Caring for a child with type 1 diabetes during COVID-19 lockdown in a developing country: Challenges and parents’ perspectives on the use of telemedicine

Abstract

Background and Aim: Jordan implemented abrupt and extreme lockdown measures to prevent the spread of COVID-19. This study aims to evaluate the effect of these measures on paediatric patients with type 1 diabetes in terms of acute metabolic complications and shortages in insulin and glucose measuring supplies. It also evaluates the caregivers' perceptions of the use of telemedicine during the lockdown. Methods: This is a questionnaire-based cross-sectional study. It was completed using Google forms and patients/caregivers were asked to consent if they agreed to answer. Results: 235 patients/families participated in the study. The mean age of the patients was 10.8 years ± 3.9 years (N = 229). Twenty-four children (10.2%) needed to visit the emergency department during the lockdown period which lasted for 10 weeks. Of these, eight (3.4%) were hospitalized due to acute metabolic complications. Families (58.3%) faced insulin shortages and 14% had to ration insulin, i.e., decrease the dose, during the lockdown. Glucose monitoring strips were rationed by 43.4% of families leading to more frequent low/ high glucose readings in 75.5% of children of these families. Telemedicine using phones and social media applications was utilized for communication with healthcare professionals and continuing medical care. Most of the participants (85.5%) described it as a smooth and positive experience. Conclusions: The extreme lockdown due to COVID-19 pandemic caused insulin and glucose measuring equipment shortages in children with diabetes in Jordan. However, the use of telemedicine for providing guidance and support was perceived positively by the families.

COVID-19 associated with diabetes and other noncommunicable diseases led to a global health crisis

“…In the Philippines, only 10% of T1D individuals had no difficulties receiving their insulin, BG test strips and lancets [7]. In Jordan, children with T1D experienced shortage of insulin and/or BG strips in 58.3% and 43.4% of the cases, respectively, during the lockdown [38]. Consequently, BG variability increased in 75.5% of them [38].…”

“…In Jordan, children with T1D experienced shortage of insulin and/or BG strips in 58.3% and 43.4% of the cases, respectively, during the lockdown [38]. Consequently, BG variability increased in 75.5% of them [38]. Therefore, the stay-at-home guidance did not suffice and needed to be complemented with strategies to allow individuals with diabetes and other NCDs to access health services, medicines, and maintain a healthy lifestyle.…”

“…Furthermore, to prevent shortage, global entities, including PAHO [43], recommended PwD to stock medicines for at least 2 to 3 months. In addition to home delivery of medicines and supplies and/or provide them in quantities for 2-3 months, some nations or local health systems facilitated prescription refilling and allowed family members to collect drugs and supplies; all to reduce the need for PwD to leave their homes, protecting those with NCDs from additional exposure to the virus [16,30,33,38,41,44,45,46].…”

“…Telemedicine was one of the key strategies to enable individuals to continue receiving medical attention while staying safe at home [16,38,44,47,48,49,50]. The lack of other options or the identification of telemedicine's potential led to its quick legal approval and reimbursement in several countries [33,45,46,49,51,52].…”

“…Different applications, technologies and uses of traditional social media, SMS or communication software and chatbots were adopted to disseminate information, educate PwD, trace individuals and monitor their health, support self-care and allow teleconsultations worldwide [16,38,44,47,52,56].…”