Endocrine Abstracts

Introduction: The global pandemic spread of SARScov2 has led to a heavy medical and socio-economic toll since December 2019. Patients suffering from chronic diseases were particularly affected during the lockdown period due to difficulties in accessing care. The aim of our study was to evaluate the impact of the 2-month lockdown introduced in Tunisia in March 2020 on diabetic patients’ glycemic control.Materials and methodsRetrospective study involving 54 diabetic patients hospitalized through the emergency room in June 2020, one month after lockdown, in the diabetology department "A" at the National Institute of Nutrition in Tunis. Glycemic control, lipid balance as well as microvascular complications of diabetes were noted for each patient before and after lockdown (in January 2020 and June 2020).

Results: Median age was 54.72 years [20-87 years]. The sex ratio (M/F) was 0,5. 74% of patients had type 2 diabetes and 26% had type 1 diabetes. Median diabetes duration was 15.5 years [2-38 years]. 20.37% of patients were on oral antidiabetic drugs (ADO), 59.26% were on insulin, and 20.37% were on a combination of insulin and ADO. 53.7% were hypertensive and 66.66% had dyslipidemia. Patients were hospitalized for unbalanced insulin-deficient diabetes in 59.27%, for switching to insulin in 20.37%, diabetic ketosis in 16.66% and for unstable type 1 diabetes with severe hypoglycemia in 3.7%. Average fasting blood glucose increased from 9.35 mmol/l before lockdown to 13.24 mmol/l (P < 10^-3). Mean HbA1C value of lockdown (10.92%) was much higher than of pre lockdown (8.5%; P < 10^-3). 3.7% of patients had developed mild nonproliferative retinopathy and 1.85% saw their pre-existing retinopathies worsen. 18.52% of patients had worsened their 24-hour microalbuminuria and developed at least moderate renal impairment. Worsening of LDL cholesterol levels was observed in 38.88% of patients. The main diabetes complications aggravating factors found were non-compliance with hygienic-dietary measures during the lockdown period (83.33%), as well as non-compliance and non-availability of medications related to patients’ absenteeism at the consultation (61.11%).

Conclusion: COVID-19 lockdown was associated with a deterioration in glycemic control and diabetes complications mainly due to non-adherence to the diet and lack of access to care.