Decentralized COVID-19 measures in Brazil were ineffective to protect people with diabetes

Abstract

Background and aims COVID-19 severity and mortality are elevated in individuals with diabetes. During the pandemic, interventions recommended globally for people with diabetes were to keep blood glucose on target whilst staying at home to curb the spread of the virus. In Brazil, similar measures were proposed. The aim of our observational study was to assess whether these measures achieved their objectives. Methods : An anonymous and untraceable survey was shared from April 22nd to May 4th. States with more than 30 respondents were included in the analysis and Fisher's exact test was performed to identify associations, with p < 0.05 considered significant. Results: Type 1 diabetes and female participants were prevalent, 60.76% and 76.12% respectively. 10 out of 26 states were included, in addition to the federal district (1562 responses). Only in three states (Bahia, Goiás and Pernambuco) less than 50% of the respondents experienced higher glycemia or higher variability during the pandemic. Goiás state, where almost half of the respondents (49.12%) have private insurance, presented the highest percentage of individuals receiving medicines for three months (35.48%) and one of the lowest percentages of blood glucose deterioration (47.17%). In the large states of Minas Gerais, Rio de Janeiro and São Paulo, consultations and/or lab exams were postponed by 37.14%, 34.33% and 40.88%, respectively. Conclusions: The decentralized measures implemented by states in Brazil left most people with diabetes unprotected. Many were forced to venture outside to collect or to purchase their monthly medical supplies and reported increased glycemic levels and/or variability.

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

“…Authors reported BG worsening in Brazil, India, China and African countries [16,31,33,35,36], while the opposite situation was observed in T1D groups in high income countries (HIC). With access to advanced technology, treatment, specialized services and HCPs used to digital health tools, PwD in HIC maintained or even improved their BG level during the pandemic [59,61,72,73,74].…”

“…With the absence of a vaccine or efficient antivirals against SARS-CoV-2, policies had to be rapidly implemented. Early measures seemed to be extremely limited in different parts of the world [16,30,31]. Among the countries the experienced high COVID-19 burden, Brazil was alerted that 34-54.5% of its adults were at risk of severe COVID-19 [32], and in Mexico, verified associations between severe COVID-19 and premature death with NCDs prompted researchers to recommend early protection of these high-risk populations [10].…”

“…In Australia, each organization provided communication and updates to their respective members [42]. Countries such as Brazil missed a centrally orchestrated response by the Ministry of Health [31], setting up formal links with the civil and the scientific societies. At least a partnership comprising multiple scientific societies was developed to produce a guide for national public health networks, launched by the National Council of Health Secretariats in Brazil (CONASS, www.conass.org.br/guia).…”

“…In some African and Latin American countries, food insecurity and lack of financial health protection was a reality for PwD [30,37]. In Brazil, individuals depending exclusively on the public health system were less compliant with the stay-at-home recommendations and often experienced an increase in BG [31,33]. In India, only 47.4% had a glucometer at home, 62.5% did not buy all the medicine they needed due to financial reasons, and only 29.8% had access to teleconsultation during the pandemic [35].…”

Change in glucose‐lowering medication regimens in individuals with type 2 diabetes mellitus during the COVID‐19 pandemic in Germany

“…9 The treatment and management of people with type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic has also been investigated. [10][11][12][13][14][15][16][17][18][19][20] For example, a study in individuals diagnosed with T2DM and followed in a tertiary care centre in India, showed that only 24% met a physician during the lockdown (23 March to 23 June 2020), and that the vast majority of patients undergoing blood glucose monitoring (81%) had insufficient glycaemic control. 17 The deleterious impact of the ongoing pandemic on T2DM management probably involves the overload of healthcare systems 12,21 and delays in seeking medical care because of fear of contracting COVID-19.…”