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Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks
  1. Unjali P Gujral1,
  2. Leslie Johnson2,
  3. Jannie Nielsen1,
  4. Priyathama Vellanki3,
  5. J Sonya Haw3,
  6. Georgia M Davis3,
  7. Mary Beth Weber1,
  8. Francisco J Pasquel3
  1. 1 Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  2. 2 Department of Family Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3 Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Francisco J Pasquel; fpasque{at}emory.edu

Abstract

The COVID-19 pandemic is considered a mass casualty incident of the most severe nature leading to unearthed uncertainties around management, prevention, and care. As of July 2020, more than twelve million people have tested positive for COVID-19 globally and more than 500 000 people have died. Patients with diabetes are among the most severely affected during this pandemic. Healthcare systems have made emergent changes to adapt to this public health crisis, including changes in diabetes care. Adaptations in diabetes care in the hospital (ie, changes in treatment protocols according to clinical status, diabetes technology implementation) and outpatient setting (telemedicine, mail delivery, patient education, risk stratification, monitoring) have been improvised to address this challenge. We describe how to respond to the current public health crisis focused on diabetes care in the USA. We present strategies to address and evaluate transitions in diabetes care occurring in the immediate short-term (ie, response and mitigation), as well as phases to adapt and enhance diabetes care during the months and years to come while also preparing for future pandemics (ie, recovery, surveillance, and preparedness). Implementing multidimensional frameworks may help identify gaps in care, alleviate initial demands, mitigate potential harms, and improve implementation strategies and outcomes in the future.

  • diabetes mellitus, type 2
  • diabetes complications
  • delivery of health care
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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Footnotes

  • Contributors UPG, LJ, and FJP conceptualized the article and designed Figure 1. UPG and FJP wrote the first draft of the manuscript. JN and MBW wrote and edited sections of the manuscript. PV, JSH, and GMD critically reviewed the approach and edited successive drafts. FJP created the concept and designed the approaches for the framework. All authors approved the final version.

  • Funding This project was supported in part by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant number P30-DK-111024. PV is supported in part by National Institutes of Health (NIH) grant 1K23DK113241. FJP is supported in part by NIH grant 1K23GM128221-01A1.

  • Competing interests PV has received consulting fees from Merck and Boehringer Ingelheim. FJP has received unrestricted research support from Merck and Dexcom and consulting fees from Merck, Boehringer Ingelheim, Sanofi, Lilly, and AstraZeneca.

  • Patient consent for publication Not required.

  • Ethics approval We did not obtain ethics approval for this manuscript as it is a review article and did not require working with human subjects.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.