Research Unit, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
Front Endocrinol (Lausanne). 2023 Feb 3;14:1068018. doi: 10.3389/fendo.2023.1068018. eCollection 2023.
The lockdown at the start of coronavirus disease 2019 (COVID-19) pandemic in Saudi Arabia (March 2020 to June 2020) shifted routine in-person care for patients with type 2 diabetes mellitus (T2DM) to telemedicine. The aim of this study was to investigate the impact telemedicine had during this period on glycemic control (HbA1c) in patients with T2DM.
4,266 patients with T2DM were screened from five Ministry of National Guard Health Affairs hospitals in the Kingdom of Saudi Arabia. Age, gender, body mass index (BMI), HbA1c (before and after the COVID-19 lockdown), duration of T2DM, comorbidities and antidiabetic medications data were obtained. Mean and standard deviation of differences in HbA1c were calculated to assess the impact of telemedicine intervention. Correlations between clinically significant variances (when change in the level is ≥0.5%) in HbA1c with demographics and clinical characteristic data were determined using chi square test.
Most of the participants were Saudis (97.7%) with 59.7% female and 56.4% ≥60 years of age. Obesity was 63.8%, dyslipidemia 91%, and hypertension 70%. Mean HbA1c of all patients slightly rose from 8.52% ± 1.5% before lockdown to 8.68% ± 1.6% after lockdown. There were n=1,064 patients (24.9%) whose HbA1c decreased by ≥0.5%, n =1,574 patients whose HbA1c increased by ≥0.5% (36.9%), and n =1,628 patients whose HbA1c changed by <0.5% in either direction (38.2%). More males had significant improvements in glycemia compared to females (28.1% vs 22.8%, p<0.0001), as were individuals below the age of 60 years (28.1% vs 22.5%, p<0.0001). Hypertensive individuals were less likely than non-hypertensive to have glycemic improvement (23.7% vs 27.9%, p=0.015). More patients on sulfonylureas had improvements in HbA1c (42.3% vs 37.9%, p=0.032), whereas patients on insulin had higher HbA1c (62.7% vs 56.2%, p=0.001). HbA1c changes were independent of BMI, duration of disease, hyperlipidemia, heart and kidney diseases.
Telemedicine was helpful in delivering care to T2DM patients during COVID-19 lockdown, with 63.1% of patients maintaining HbA1c and improving glycemia. More males than females showed improvements. However, the HbA1c levels in this cohort of patients pre- and post-lockdown were unsatisfactorily high, and may be due to in part lifestyle, age, education, and hypertension.
2019 年冠状病毒病（COVID-19）大流行期间，沙特阿拉伯（2020 年 3 月至 2020 年 6 月）实行了封锁，将 2 型糖尿病（T2DM）患者的常规门诊护理转为远程医疗。本研究旨在调查在此期间远程医疗对 T2DM 患者血糖控制（HbA1c）的影响。
从沙特阿拉伯国民警卫队卫生部的五家医院筛选出 4266 名 T2DM 患者。获取年龄、性别、体重指数（BMI）、HbA1c（COVID-19 封锁前后）、T2DM 持续时间、合并症和抗糖尿病药物数据。计算 HbA1c 差异的均值和标准差，以评估远程医疗干预的影响。使用卡方检验确定 HbA1c 临床显著变化（当水平变化≥0.5%时）与人口统计学和临床特征数据之间的相关性。
大多数参与者为沙特人（97.7%），其中 59.7%为女性，56.4%≥60 岁。肥胖占 63.8%，血脂异常占 91%，高血压占 70%。所有患者的平均 HbA1c 略有升高，从封锁前的 8.52%±1.5%升至封锁后的 8.68%±1.6%。有 n=1064 名（24.9%）患者的 HbA1c 降低≥0.5%，n=1574 名患者的 HbA1c 升高≥0.5%（36.9%），n=1628 名患者的 HbA1c 在两个方向上的变化<0.5%（38.2%）。与女性相比，更多男性的血糖得到明显改善（28.1%比 22.8%，p<0.0001），年龄在 60 岁以下的患者也是如此（28.1%比 22.5%，p<0.0001）。与非高血压患者相比，高血压患者血糖改善的可能性较小（23.7%比 27.9%，p=0.015）。接受磺脲类药物治疗的患者 HbA1c 改善的比例更高（42.3%比 37.9%，p=0.032），而接受胰岛素治疗的患者 HbA1c 更高（62.7%比 56.2%，p=0.001）。HbA1c 的变化与 BMI、疾病持续时间、血脂异常、心脏和肾脏疾病无关。
远程医疗在 COVID-19 封锁期间有助于为 T2DM 患者提供护理，63.1%的患者维持 HbA1c 并改善血糖。与女性相比，更多的男性患者得到改善。然而，该队列患者封锁前后的 HbA1c 水平仍不理想，这可能部分归因于生活方式、年龄、教育程度和高血压。
