Table 2

Selection of guidance and recommendations relating to routine care in PWD during COVID-19 pandemic

ServiceRecommendations
Inpatient diabetes services• Inpatient diabetes services will need to continue and potentially increase capacity, with need for team approach re: glycemic control and nutritional status, and consideration of “virtual visits” for reviews (see management in hospital) (68).
Urgent/acute diabetes care (outpatient)• Face-to-face consultations should continue in the following circumstances: a new diagnosis of T1D; urgent insulin start where symptomatic, HbA1c >10% (86 mmol/mol), or ketones detected; teaching blood glucose monitoring for urgent reasons; or in cases where physical examination is essential (e.g., foot ulcer, infection, some points in pregnancy) (69).
• Virtual (telephone, video, or e-mail) consultations should be used in the following circumstances: follow-up of new T1D diagnoses; vulnerable patients (recent hospital admission, recurrent severe hypoglycemia, HbA1c >11% [99 mmol/mol]); intensive follow-up in high-risk situations; or where risk of attending an appointment face-to-face is greater than the benefits (69).*
Routine diabetes care• Consider routine diabetes care delivered virtually in the context of broader long-term condition management and prioritization, taking into account individual risk factors and clinical needs (68).
• The following should be deferred: routine appointments where diabetes is stable and well-managed; face-to-face structured group education courses; flash glucose monitoring start sessions; where the risk of attending an appointment is greater than the benefits; and where deferring appointments will not compromise clinical care (69).
Foot services for PWD• May need to continue at full capacity with consideration of moving support to remote forms where possible (68); many of these services are essential (70).
• Access to in-person support should continue for those with acute or limb-threatening problems (70) or where physical examination is essential (69).
• All new referrals should ideally be reviewed within 24 h (70).
Pregnancy services for PWD• May need to continue at full capacity with consideration of moving support to remote forms where possible (68).
• In-person support will be essential for physical examinations and/or teaching blood glucose monitoring at some points in pregnancy (69).
Blood tests for PWD• Urgent blood test monitoring should continue (e.g., declining renal function, raised potassium, low sodium) (69).
Eye screening for PWD• This was not mentioned in the guidance reviewed but we understand in most affected countries eye screening has been halted in view of high risk of transfer. Of note, evidence indicates that risk stratifying is possible (71).
  • * PWD may be concerned about the need to visit hospital; they should be encouraged to contact their physician in case of any signs or symptoms related to acute diabetes complications.