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Covid-19 Primary Care Resources

Diabetes reviews

People with diabetes should intensify their glycaemic control for the primary prevention of Covid-19 illness

This information is sourced from NHSE, the NHS Specialist Pharmacy ServiceDiabetes UK, and the Primary Care Diabetes Society (PCDS):

Recent studies on Covid-19 related mortality in Type 1 and Type 2 diabetes reveal that people with type 1 diabetes were 3.5 times more likely to die in hospital with Covid-19 than those without diabetes, and people with type 2 diabetes were just over twice as likely to die

The PCDS recommend that:

People with diabetes and without Covid-19 should intensify their glycaemic control as required for the primary prevention of Covid-19 illness

Whether to review remotely or face to face

  • NHSE advise that remote consultations should be used where appropriate
  • If data can be gathered by the person at home, these can be included in a pre-review questionnaire, which can then be reviewed to decide if a remote consultation is appropriate
  • Consider whether a face to face test or examination is needed: are the results likely to change management?

The PCDS recommend that face-to-face consultation is undertaken if a review is needed, and measurements cannot be collected remotely. eg:

  • To capture data (e.g. blood glucose or BP monitoring) or review foot problems
  • If unsuitable for remote consultation but require review
  • Following a remote consultation, if concerns are identified and cannot be resolved remotely

Tools to help people with diabetes gather data and perform self examinations at home

Remote foot assessment

  • Ask the person to document symptoms related to the feet and legs, visually check all parts of their feet themselves (using a mirror or with help), including identifying dry or cracked skin, changes in colour, ulcers, rashes or blisters
  • If changes or concerns are identified, try to arrange photos to be shared prior to the consultation
  • The Diabetes UK ‘Touch the Toes’ test uses the validated Ipswich Touch Test to enable patients to check sensation in their feet

SGLT2 Inhibitors

  • SGLT2i tablets can mask the symptoms of diabetic ketoacidosis, which can be caused by coronavirus
  • Patients with type 1 diabetes were advised to stop taking SGLT2i during March and April. Updated guidance now advises that their doctor ‘may’ want to stop their SGLT2i. They need to be aware of the significantly increased risk of DKA and reminded about presenting symptoms, ketone measurement, sick day guidance and prompt medical advice
  • Patients with Type 2 diabetes should continue to take SGLT2i tablets unless they become unwell in which case they should stop them

Diabetes education

Diabetes education for patients whilst unable to access face to face education is available from Diabetes UK learning zone

Diabetes UK has online advice and a helpline for patients with diabetes on managing their condition and health checks during the pandemic

See also: Long term condition reviews