Remodelling diabetes services and emerging innovation

Abstract

The COVID-19 pandemic is a major international emergency leadin g to unprecedented medical, economic and societal challenges. Countries around the globe are facing chal lenges with diabetes care and are similarly adapting care delivery, with local cultural nuances. People with diabete s suffer disproportionately from acute COVID-19 with higher rates of serious complications and death. In-patient ser vices need specialist support to appropriately manage glycaemia in people with known and undiagnosed diabetes present ing with COVID-19. Due to the restrictions imposed by the pandemic, people with diabetes may suffer longer-term har m caused by inadequate clinical support and less frequent monitoring of their condition and diabetes-relate d complications. Outpatient management need to be reorganised to maintain remote advice and support services, focusing on proactive care for the highest risk, and using telehealth and digital services for consultations, self-m anagement and remote monitoring, where appropriate. Stratification of patients for face-to-face or remote follow-up should be based on a balanced risk assessment. Public health and national organisations have generally responded rapi dly with guidance on care management, but the pandemic has created a tension around prioritisation of communi cable vs non-communicable disease. Resulting challenges in clinical decision-making are compounded by a redu ced clinical workforce. For many years, increasing diabetes mellitus incidence has been mirrored by rising prevent able morbidity and mortality due to complications, yet innovation in service delivery has been slow. While the cur rent focus is on limiting the terrible harm caused by the pandemic, it is possible that a positive lasting legacy of COVID-19 might include accelerated innovation in chronic disease management.