van Grondelle Saskia E, Güzel Bilal, Mijnsbergen Manon D, Uitewaal Paul, Kist Janet M, van Bruggen Sytske, Vos Hedwig M M, Numans Mattijs E, Vos Rimke C
Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands.
GGD Haaglanden and Rubenshoek, The Hague, The Netherlands.
BMC Prim Care. 2024 Dec 27;25(1):438. doi: 10.1186/s12875-024-02691-z.
This study aimed to explore the impact of the COVID-19 pandemic and resulting changes to diabetes care, especially concerning disease control, the use of (tele)consultation and lessons worth implementing to improve diabetes care, with a specific focus on ethnic minority groups.
A mixed-methods prospective cohort study among people with type 2 Diabetes Mellitus (T2DM) treated in primary care during the COVID-19 pandemic. A survey was sent regionally, including items related to teleconsultation and amount of contact with the healthcare professional. We conducted interviews based on the chronic care model with individuals from various ethnic backgrounds living in a deprived neighbourhood. Change in diabetes control (HbA1c, fasting glucose, LDL, systolic BP, BMI, eGFR) was evaluated based on routine care data. Latent class analysis was performed to identify groups who were more at risk for decreased glycaemic control.
Most people maintained face-to-face (59%) or telephone (44%) contact with their healthcare provider. A decrease in consultations was observed. Based on the interviews, factors important for maintaining good glycaemic control were the use of medical devices, religion, routines and social support from family and friends. We did not find a clinically relevant change in diabetes control and no specific group was identified as at risk for worse diabetes regulation.
In the context of proactive care, remote healthcare and self-regulation have a crucial role for people with T2DM. It is important to identify barriers and facilitators for maintaining good glycaemic control among vulnerable groups, such as ethnic minority groups.
本研究旨在探讨2019年冠状病毒病（COVID-19）大流行及其导致的糖尿病护理变化的影响，特别是在疾病控制、（远程）会诊的使用以及值得实施以改善糖尿病护理的经验教训方面，特别关注少数民族群体。
一项混合方法的前瞻性队列研究，研究对象为在COVID-19大流行期间接受初级保健治疗的2型糖尿病（T2DM）患者。在区域范围内开展了一项调查，包括与远程会诊以及与医疗保健专业人员的接触次数相关的项目。我们基于慢性病护理模型，对居住在贫困社区、具有不同种族背景的个体进行了访谈。根据常规护理数据评估糖尿病控制情况的变化（糖化血红蛋白、空腹血糖、低密度脂蛋白、收缩压、体重指数、估算肾小球滤过率）。进行了潜在类别分析，以确定血糖控制下降风险较高的群体。
大多数人与他们的医疗保健提供者保持面对面（59%）或电话（44%）联系。会诊次数有所减少。根据访谈，对维持良好血糖控制重要的因素包括医疗设备的使用、宗教信仰、日常生活习惯以及家人和朋友的社会支持。我们未发现糖尿病控制存在临床相关变化，也未确定有特定群体存在糖尿病控制恶化的风险。
在积极护理的背景下，远程医疗保健和自我管理对T2DM患者至关重要。识别弱势群体（如少数民族群体）中维持良好血糖控制的障碍和促进因素非常重要。
