Endocrine Abstracts

Background: During the first wave of the COVID pandemic a large proportion of diabetic clinics and services were reduced or postponed, combined with a move to telephone consultations for GPs. Diabetic nurse specialists were also re-deployed from regular inpatient services. Additionally, patients were reluctant to seek out healthcare services either due to the risk of contracting COVID or not wanting to place unnecessary stress on the healthcare services.

Audit & results: A local audit carried out in March to May 2020 showed an increase in newly diagnosed diabetics presenting with more severe complications such as hyperglycaemic hyperosmolar syndrome or diabetic ketoacidosis. The audit also noted a large increase in patients admitted with delayed presentations of acute diabetic foot problems following the end of the first lockdown, and a similar pattern of reduction in admission with the second lockdown. Young patients were less likely to engage with virtual services as compared to face to face consultations. The use of dexamethasone for the management of COVID further complicated the inpatient management of diabetes.

Actions: Given that a third of all deaths in the first wave of COVID were diabetic, good diabetic control is key. The implementation of a new management of hyperglycaemia protocol has resulted in better control of blood glucose for inpatients, especially those prescribed dexamethasone and 0 datixes on hypoglycaemic events since the implementation of the protocol. Outpatient and inpatient services must be continued to ensure adequate ongoing diabetic care.