes self-management during the COVID-19 pandemic. However, since the coronavirus subject area is new, most studies have discussed COVID-19 preventive measures instead of actions specifically directed toward diabetes self-management, revealing a literature gap.

The impact of pandemic preventive measures on healthcare access and diabetes self-management has been evident. Social distancing measures combined with lockdowns have reinforced the need for healthcare professionals to educate patients better and encourage them to monitor their blood glucose levels, maintain healthy nutrition and enhanced lifestyle, have an adequate supply of medications, and acquire knowledge on what to do if they become infected(41).

More than ever, it is time to search for social measures to improve the population's diet and lifestyle. Besides, individually targeted health promotion measures aiming at weight management, behavioral changes, and psychology services must be implemented. Specialized care should not be limited to managing advanced/complex cases. Health professionals must take responsibility for implementing strategies for optimal treatment of less complex cases(42), as clinically stable patients follow up on an outpatient basis in primary and secondary services.

The reviewed studies discuss recommendations for promoting a healthy lifestyle during the pandemic. Patients with diabetes must keep enough medications and glucose monitoring devices stored at home(10-11,19-20,22,24,29-35,37,39-40). The diet should be low in carbohydrates and fats, with optimal protein consumption, and composed of four to six meals daily (including snacks, lunch, and dinner). Physical activity improves immunity, although it is prudent to avoid crowded places such as gyms and swimming pools(22). Home exercises with an exercise bike, treadmill, or running are recommended(10). One of the studies emphasizes that regular physical activity in a safe home environment is an important strategy for young people with type 1 diabetes(43) and vulnerable patients to severe COVID-19.

In keeping with the above, it is known that COVID-19 has affected the population's lifestyle and led to changes in their daily habits. The situation resulting from the COVID-19 pandemic likely triggered bad eating habits, thus increasing the consumption of sugary foods and snacks and sedentarism, worsening diabetes control. Such outcomes must be considered, and care plans for patients with diabetes must be individualized(44). Since fluctuations in blood glucose levels are expected to occur more frequently, nurses must instruct their patients to perform frequent blood glucose monitoring.

Authors(24,27) have also presented recommendations for older adults with diabetes, who are especially vulnerable to the complications of COVID-19(45). Older adults must be monitored intensively to prevent diabetes from getting worse, and since they may have other comorbidities, they require effective strategies to avoid exposure to the new coronavirus(46). Elderly people, in addition to diabetes, may have other conditions such as obesity, hypertension, and cardiovascular disease. Thus, healthcare professionals must implement preventive and control measures against COVID-19 to reduce the risk of contamination of these individuals and make family members aware of the increased risk of complications in this group, as their condition is related to a poor prognosis.

Some studies covered interventions for pregnant type 1 diabetic women(14), children(16), young adults(33), and adults(28). Such studies emphasized blood glucose monitoring, insulin administration, and early identification of ketoacidosis. On the one hand, more attention should be paid to diabetic patients on insulin therapy(46) since there are reasons to suspect that blocking conditions may deleteriously affect glycemic control. Nevertheless, on the other hand, this was not seen in a large cohort of individuals in the UK. In general, there was a small but significant improvement in important metrics, including target HbA1c(47).

Another survey reports a significant increase in the frequency of children and adolescents presenting severe ketoacidosis during the pandemic when social distancing was enacted. This illustrates the need to encourage children and their families to continue to seek and receive healthcare during the pandemic(48). It is known that type 1 diabetes demands continuous use of insulin, and the lack of glycemic control can lead to ketoacidosis, requiring greater awareness and self-management. Families must be involved in the interdisciplinary team's therapeutic planning since a part of this population comprises children and adolescents who need family support.

Concerning foot care, studies(36-37) demonstrate that patient education and remote assistance are important to promote self-management and prevent complications. It is known that poor management of diabetic foot causes prolonged morbidity, hospitalization, amputations, and death. However, given the COVID-19 crisis, it has been difficult to maintain high care standards for patients with diabetic feet (49). Great challenges exist in raising people's awareness of the self-management of diabetes. In this challenging context, healthcare professionals must develop reliable and continuous monitoring strategies that ensure interpersonal communication according to each patient's needs.

Another aspect mentioned by some studies was the increased use of digital health technologies and telehealth for diabetes monitoring and management during the COVID-19 pandemic(26,50). Remote patient education and counseling can improve the patient's understanding of the diabetic foot and other risks related to the disease. Besides, the collaboration between different professionals allows a cohesive and quality approach to improve self-examination and detect signs of ulceration or infection(49).

The studies have also presented guidelines on how to deal with psychosocial issues(11,34,40), stress reduction(12,27,37), anxiety and depression(15,38-39), emotional support(16), and mental health(24,30). All health professionals and society must focus on mental health and preventive measures for COVID-19 to prevent chronic psychiatric illnesses. People with pre-existing psychological illnesses need extra care and precautions to prevent relapse or complications(51). In general, the health team must be aware of the impact of the pandemic on mental health and extend support to people through remote or face-to-face strategies.

Using teleconsultation to raise awareness of people with diabetes on disease management is a challenge(10-16,18-19,25-28,30-32,35-37,40). Telecommunication strategies such as telehealth and video consultations are key in exchanging vital information for diagnosis and treatment, especially during the pandemic. Telehealth can be a revolutionary step in treating diabetes, and patients can have immediate access to adequate care through these resources(52) and the entire population with diseases associated with COVID-19 complications, such as diabetes.

Despite the above arguments, it is important to consider that some patients already struggling with self-care may also be struggling with technology use. Losing face-to-face contact can lead to demotivation and greater disconnection(42). In the era of general restrictions on face-to-face communication, nurses and other healthcare professionals are even more required to show empathy and have skills to support patients remotely in their doubts and encourage self-care behaviors.

The main findings of this scoping review can be synthesized in the following recommendations for patients with diabetes: (1) isolation and contact precautions to restrain the advance of the virus; (2) adhering to a healthy diet plan composed of three meals and a snack; (3) staying active, ideally through physical activities at home; (4) increasing the frequency of glucose self-monitoring; (5) taking antidiabetic drugs; (6) knowing how to solve acute problems, such as diabetic ketoacidosis and hypoglycemia; (7) reducing risks by adhering to foot care and other preventive measures against complications; (8) adopting strategies to reduce stress, anxiety, and depression; (9) replenishing prescriptions and monitoring supplies and medications to avoid running out of the drugs; and (10) using digital technological resources and telemonitoring to receive guidance and counseling during the pandemic.

The limitations of this scoping review include the fact that we may not have identified all relevant studies in the published literature despite our efforts to be as comprehensive as possible in the three search strategies used. Besides, despite using three reviewers to standardize the data selection and extraction processes, there is always the possibility of bias when interpreting the literature.

CONCLUSION

The current scoping review indicates that the nursing-based actions that have been recommended and carried out during the COVID-19 pandemic to improve diabetes self-management are not different from what has been consolidated, but some adaptations have been undertaken as a response. The need for self-care, social support, and a collaborative and patient-centered approach is reinforced. Future investigations assessing the impact of the pandemic on people diagnosed with diabetes and on the healthcare provided to them must be carried out, as there is a lack of research in this area.

CONFLICT OF INTEREST

The authors have declared that there is no conflict of interest.

REFERENCES

1. Hussain S, Baxi H, Chand Jamali M, Nisar N, Hussain MS. Burden of diabetes mellitus and its impact on COVID-19 patients: a meta-analysis of real-world evidence. Diabetes Metab Syndr. 2020;14:1595-602. https://doi.org/10.1016/j.dsx.2020.08.014

2. Papazafiropoulou AK, Antonopoulos S. The COVID-19 pandemic and diabetes mellitus. Arch Med Sci Atheroscler Dis. 2020;5:200-5. https://doi.org/10.5114/amsad.2020.97435

3. Katulanda P, Dissanayake HA, Ranathunga I, Ratnasamy V, Wijewickrama PSA, Yogendranathan N, et al. Prevention and management of COVID-19 among patients with diabetes: an appraisal of the literature. Diabetologia. 2020;63:1440–52. https://doi.org/10.1007/s00125-020-05164-x

4. American Association of Diabetes Educators. An effective model of diabetes care and education: revising the AADE7 Self-Care Behaviors®. Diabetes Educ. 2020;46:139-60. https://doi.org/10.1177/0145721719894903

5. Parise M, Tartaglione L, Cutruzzola A, Maiorino MI, Esposito K, Pitocco D, et al. Teleassistance for patients with type 1 diabetes during the COVID-19 pandemic: results of a pilot study. J Med Internet Res. 2021;23:e24552. https://doi.org/10.2196/24552

6. Silva PSC, Boing AF. Factors associated with leisure-time physical activity: analysis of Brazilians with chronic diseases. Cien Saude Colet. 2021;26:5727-38. http://doi.org/10.1590/1413-812320212611.32432020

7. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis [Internet]. JBI: Adelaide; 2020 [cited 2022 Mar 30]. Available from: https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-12

8. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. Prisma extension for scoping reviews (Prisma-ScR): checklist and explanation. Ann Intern Med. 2018;169:467-73. https://doi.org/10.7326/M18-0850

9. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40-6. https://doi.org/10.1016/j.jclinepi.2016.01.021

10. Wicaksana AL, Hertanti NS, Ferdiana A, Pramono RB. Diabetes management and specific considerations for patients with diabetes during coronavirus diseases pandemic: a scoping review. Diabetes Metab Syndr. 2020;14:1109e1120. https://doi.org/10.1016/j.dsx.2020.06.070 [included in the review]

11. Banerjee M, Chakraborty S, Pal R. Diabetes self-management amid COVID-19 pandemic. Diabetes Metab Syndr. 2020;14:351-4. https://doi.org/10.1016/j.dsx.2020.04.013 [included in the review]

12. Ranscombe P. How diabetes management is adapting amid the COVID-19 pandemic. Lancet Diabetes Endocrinol. 2020;8:571. https://doi.org/10.1016/S2213-8587(20)30181-9 [included in the review]

13. Bhaskar S, Rastogi A, Chattu VK, Adisesh A, Thomas P, Alvarado N, et al. Key strategies for clinical management and improvement of healthcare services for cardiovascular disease and diabetes patients in the Coronavirus (COVID-19) settings: recommendations from the REPROGRAM consortium. Front Cardiovasc Med. 2020;7:112. https://doi.org/10.3389/fcvm.2020.00112 [included in the review]

14. Murphy HR. Managing diabetes in pregnancy before, during, and after COVID-19. Diabetes Technol Ther. 2020;22:454-61. https://doi.org/10.1089/dia.2020.0223 [included in the review]

15. Taheri S, Chagoury O, Tourette M, Skaroni I, Othman M, Bashir M, et al. Managing diabetes in Qatar during the COVID-19 pandemic. Lancet Diabetes Endocrinol. 2020;8:473-4. https://doi.org/10.1016/S2213-8587(20)30154-6 [included in the review]

16. Garg SK, Rodbard D, Hirsch IB, Forlenza GP. Managing new-onset type 1 diabetes during the COVID-19 pandemic: challenges and opportunities. Diabetes Technol Ther. 2020;22:431-9. https://doi.org/10.1089/dia.2020.0161 [included in the review]

17. Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8:546–50. https://doi.org/10.1016/S2213-8587(20)30152-2 [included in the review]

18. Isip-Tan IT, Gutierrez J, Bernardo DC. Use of Facebook to serve information needs of persons with diabetes amid the COVID-19 Pandemic. J ASEAN Fed Endocr Soc.  2020;35:32-7. Available from: https://doi.org/10.15605/jafes.035.01.09 [included in the review]

19. Morris D. What is the effect of COVID-19 on people with diabetes? Independent Nurse. 2020;5:12-7. https://doi.org/10.12968/indn.2020.5.12 [incluída na revisão]

20. Puig-Domingo M, Marazuela M, Giustina A. COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology. Endocrine. 2020;68:2-5. https://doi.org/10.1007/s12020-020-02294-5 [incluída na revisão]

21. American Association of Clinical Endocrinologists. AACE position statement: coronavirus (COVID-19) and people with diabetes [Internet]. [place unknown]: AACE; 2020 [cited 2022 Mar 30]. Available from: https://www.aace.com/recent-news-and-updates/aace-position-statement-coronavirus-covid-19-and-people-diabetes-updated [included in the review]

22. Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr. 2020;14:211-2. https://doi.org/10.1016/j.dsx.2020.03.002 [included in the review]

23. Hartmann-Boyce J, Morris E, Goyder C, Kinton J, Perring J, Nunan D, et al. Managing diabetes during the COVID-19 pandemic. The Center for Evidence-Based Medicine [Internet]. 2020 [cited 2022 Mar 30]. Available from: https://www.cebm.net/covid-19/managing-diabetes-during-the-covid-19-pandemic/ [included in review]

24. Sinclair AJ, Forbes A. Older people with diabetes: Why frailty imposes an additional challenge during the COVID-19 pandemic. Touch endocrinology [Internet]. 2020 [cited 2022 Mar 30]. Available from: https://www.touchendocrinology.com/insight/older-people-with-diabetes-why-frailty-imposes-an-additional-challenge-during-the-covid-19-pandemic/31 [incluída na revisão]

25. Ghosh A, Gupta R, Misra A. Telemedicine for diabetes care in India during COVID-19 pandemic and national lockdown period: guidelines for physicians. Diabetes Metab Syndr. 2020;14:273-6. https://doi.org/10.1016/j.dsx.2020.04.001 [included in the review]

26. Lim ST, Yap F, Chin X. Bridging the needs of adolescent diabetes care during COVID-19: a nurse-led telehealth initiative. J Adolesc Health. 2020;67:615-7. https://doi.org/10.1016/j.jadohealth.2020.07.012 [included in the review]

27. Sy SL, Munshi MN. Caring for older adults with diabetes during the COVID-19 pandemic. JAMA Intern Med. 2020;180:1147-8. https://doi.org/10.1001/jamainternmed.2020.2492 [incluída na revisão]

28. Scott ES, Jenkins AJ, Fulcher GR. Challenges of diabetes management during the COVID-19 pandemic. Med J Aust. 2020;213:56-7. https://doi.org/10.5694/mja2.50665 [incluída na revisão]

29. Abdi A, Jalilian M, Sarbarzeh PA, Vlaisavljevic Z. Diabetes and COVID-19: a systematic review on the current evidences. Diabetes Res Clin Pract. 2020;166:1-14. https://doi.org/10.1016/j.diabres.2020.108347 [included in the review]

30. Hartmann-Boyce J, Morris E, Goyder C, Kinton J, Perring J, Nunan D, et al. Diabetes and COVID-19: risks, management, and learnings from other national disasters. Diabetes Care. 2020;43:1695-703. https://doi.org/10.2337/dc20-1192 [included in the review]

31. Wake DJ, Gibb FW, Kar P, Kennon B, Klonoff DC, Rayman G, et al. Endocrinology in the time of COVID-19: remodeling diabetes services and emerging innovation. Eur J Endocrinol. 2020;183:G67-77. https://doi.org/10.1530/EJE-20-0377 [included in the review]

32. Tao J, Gao L, Liu Q, Dong K, Huang J, Peng X et al. Factors contributing to glycemic control in diabetes mellitus patients complying with home quarantine during the coronavirus disease 2019 (COVID-19) epidemic. Diabetes Res Clin Pract. 2020;170:108514. https://doi.org/10.1016/j.diabres.2020.108514 [included in review]

33. Pal R, Yadav U, Grover S, Saboo B, Verma A, Bhadada SK. Knowledge, attitudes and practices towards COVID-19 among young adults with type 1 diabetes mellitus amid the nationwide lockdown in India: a cross-sectional survey. Diabetes Res Clin Pract. 2020;166:108344. https://doi.org/10.1016/j.diabres.2020.108344 [included in the review]

34. Jethwani P, Saboo B, Jethwani L, Kesavadev J, Kalra S, Sahay R, et al. Management of children and adolescents having type 1 diabetes during COVID-19 pandemic in India: Challenges and solutions. Int J Diabetes Dev Ctries. 2020;40:335-9. https://doi.org/10.1007/s13410-020-00865-w [included in the review]

35. Kiran T, Moonen G, Bhattacharyya OK, Agarwal P, Bajaj HS, Kim J, et al. Managing type 2 diabetes in primary care during COVID-19. Can Fam Physician. 2020;66(10):745-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571649/ [included in the review]

36. Cerqueira MMBF, Merces MC, Cerqueira JMF, Silva DAR, Almeida OS, Gomes AMT. Proposals on self-care for diabetic foot during the COVID-19 pandemic in Brazil. Acta Paul Enferm. 2020;33:e-EDT20200005. https://doi.org/10.37689/acta-ape/2020edt0005 [included in the review]

37. Mukona DM, Zvinavashe M. Self-management of diabetes mellitus during the COVID-19 pandemic: recommendations for a resource limited setting. Diabetes Metab Syndr. 2020;14:1575-8. https://doi.org/10.1016/j.dsx.2020.08.022 [included in the review]

38. Rose KJ, Scibilia R. The COVID-19 pandemic - Perspectives from people living with diabetes. Diabetes Res Clin Pract. 2020;108343. https://doi.org/10.1016/j.diabres.2020.108343 [included in the review]

39. Grabia M, Markiewicz-Żukowska R, Puścion-Jakubik A, Bielecka J, Nowakowski P, Gromkowska-Kępka K, et al. The nutritional and health effects of the COVID-19 pandemic on patients with diabetes mellitus. Nutrients. 2020;12:3013. https://doi.org/10.3390/nu12103013 [included in the review]

40. Quinn LM, Davies MJ, Hadjiconstantinou M. Virtual consultations and the role of technology during the COVID-19 pandemic for people with type 2 diabetes: the UK perspective. J Med Internet Res. 2020;22:e21609. https://doi.org/10.2196/21609 [included in the review]

41. Chee YJ, Tan SK, Yeoh E. Dissecting the interaction between COVID-19 and diabetes mellitus. J Diabetes Investig. 2020;11:1104-14. https://doi.org/10.1111/jdi.13326

42. Petrie JR, Boyle JG, Ali K, Smith C, Morrison D, Kar P. A post COVID-19 'Marshall Plan' for type 2 diabetes. Diabet Med. 2021;38:e14439. https://doi.org/10.1111/dme.14439

43. Tornese G, Ceconi V, Monasta L, Carletti C, Faleschini E, Barbi E. Glycemic control in type 1 diabetes mellitus during COVID-19 quarantine and the role of in-home physical activity. Diabetes Technol Ther. 2020;22:462-7. https://doi.org/10.1089/dia.2020.0169

44. Ruiz-Roso MB, Knott-Torcal C, Matilla-Escalante DC, Garcimartín A, Sampedro-Nuñez MA, Dávalos A et al. COVID-19 lockdown and changes of the dietary pattern and physical activity habits in a cohort of patients with type 2 diabetes mellitus. Nutrients. 2020;12:2327. https://doi.org/10.3390/nu12082327

45. Moraes EN, Viana LG, Resende LMH, Vasconcellos LS, Moura AS, Menezes A et al. COVID-19 in long-term care facilities for the elderly: laboratory screening and disease dissemination prevention strategies. Cien Saude Colet. 2020;25:3445-58. http://dx.doi.org/10.1590/1413-81232020259.20382020

46. Shang J, Wang Q, Zhang H, Wang X, Wan J, Yan Y, et al. The relationship between diabetes mellitus and Covid-19 prognosis: A retrospective cohort study in Wuhan, China. Am J Med. 2021;134:e6-e14. https://doi.org/10.1016/j.amjmed.2020.05.033

47. Dover AR, Ritchie SA, McKnight JA, Strachan MWJ, Zammitt NN, Wake DJ, et al. Assessment of the effect of the COVID-19 lockdown on glycaemic control in people with type 1 diabetes using flash glucose monitoring. Diabet Med. 2021;38:e14374. https://doi.org/10.1111/dme.14374

48. Lawrence C, Seckold R, Smart C, King BR, Howley P, Feltrin R, et al. Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID-19 pandemic. Diabet Med. 2021;38:e14417. https://doi.org/10.1111/dme.14417

49. Jaly I, Iyengar K, Bahl S, Hughes T, Vaishya R. Redefining diabetic foot disease management service during COVID-19 pandemic. Diabetes Metab Syndr. 2020;14:833-8. Available from: https://doi.org/10.1016/j.dsx.2020.06.023

50. Negreiros FDS, Araújo AL, Mattos SM, Moreira TR, Cestari VRF, Silva LMS, et al. Digital technologies in the care of people with diabetes during the COVID-19 pandemic: a scoping review. Rev Esc Enferm USP. 2021;55:e20210295. https://doi.org/10.1590/1980-220X-REEUSP-2021-0295

51. Hazarika M, Das S, Bhandari SS, Sharma P. The psychological impact of the COVID-19 pandemic and associated risk factors during the initial stage among the general population in India. Open J Psychiatry Allied Sci. 2021;12:31-5. https://doi.org/10.5958/2394-2061.2021.00009.4

52. Sayed S. COVID-19 and diabetes: Possible role of polymorphism and rise of telemedicine. Prim Care Diabetes. 2021;15:4-9. https://doi.org/10.1016/j.pcd.2020.08.018

Submission: 04/06/2022

Approved: 04/24/2023